•    Those who like their current coverage will not be able to keep it. By the fifth year, their employers must offer the same standardized coverage to them that everyone in the exchange gets.

•    Given the government establishment of permitted benefit options, employer innovation in this area will cease. So, for example, employers who experimented with giving employees chronic care drugs without cost sharing would not be able to figure out the next innovation that would help reduce health care costs or improve health care.

•    Given the required coverage, it will be much more difficult for insurers and employers to refuse to cover services that have proven ineffective – as an unelected federal board will decide what benefits must be covered.

•    Many employers will not be able to pay 72.5 percent of employee premiums, and will have to lay off workers or not hire more of them.

•    Employers with sicker employees will dump them into the connector coverage; those with healthier employees will self-insure.

•    Given how expensive health insurance is and how little the House bill does to curtail the cost of care, increasingly compensation will be directed to health care and not to wages, given the 72.5 percent employer-contribution mandate.

•    The House bill has only a modest penalty for people who choose not to have health insurance. This will drive up health insurance costs for those who actually buy coverage as the penalty is insufficient to encourage people to get covered. The current rate of persons with car insurance is only 85 percent.

•    The Massachusetts experience shows that individuals, even with a mandate, will wait until they are sick to get coverage that is guarantee issue. In Massachusetts, Harvard Pilgrim’s experience is that individuals enroll for several months, incurring on average around $2500 in costs, and then drop coverage. Unless the penalty for not enrolling is steeper, individuals will wait to enroll until they are sick.

•    The bill is a huge taxpayer give away. People making more than $80,000 get a government handout, leaving the taxpayers to entirely foot the bill of many of their fellow workers.

•    Given the budget deficit and the national debt, how can we afford to increase demand for health care services when we have no way to hold those providing the care accountable for the services they deliver? Hospitals still get paid to readmit patients after they have given inappropriate care.

•    As Atul Gawande’s piece in the New Yorker demonstrated, as long as the incentives in medicine are to get paid for ordering more tests and providing more services, we can give everyone in the country insurance but we will not have reformed health care. And the House bill merely spends more money hand over fist without doing much of anything to rearrange the economic incentives, so the current trends will continue.