Congress just legislated 1/6 of the economy out of existence:
Step 1) Obama signs the bill which has now passed the House and Senate. Reconciliation is irrelevant at this point. It really doesn't matter.
Step 2) Over the next four years, increased taxes and the knowledge of increased legal restraints on businesses and the private health insurance industry further depress the economy.
Step 3) Republicans win big in 2010 and 2012 due to general dissatisfaction with the Democrats. However, repealing this legislation will be just as difficult as trying to repeal Social Security, Welfare, Medicare, and Medicaid, ie impossible. Any attempt to do so will be demonized as "Republicans trying to take away your health care."
Step 4) Over the course of the next decade the law's actual legislative mechanisms begin to take effect. Everyone will be required to purchase health insurance but many will choose to pay a fine rather than pay for something which they don't actually have to own until they get sick. Once they get sic, they'll be able to purchase insurance because this legislation prohibits denial based on pre-existing conditions.
Step 5) As the insurance companies' existence depends upon healthy individuals paying in more than the cost of care for sick individuals, the insurance industry is driven out of business.
Step 6) The way is now paved for either a) a Republican repeal of the legislation, or b) the creation of a state-run health insurance company.