Obama came into office with the expressed intent to work with the Republicans to get important legislation passed. The first real test of Republican cooperation in return to Obama's outreach was the stimulus package. So Obama and the Democrats crafted a bill that included much that was intended to get Republican Senators to vote for it.
As Steve Benen points out, Obama has not forgotten being stiffed by the Republicans after he and the Democratic Congressional leadership watered the stimulus bill down badly so that Republican Senators could vote for it and explain their vote to their constituencies at home. Instead of working with Obama, they then followed Limbaugh and provided zero Senate Republican votes for the stimulus bill.
They are going to pay for that. That's what the reconciliation plan is all about. The Republicans can still work with Obama and get some of what they want in Health care, and pass a universal healthcare bill within the next six months. If they don't cooperate, then the Democrats go the reconciliation route and pass an all-Democrat plan.
My bet is that the Republicans are so crazed that they will follow Rush Limbaugh instead of work for the good of the American people and work with Obama.
There is a reason why the National Republican Senatorial Committee (NRSC) chair Senator John Cornyn has said he did not think that the Republicans were going to keep a 40 Senator minority in 2010. Their radical conservative base won't let them compromise conservative principles even if that is politically suicidal. The marginal Senators who are up for reelection have a choice, much as does Senator Arlen Spector. They can run to win the general election but lose the primary and never get there, or they can cater to their conservative base, get the nomination, and be defeated by the Democrats supported by the Independent voters.
In my example, Senator Spector's other choice is to turn Democrat and see if he can win the nomination there. If he could win that, he can probably win reelection in the general election, but the Republicans still lose the Senate seat.