Obama's health care reform doesn't fit in that category. He wants to do a Grand Restructuring of the entire medical system of the country. It's not just opponents of centralization like me who don't like that. It's anyone who's afraid of the status quo being made worse, or thinking the government should focus on higher priorities (say, jobs). So no, he can't get his bill done with 59 senators. It wasn't going to happen with 60 senators either. Not because of the Republicans, but because there were a lot of Dems who didn't want to risk pissing off their constituents.
59 votes is probably still enough to push through a "public option" covering people who can't get health insurance other ways . . . as an option. It's making coverage mandatory and forcing everyone to get their health insurance through a new system that's keeping it from being passed.