It's the holiday season, and whether you view H.R. 3962 as the perfect holiday gift or as a lump of coal, the fact remains that much of this year has been wrapped up in debating, voting and debating some more, on health care reform.

Unless you've been living at the North Pole, you know that in November the House passed health care reform legislation (H.R. 3962) that, if approved, will change the health care system as we know it. At presstime, the Senate had yet to begin full debate on its version of reform, but Majority Leader Harry Reid (D-Nev.) said publicly that he plans to send a bill to President Obama in time for Christmas.

With that hurried timeline, it will take not only 60 senators but all of Santa's elves to pass legislation. In a frank discussion I had recently with Helen Darling, president of the National Business Group on Health, she told me that she doubts the Senate will "finish this by the end of the year. But there's been a lot of pressure to finish it and I think we'll have something early next year."

So, as the countdown to 2010 begins, it could be an ominous ball drop, as Darling ticked off 10 major problems she has with H.R. 3962.

10. The bill lacks meaningful ways to control health care costs. Although lowering costs is the number one issue for consumers, the issue seems to have escaped House members, Darling asserted. "There is no limit on payments for services and treatments that are not effective or are overused - there is no payment reform whatsoever." Citing the decrease in U.S. gross domestic product this year, she noted "we have a poorer country, yet hospital and physicians' fees have increased."

9. The bill sets the nation up for even worse deficits and crushing national debt by not getting more savings from the health system and making the coverage more affordable. "There is still a lot of overuse in the system," Darling stressed. "And, there still are too many health care quality and patient safety issues, like hospital-acquired infections, for [House lawmakers] not to press for [greater cost savings]."

8. There is no support for evidence-based medicine or a way to make certain that we don't pay for treatments that are not effective. Although the American Recovery and Reinvestment Act earmarked funds for comparative effectiveness research - what Darling calls "finding out what works and what doesn't work under what circumstances" - in health care, the research hits an obstacle in H.R. 3962. The bill states that comparative effectiveness data can't be used to influence HHS in coverage decisions.

Huh?

That's what Darling said, although much more articulately. "It's quite a blow to say that [comparative effectiveness data] can't be used in coverage decisions. If something isn't effective at all, or isn't as effective as something else, it shouldn't be covered."

7. There is no independent commission that could help Congress make the decisions to eliminate wasteful and harmful treatments and spending. "We've got to have a mechanism to control costs and eliminate wasteful - and at times, harmful - treatments," Darling said. "To rely on Congress, as clunky as that machine is, or the administration, as risk-averse as it is, to take on those decisions just doesn't make sense."

So, who should take them on? According to Darling, a nonpartisan group of physicians, hospital administrators, health plans, employers, economists and researchers.

6. H.R. 3962 does nothing to correct medical liability problems and related costly defensive medical practices. Again, Darling said, an independent, multi-stakeholder commission should take steps to make plaintiffs and physicians feel protected in litigation.

5. The bill doesn't expand employers' ability to help employees actively engage in wellness activities or achieve health goals. She holds out hope, however, for the Senate version of the bill, where proposals allow for employers to use up to 30% of premiums to incent workers to participate in wellness programs.

4. There are serious questions about the public option and how it would operate. "Aside from concerns about its ambiguity, if it operates in a way that makes its own costs lower, it automatically means an increased cost burden to employers," Darling asserted. "Something like a trigger is a better plan, because then we're not trying to solve a problem that doesn't exist."

3. It opens ERISA plans to unacceptable burdens. Mention ERISA and health care reform in the same sentence, and HR/benefits pros get very nervous. And with good reason, Darling said, as the bill would require employer-sponsored health plans to meet detailed federal requirements to avoid costly fines.

2. Moreover, she noted, the bill contains a particularly outrageous requirement that any employer still offering retiree medical coverage would have to continue it indefinitely.

1. Employers that provide comprehensive benefits could still be subject to an 8% payroll tax if employees decline employer coverage because it costs more 12% of their income. "If you're making $30,000 a year, it doesn't take much for [health insurance premiums to add up to] 12%. So, if that employee declines coverage, employers still would have to pay the 8% tax," she said.

So, happy holidays, pros. Raise an eggnog to the employer-sponsored system - flawed though it may be - while you still can. And we'll ring in the new year of reform together next month.