So the House voted on the rule for the “Repealing the Puppy-Kicking Health Care Law that Actually Gives Every American Citizen Cooties Act” today, passing it by a count of 236-181. Only four Democrats crossed the aisle to give consent to the rule: Mike McIntyre, Dan Boren, Larry Kissell and Mike Ross. Not even Heath Shuler would touch this. Pete Sessions and Mike Fitzpatrick voted “present” because the vote letting them off the hook for violating the Constitution by participating in votes without being sworn in hadn’t passed yet.

While it’s just a vote on the rule and not the bill, it’s a pretty good indicator of how many votes Republicans can expect (although presumably they’d get Sessions and Fitzpatrick back, along with the 7 Republicans who didn’t vote). Needless to say, 236 is less than the 290 that would be needed to override a veto, which the President formally pledged to do. That’s if the bill by some miracle reaches his desk, which, considering that the Democrats who control the Senate have vowed not to take it up, won’t happen.

While the repeal effort will fail, it fulfills a campaign promise Republicans made to their base. And they still hold the strings on the funding. So while the spectacle of the charges and counter-charges and the use of the issue in 2012 and beyond is mildly diverting, the real showdown will come when the White House asks for implementation funding.

It’s also been useful to watch Republicans try to delegitimize the CBO. John Boehner yesterday said that CBO is “locked within constraints of the 1974 Budget Act.” He made a bunch of claims about double-counting and not taking into account the long-term funding deficit of the CLASS Act and a host of other nitpicks, most of which just aren’t true. The CBO isn’t working with a perfect model, but they also couldn’t take into account some of the fiscal benefits of the bill, like the savings derived from greater use of preventive care.

I hope people don’t think that Republicans are engaging in a serious effort to understand the costs of the health care law. That’s completely besides the point. They’re trying to demolish CBO in the minds of the public, or at least their partisans, because throughout the year, they’re going to create policies that CBO will frown upon. They’d rather turn the whole thing into a food fight to dislodge CBO from their perch as a neutral arbiter. Then they can create their own reality. It’s always the same thing with these people.

As for health care in the long term, I actually think this David Brooks op-ed does a not-terrible job of laying out the challenges. Indeed some of the predictions could end up wildly off-base, though I’d add that the assumptions on the high-risk pools sucked because it was a typical Republican idea that winds up far more expensive than they think. There is enough public upset about the law, from the left and the right, to wound it somewhat, and the consolidation and mergers in the health industry generally will tear away at the hopes of competition lowering costs. And the providers were barely nicked by the law anyway. I think it’s worth taking this point from Brooks seriously:

When the crisis comes, Democrats will face an interesting choice — to patch the Obama system or try to replace it with something bigger. The administration may want a patch, but by a ratio of nearly 2 to 1, according to a CNN poll, Democratic voters would prefer a more ambitious law. Liberals could logically say that the mistake was trying to create a hybrid system, rather than moving straight to a single-payer one.

Simply put, at some point in the not-too-distant future, Congress will have to come back to health care. The best-case scenario in the short term could be the Wyden-Brown state opt-out waiver.