This whole debate gets really convoluted in a hurry. You can get to the bottom of it, but it takes a fair amount of time and a certain tolerance for ambiguity. I just got done doing a bunch of research on how to replace my 250W Dell PSU, after I wanted to upgrade my PSU, so here's what I learned...
If you want to estimate power consumption for a card, I'd just go to a good product site with lots of informed customer reviews (I found www.newegg.com to be the best site) and see what comments people might make about power requirements.
The reason NVidia, like all the game card manufacturers, err on the high side in terms of estimating wattage requirements is because power consumption is complicated, they don't trust vendors to publicize all the information that's needed, and they don't trust most customers to figure it out.
The main requirement for a driver is how many Amps you can run on your 12V rail. In general, bigger PSUs (with higher Wattage) have higher Amp limits on their 12V rail(s).
However, the video card isn't the only thing drawing on a PSU (the processor and various drives join the list of usual suspects here). If a PSU is generating too much power for too many different things, regardless of how much current a single rail can support, it'll start to heat up in a hurry.
If it runs too hot, and there's no good way dissipate that heat (that's why they talk about fans and cooling), bad things can happen to your computer. You can get a feel for some of these details at a site like http://www.pcpower.com/technology/myths/.
Happy Hunting!!