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This is the most significant victory for Obama since he took office. The cool professor has been bloodied in battle, earned his spurs. But at what cost? What price will he pay?

While many voters chose Obama because he talked of a different way of doing things, this messy business of backroom deals and arm-twisting has further lowered the reputation of Washington.

And while many Americans seem genuinely to yearn for the cross-party accord they call bipartisanship, and politicians at least pay it pious lip service, this lengthy debate has revealed a gaping ideological chasm.

President Obama identified overhauling the healthcare system as his priority and he's got what he wanted, a victory that eluded Teddy Roosevelt, Richard Nixon and Bill Clinton. But when he threw down the gauntlet, the conservatives eagerly picked it up. Healthcare didn't create the Tea Party movement but it gave it a focus and a cause.

There are dangers to his left as well as his right. He's harmed his reputation with his own power base, for many liberals feel there have been so many compromises the bill is hardly worth it.

So it's a pivotal moment. But it's not clear which way the balance will swing.

Many Republicans are convinced that while they lost the battle, they will win the war. They are sure the vote in Massachusetts for a Senate seat in January and the opinion polls delivered a clear message. They agree with the Tea Party Patriots and the cable networks that this is an un-American measure, hated by the American people so much that it will hand victory to them in November's elections to the House and the Senate. They may be right. But Democrats will do their best to point towards popular measures in the bill.

It has been a messy and sometimes ugly process. Obama has clearly been feeling his way, and has made plenty of mistakes. But does he impress with his toughness and tenaciousness, or repel those who voted for him because they thought he was different?

Does success breed success and will Obama be able to steam ahead with difficult laws on immigration and the environment? Or does his party feel burnt out, beaten up and that their president has called in all the favours he can afford?

The first opinion polls after this vote, and in the coming weeks, will make fascinating reading.

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