Tony Blair may have won the hospitals vote but any hopes he had of finally emerging from the black tunnel which has recently engulfed his government have been dashed.
Hospitals row provided a rallying point
On the same day he delivered a self-confident, even combative performance to a committee of senior MPs, his backbenchers gave him the fiercest kick of his premiership.
And he must now know more clearly than ever before that there is serious, potentially devastating trouble ahead.
Not only will the Lords, Labour backbenchers and the unions step up the fight against foundation hospitals, other issues such as student fees threaten even greater damage.
The prime minister only escaped a humiliating defeat over his controversial plans for the NHS by the skin of his teeth.
If Scottish and Welsh MPs - whose countries are not affected by the proposal - had not voted with the government, he would have lost.
That itself is an issue that is now set to dog the government.
If many of those backbenchers who abstained had decided to vote against, he would also have lost.
And if he had not threatened to spark the Armageddon scenario, by tabling a confidence vote in the government had failed to get his way, he would almost certainly have lost.
Even so, despite all the arm twisting, the offers of concessions and warnings of electoral trouble ahead if they refused to back the government, most of the rebels still refused to cave in.
Thanks to both the Tories and the Liberal Democrats voting against the government, the prime minister's majority was slashed from around 170 to just 35.
Two tier system
But the size of the rebellion, including the abstentions, indicates serious and continuing trouble ahead for the government over this policy - and others.
The rebels, led by former health secretary Frank Dobson, warned that the government will pay the price in the next election for pursuing the radical proposal, which they believe will create a two tier system.
They fear traditional Labour voters are almost universally opposed and will abandon Labour as a result.
Mr Blair, on the other hand, is deeply concerned that unless he is allowed to press ahead with the plan, he will not get the improvements in the NHS he needs before the next election.
Disunity can only help the Tories who are showing real signs of capitalising on the government's troubles
And that will itself see people turning away from Labour as it fails to deliver.
It is also clear that the newly left-wing public sector unions will abandon their campaigns against the proposal.
This guarantees another year of edge-of-the-seat TUC and Labour conferences this autumn.
Ministers believe that the vote had united rebels behind a single, identifiable banner.
The bright side of that theory for the government is that it means backbenchers opposed to the war on Iraq, tuition fees and a host of other smaller issues joined with the anti-foundation hospital rebels to give the government a bloody nose.
The size of the hardcore anti-foundation hospitals group, they believe, is smaller. But that is looking for silver linings.
The downside - and it is a pretty big one - is that it means groups of rebels are looking for flags to rally around.
And that could spell future trouble for the government. It suggests that Labour's traditionalists are gaining in strength and purpose.
And each time they black the government's eye, they grow in confidence.
The greatest threat the prime minister can use, of course, is that disunity can only help the Tories who are showing real signs of capitalising on the government's troubles.
It is a pretty desperate measure, but it is one the prime minister has found himself using more and more of late.