Frankly, the fact that the health exchanges and the public option won't be established until 2013 makes me cringe. I know there are budget issues, and there are immediate programs (high-risk assistance) and regulations (rescission, pre-existing conditions, etc) that go into effect right away, but it's clear that one of major holes in the House bill is this 2013 thing.
It's only three years away, but a lot can happen in three years, including a midterm and a presidential election. And on the bright side, there are more than a few spending bills in those interim years onto which reform bill fixes can be attached. Nevertheless, here are the major problems with the reform bill as it currently stands:
--2013 for the exchanges
--Stupak language
--Public option rates and eligibility
--Truly punitive consequences for insurers who refuse to abide the new regulations
--Drug price negotiation (Senate only)
None of this should be insurmountable. But I imagine some of it will happen after final passage via amendments attached to spending bills.