Counting the new Republican Senator Scott Brown from Massachusetts, the 41 Republicans in the Senate come from states representing just over 36.5 percent of the total US population. The 59 others (Democratic plus 2 Independent) represent just under 63.5 percent. (Taking 2009 state populations from here. If you count up the totals and split a state's population when it has a spit delegation, you end up with about 112.3 million Republican, 194.7 million Democratic + Indep. Before Brown's election, it was about 198 million Democratic + Ind, 109 million Republican.)
Let's round the figures to 63/37 and apply them to the health care debate. Senators representing 63 percent of the public vote for the bill; those representing 37 percent vote against it. The bill fails.
I believe this health reform bill is as good as it will get in confronting a real and pressing problem. But the system we have is designed to prevent change. And that's the underlying reality here: if the governing political party is not united, and the opposition party is determined not to improve legislation but to kill a presidency, and exploit populism for purely partisan purposes, then it's very, very hard to pass major legislation.