Douthat does a health care reform pre-mortem:

In the end, when the history of the health care debate is written, I don’t think any of the choices that G.O.P. lawmakers made this year will loom particularly large. The choices that they made, or didn’t make, across the last fifteen years are what made all the difference. Between the defeat of Clintoncare and the election of Barack Obama, the Republicans had plenty of chances to take ownership of the health care issue and pass a significant reform along more free-market, cost-effective lines. They didn’t. The system deteriorated on their watch instead. And now they’re reaping the consequences.

That seems a pretty fair assessment to me although it doesn't absolve the GOP of abdicating all responsibility this year to place country before party. By that, I mean constructively engaging the process to improve the result rather than total oppositionism and partisanship. But that is also a function of the past many years as the GOP put Rovianism before any coherent governing philosophy and culture war before any real attempt to innovate policy or better understand government.