Refusing to concede permanent defeat on health reform, Senate Republican leader Mitch McConnell wants to “repeal the whole bill” and replace it with insurance reforms and other measures that could get bipartisan agreement.

“They got health care,” McConnell told POLITICO with a mischievous glint in his eye. “We’ll see whether that’s a gift worth receiving.”

McConnell said that if Republicans were to win back the Senate majority in November, “at the top of our list would be to repeal and replace this health care bill.”

Politico’s reporter concedes the Republicans aren’t going to get 67 votes needed to override an Obama veto that would greet repeal attempts, but it’s no longer inconceivable that the Senate could flip, leaving the remaining Democrats (especially those up for re-election in 2012) quaking. Republicans have excellent to good shots at picking up Pennsylvania, Delaware, Colorado, Arkansas, North Dakota, Nevada, and Illinois. Throw in Wisconsin (if former governor Tommy Thompson runs) and California as competitive states, and you see a pathway to a GOP Senate takeover. (I suspect both sides are going to be very nice to Independent Joe Lieberman, who may once again be in the catbird seat after the November election.) Certainly there will be other issues — repeal of the Bush tax cuts in 2011, unemployment, and national security. But if you have a large base of active support on one key issue — which the other side obsessively emphasizes — it’s hard to resist making that issue the central focus of the campaign.

If Republicans run and win big on a “Repeal ObamaCare” message, Democrats will once again face a choice: continue to ignore the will of the voters, or take another look at the monstrous health-care entitlement (and the additional mounds of debt accumulated by then). We know Obama’s answer — he’d rather have just one term than give up his grand achievement. But by then, Democrats may have a different answer.