Yes, there are many Republican partisans who've imbibed the hocum of death panels, skyrocketing costs and all the rest. But the real fear among Republican strategists is that reform will work and in so doing become an ideological and political defeat of immense proportions for the Conservative movement.
It's edifying again to go back to the brilliant and notorious 'Kristol Memo' of 1993, an encapsulation not only of the massive defiance strategy against Health Care Reform but in many ways the initial manifesto of manufactured gridlock as a political strategy that now rules our national politics. Kristol, of course, is Bill Kristol of the Weekly Standard, Fox News and more. But at the time he was only coming into his role of ur-GOP big think strategist - a role which has dimmed somewhat in recent years but grew through the 90s and well into the Bush administration. Going back to Kristol's basic argument about the political effects of Health Care Reform is key.
Not only would passage of Health Care Reform in 1994 not hurt Clinton's reelection prospects in 1996, he wrote, "the long-term political effects of a successful Clinton health care bill will be even worse--much worse. It will relegitimize middle-class dependence for "security" on government spending and regulation. It will revive the reputation of the party that spends and regulates, the Democrats, as the generous protector of middle-class interests. And it will at the same time strike a punishing blow against Republican claims to defend the middle class by restraining government."
Take this out of con-speak and you have a very candid statement that health care reform would work. Average people would like it. And it would "rekindle" the belief that government activism can be part of the solution in helping sustain and protect the middle class. Kristol was clear that this would not only an ideological defeat but also a political one inasmuch as Democrats are the party of government.
The irony of course is that 'Obamacare' is actually something like what 'responsible' Republicans were putting forward at the time as the market-based alternative to the dreaded ClintonCare. (Yes, for you youngins', before Obamacare there was ClintonCare, nee HillaryCare.) But the key is government reform being allowed to work.
Republicans know that if Obamacare gets in place, they'll never be able to repeal it. Just as everyone across the political spectrum now has to pledge fealty to Medicare and Social Security even though they were in their time equally awfully assaults on America, freedom and everything else. That doesn't mean that Obamacare will be perfect. And our politics is so polarized today that it will take many GOP ideologues a very long time to warm to it. But going back will quickly become politically unviable. That's why they're fighting so hard.