People understand Obamacare won't last. They see many states being down to one insurer, premiums skyrocketing, and deductibles reaching stratospheric levels. They understand what comes next won't be perfect either and even that some people who have insurance now may not going forward.

What they don't understand is how a handful of senators can hold the entire Congress hostage. They don't understand how it possibly could make sense for someone such as Sen. Dean Heller, R-Nev., who is up for re-election next year, to have so much trouble finding something he can vote for.

They don't understand how they can give Republicans control of both houses of Congress, the White House, and more than a thousand state and local offices – all because they were told this was the way to get rid of Obamacare – and Obamacare still stands.

They want the problem solved. Republicans in general still believe their party is the right one to make it happen. But they are getting more and more comfortable with the idea of exploring other options if the GOP can't get this across the finish line.

Democrats, to their credit, have done a good job of mucking up the process. Between their obstruction on Obamacare and their cloud of dust on Russia-Russia-Russia, they have kept the president from moving infrastructure, tax reform, and budget legislation – all early first-term goals.

And if Republicans can't get 50 votes for repeal, Democrats' more extreme plans will gain credence. They always viewed Obamacare as an interim step. The real goal, and Democrats are getting open about admitting it, is to pursue a full European-style single-payer healthcare system.

Sen. Elizabeth Warren, D-Mass., already has called for Democratic candidates to campaign on enacting single-payer. Sen. Bernie Sanders, I-Vt., has long supported it, and it will likely become part of the new " Better Ingredients, Better Pizza, Papa John's" agenda Democrats introduced to retake Congress.

That means this is about much more than a battle over health policy. This is about the country's future, its jobs and choices, and the ability of the Republican Party to govern.

For seven years and four election cycles, Republicans in Congress have vowed they would repeal Obamacare if they ever got the chance. First, they couldn't do it till they took the Senate. Then, they got the Senate and even passed repeal legislation through both houses of Congress, only to have it vetoed by President Barack Obama.

Now, they have a president who says he is waiting with pen in hand to sign pretty much whatever Republicans can come up with.

Yes, the polling is scary – six in 10 want to keep Obamacare at this point, and 74 percent want the GOP to reach out to Democrats. But the poll that counts is the one that put them in office: this is what most of them were elected to do.

They need to come up with something. Failure is not an option.

Trump, the Washington outsider who never had held political office before, understands the stakes better than these seasoned veterans. "If Republicans don't Repeal and Replace the disastrous ObamaCare," he tweeted recently, "the repercussions will be far greater than any of them understand!"

Failing to repeal Obamacare could mean no tax reform, no growing economy, no entitlement reform and, quite possibly, no control of any of the power centers on either end of Pennsylvania Avenue. And they won't be able to say they didn't deserve to be ousted.

So what to do? Some say take a page from the playbook of Hillary Clinton of all people. When Clinton lost her bid to push healthcare reform during the 1990s, she settled for small-bore ideas that have become big, such as the Children's Health Insurance Program. She put points on the board. She won votes. And she moved the ball incrementally in the direction of government-controlled health insurance.

This is not so much a matter of seeking small legislative accomplishments as having the ability to see the larger picture, as Karl Rove puts it, and make the small compromises that will get a big piece of legislation across the finish line.

As it stands, moderates say the current legislation does not solve all the problems, and conservatives say it doesn't do enough to temper government overreach. They need to figure out how to get most of what they want now and the rest later.

Americans can live with that. They know Democrats reflexively will oppose anything Republicans put forth. They know this is not a one-time-fix project. And they know Republicans are altering one-sixth of the economy and need to be careful.

Yes, Republicans would seem to have everything they need to repeal Obamacare. But what they need now is results. They need to make some progress so voters will re-elect them in 2018 to finish the job.

History argues against them – the president's party has lost seats in Congress in 18 of the last 20 mid-term elections. Average turnover in the House is 33 seats; the Democrats would need just 24 to retake control.

So yes, the stakes are large. And the time to solve the problem is now.

Ford O'Connell (@Ford Connell) is a contributor to the Washington Examiner's Beltway Confidential blog. He is an adjunct professor at The George Washington University Graduate School of Political Management, worked on John McCain's 2008 presidential campaign, and authored the book "Hail Mary: The 10-Step Playbook for Republican Recovery."

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