Like it or not, President Barack Obama and House Speaker Nancy Pelosi have managed to pass a comprehensive health insurance reform bill. The big question is what happens now?

The vast majority of those in the insurance business don't like this legislation, and understandably so, since it focuses practically all of its attention on the industry, without reforming the way health care is delivered.

It also fails to offer medical malpractice relief, guaranteeing that defensive medicine will continue to be practiced, driving up costs. Meanwhile, the penalties for not buying mandated coverage are way too small to coax everyone into the system, which could create adverse selection.

But these shortcomings can be repaired, and there is still plenty of time to make fixes–as many parts don't go into effect for years. Indeed, the battle over health reform should not end with this bill's signing. This should be just the beginning of an ongoing effort to add cost control and tort reform to the legislation.

This is, perhaps, nothing but a pipe dream in such a politically toxic culture. Instead of accepting the reality of the situation and moving forward in an evolving process, those in “the no” will probably do all they can to prevent implementation, including constitutional challenges over the mandate to buy coverage.

Meanwhile, the Democrats, sore over being demonized by the bill's opponents, won't be eager to add provisions–particularly any that harm their trial lawyer backers.

At the very least, the new law will be the key point of contention in November's midterm elections, with Republicans vowing to repeal health reform once they retake control of Congress, as a prelude to retaking the White House in 2012.

However, I can't imagine opponents winning many votes campaigning on the platform that insurers should be allowed to exclude those with pre-existing conditions, or drop coverage for anyone who gets sick. And once people realize they'll get subsidies from Uncle Sam to help buy insurance, anyone who wants to revoke such financial support will have a hard sell.

I'm not a big fan of this bill. It takes too long for the key provisions to go into effect, leaving tens of millions uninsured in the meantime. It lacks a public option to provide competition for private carriers. And as I mentioned earlier, it doesn't control costs, reform medical malpractice, or avoid the potential for adverse selection.

As I've argued before, we all would have been better off with an assigned risk pool to cover the uninsured, with policyholders split up among the health carriers writing in a given state, according to their market share.

But be that as it may, I give the Democrats credit for taking a gutsy vote in support of a principle I firmly believe in–that everyone should have health insurance coverage regardless of their job status, medical condition or financial situation. I don't believe Republicans share that goal, which made compromise unattainable.

Bottom line, this law could have been a lot worse for the insurance industry. There is no public option to potentially drive carriers out of business. Insurers will see billions in additional premiums, thanks to government mandates and subsidies. Agents are not being forced out of the market.

But this measure could also be a lot better, and my hope is that Republicans and the insurance industry keep pushing to improve it, rather than just trying to undermine or derail it, while leaving millions uninsured.

What do you folks think?