Senate Democrats delivered President Obama the best Christmas present Thursday, an $871 billion health reform bill on a 60-39 party line vote.

As with the most important gifts, this one comes with a lot of meaning.

Forget the noise over abortion and death panels. Here’s the reality: If Democrats in the House and Senate can resolve their significant differences and craft a compromise between them (forget about a bipartisan meeting of the minds, though, this promises to be a one-party affair) that President Obama can call his own, health care reform will affect every business and individual in the United States.

Obama called the bills "legislation that brings us toward the end of a nearly century-long struggle to reform America’s health care system," and said they include "the toughest measures ever taken to hold the insurance industry accountable."

But will it lead to higher premiums for most Americans? Will small employers see any kind of a break from crippling costs or will mandates force some out of business? Will the insurance lobby learn to play along, or will it set out to turn the 2010 and 2012 elections into an all-out effort to oust the reformers from office? Will there be malpractice reforms or cheaper medications or more health care rationing or a more logical pay system for doctors?

We won’t know any of those things for some time. But here’s what we can say about this year’s national debate on health reform:

A Mandate Is a Terrible Thing to Ignore: Barack Obama got elected partly because many Americans believed him when he said he was going to tackle health reform. Now, a lot of Americans believed Bill Clinton on that front in 1992, and his attempts to change the system crashed and burned in his first year in office. Obama probably benefited from Clinton’s mistakes, and he obviously paid heed to Rahm Emanuel, his chief of staff and a veteran of the Clinton White House, who said: “Rule one: Never allow a crisis to go to waste.”

If the health care system and the economy wasn't in such crisis this year, Obama wouldn't have gotten support from business and industry groups, says Helen Darling, president of the National Business Group on Health. "Excessive growth in health care costs are hurting our economy and distressing business," Darling says. "We know we have to control health care costs."

Unlike the Clinton plan, Obama's reform won support of big business, drug companies, hospitals and doctors. Even insurers said they supported the concept. To be sure, the effort divided some major groups. The U.S. Chamber of Commerce doesn't like either the House or Senate bill. Obama may have gotten just enough support from business and industry.

But Republicans also heard Emanuel’s first rule and took away another message: they, too, saw a crisis but theirs was one of not holding either the White House or one of the two bodies of Congress for the first time in 14 years. Put aside their specific concerns and objections to the Democrats’ legislation for a moment. They saw a clear political value to warning the public about the changes that were coming, and we should all expect to hear much more about what Republicans see as the crisis—a march to socialism.

The Smaller the Business, the More Uncertainty Exists: It sounds like a politically opportunistic idea: tax insurance companies like UnitedHealth Group Inc. and Aetna Inc. Senate Democrats are proposing just that: taxing the insurers $70 billion over 10 years, beginning in 2011. But the tax will be passed through to the insured customers and that's largely small businesses. (The House bill proposes taxing wealthy individuals rather than the insurance industry.)

When President Obama says if you like your insurance, it won't change, he's speaking about people who are covered through large employers. Small businesses will eat the majority of costs related to any insurance tax.

"For a bill that was supposed to be all about small business—and small business is all about lowering costs—it's not happening," says Stephanie Cathcart, a spokeswoman for the National Federation of Independent Business. "All it's about is how much they're going to stick it to us."

Many small businesses will be required to provide insurance. The Senate bill requires businesses with 50 or more employees to cover their workers or pay a penalty to the government. The House version has a similar pay or play edict but determines size based on payroll. Employers with annual payroll of $500,000 or less are exempt.

Small-business groups say they want insurance market reform because they pay more on average than big companies for comparable health care. But they say the two bills don't do enough to cut medical costs that get passed through insurers onto customers. The tax on insurers exacerbates the problem, they say.

"We asked for reform, we need reform, we want reform," Cathcart says. It's just not the reform the small operators were looking for, she says.

Washington Can't Do Everything. President Obama vowed to expand health care coverage, improve quality of care and lower costs. The bill is going to extend insurance coverage to more people but the care and the cost promises don't look like they're going be kept.

Health reform is "not going to do a lot to lower costs across the board," says Michael Helmar, an economist with Moody's Economy.com in Reno, Nevada. "It's not just the structure of the industry—it's the structure necessary to operate. You have to pass through medical costs. If you force insurance companies to charge lower premiums, some of them will go broke. There's limited competition in the industry. If they have costs, they're able to pass them through."