While there is still a ways to go (reconciliation and final votes in the House and Senate), it now appears more likely than not that the health reform bill pending in Congress will pass.

The fact that the proposal that passed the Senate is being vigorously assailed by both liberals and conservatives suggests that perhaps the law is appropriately balanced among the various interests that needed to be accommodated. The proposal is neither the “unmitigated disaster” that Republicans claim, nor is it as good as it should have been. It is, instead, an incremental step toward universal coverage that is both comprehensive and affordable.

Upon final passage, each interest group will put its spin on it and it will still be very difficult for any of us to know which interest group to believe. But the only interest group I am concerned about is patients.

As a physician, I am confident that my services will remain of value and that I will not be looking for work. But the current situation for patients is unacceptable, whether they have health insurance or not. Across our nation, hundreds of people are dropping their insurance every day, and recent research concludes that thousands die prematurely each year because of a lack of insurance.

Without reform, it is estimated that health insurance premiums will double in the next five years, surely leading to even more persons being uninsured. Businesses in our area are seeing 20 percent to 60 percent increases in their health insurance premiums.

I can only assume that the defenders of the status quo, those interests paying for the innumerable television ads we see each evening, are the interests which are currently benefiting from the mess we are in.

At its core, the health reform debate should be about providing affordable coverage to all Americans.

Each bill passed by the House and Senate, respectively, will cover about 94 percent of legal residents — more than 30 million people. And both bills make significant reforms to the insurance market, most, significantly, prohibiting health plans from denying coverage on the basis of pre-existing conditions and limiting what can be charged differentially to persons based on gender, age and health status.

Provisions in the Senate bill also encourage changes in the way we deliver and pay for care. Many of these provisions contain reforms that Maine is already promoting, such as the patient-centered medical home and other payment reform initiatives. Provisions promoting patient safety, more transparency and accountability are included. These are all positive.

What are the negatives?

Well, not surprisingly, it costs a lot of money to insure more than 30 million people. The cost of the bill passed in the Senate is about $870 billion over the next 10 years, paid for by a combination of reductions in the growth of Medicare, new taxes on some businesses and on high cost health plans and fees on some health-related products.

No one likes more taxes and fees, but we all pay a hidden fee now when we pay for a medical service and pay 35 percent more for the service than its cost in order to pay for the persons who pay nothing, and to help make up the shortfall resulting from Medicaid and Medicare not paying for the full cost of care they purchase on behalf of their enrollees.

Raising revenue to subsidize coverage for those who cannot afford its full cost, and requiring the purchase of such insurance, is a fairer and more rational way to pay for care.

Assuming that the House and Senate are able to reconcile the differences in the two bills and that final votes in each body are successful, our nation will be on a path toward a better health care system. But it would be a grave mistake to believe that this is the end.

It is really the beginning, and state governments and all of us, physicians, patients, insurers, hospitals and all other stakeholders, have to work together to make the new law work and to fill in any gaps. Accelerating the implementation of some of the coverage provisions would be a good start, so that persons are not waiting for insurance until 2014.

The road to reform in Washington became a bitter, partisan journey. It need not have taken that track, but we can’t change what has occurred.

What we can do, all of us, is to lower the rhetoric, avoid the extremes, and collaborate toward the goal of making these provisions work.

If they don’t work, we can work to change them. Congress has laid out the broad outlines, but there will be a lot that states and stakeholders will need to do to make it work.

That is the American way. And it is the Maine way. We already are ahead of most states because of the work of the Maine Health Management Coalition, Quality Counts, the Maine Quality Forum, HealthInfoNet and many other organizations.

I look forward to being a positive part of the process on behalf of the Maine Medical Association and its 3,300 members.

Failure is not an option when our health and the health of our neighbors are concerned.

Nancy Cummings, M.D., is an orthopedic surgeon practicing in Farmington. She serves as chairwoman of the executive committee of the Maine Medical Association. She is a graduate of Bates College.