On a perfectly partisan, 60-39 vote, the Senate agreed tonight to debate and amend a far-reaching health care bill. That debate will get started in earnest after Congress returns from next week's Thanksgiving recess. Democrats and Republicans expect to offer hundreds of amendments (each of which will be held to a 60 vote threshold) and debate for several weeks before holding yet another procedural supermajority vote--to end debate. If that gets 60 votes, then there will be an up-or-down vote on passage of the bill.
If the bill passes it will likely undergo yet more changes in conference with House negotiators. The "conference report" that emerges from that process can't be amended, but can be filibustered in the Senate, so will likely require 60 votes for passage. Only after both chambers have passed the conference report can the bill be sent to President Obama for a signature.