The Senate soundly defeated a $250 billion extension to the Medicare physician payment program Wednesday, marking a potentially inauspicious start for Democratic leaders to the formal floor debate on the larger health care overhaul.Senate Majority Leader Harry Reid (D-Nev.) — normally a master vote-counter — was unable to muster even a simple majority for the “doc fix— bill: The legislation was defeated, 47 to 53. A clearly nervous Reid paced the chamber’s well just prior to the vote and afterward looked to blame the defeat on GOP Senators, arguing it was a result of “activities and actions by the Republican-dominated Washington.—The outcome — and particularly Reid’s inability to secure at least 51 votes — could prove to be an ominous beginning for Democrats on the health care debate.Indeed, Republicans quickly seized on the doc fix vote to show that Reid lacks support the broader Democratic reform agenda.“In the Senate’s first vote on health care spending this year, a bipartisan majority rejected the Democrat leadership’s attempt to add another quarter trillion dollars to the national credit card without any plan to pay for it,— Senate Minority Leader Mitch McConnell (R-Ky.) said after the tally. “With a record deficit and a ballooning national debt, the American people are saying enough is enough. Today’s vote shows that this message is finally starting to get through to Congress. Hopefully it’s a sign of things to come in the health care debate ahead.—In the end, 12 Democrats and one Independent joined all 40 Republicans in voting against the bill. Among those in the Democratic Conference voting no were: Sens. Byron Dorgan (N.D.), Robert Byrd (W.Va.), Kent Conrad (N.D.), Joe Lieberman (ID-Conn.) Jon Tester (Mont.), Jim Webb (Va.), Mark Warner (Va.), Ron Wyden (Ore.), Herb Kohl (Wis.), Russ Feingold (Wis.) Bill Nelson (Fla.), Evan Bayh (Ind.) and Claire McCaskill (Mo.). The primary argument among opponents of the measure is that it should contain offsets.The vote could have been even worse had Reid, Majority Whip Dick Durbin (D-Ill.) and lead bill sponsor Sen. Debbie Stabenow (D-Mich.) not lobbied a number of Democratic holdouts, including Sens. Mary Landrieu (D-La.) and Blanche Lincoln (D-Ark.), who ultimately voted with Democratic leaders. Lincoln, who could face difficult re-election next year, appeared to be particularly pained by the vote and waited almost until the end to cast her vote.The bill would have protected doctors from scheduled cuts in Medicare over the next decade. Several Senators are looking for an alternative plan that would ensure the payments continue but that they are paid for.