Comprehensive health care reform is now a fact, passed by Congress and signed into law by President Barack Obama. Millions of Americans can look forward to a healthier and more financially secure future.

The controversy over the law's passage won't die quickly. Republican candidates will keep it alive through the next election cycle. Some attorneys general will use scarce state dollars to wage a long-shot court battle against the reforms.

Thoughtful people in public office and the medical community, however, are already at work on making health care reform a success.

Indeed, the hard part has only just begun.

n Politicians must muster the will to enact the financing provisions in the law. Specifically, they must trigger the excise tax on the "Cadillac" health insurance plans, beginning in 2018. And they must follow through with proposed cuts in Medicare spending.

The new law provides for a 15-member board of health care experts and stakeholders, which will have substantial authority to recommend ways to cut costs in the Medicare program. If those measures work, they can be adopted in the private sector. Congress should resist any attempt to weaken this much-needed commission.

n The nation's health care system must gear up for the added workload that will come from 32 million people gaining access to health insurance.

The first task is to recruit and train more primary-care physicians. The reform act creates financial incentives for medical students to specialize in primary care instead of the currently more lucrative specialties like cardiology or orthopedics.

That's a good first step. But the federal government must also lift its cap on residency slots, which was set in 2006 at 100,000 a year for all specialties.

The health care system must also work on measures, such as computerized records, to make its delivery more efficient. The paperwork burden on doctors and their staffs must be alleviated. And policymakers must find ways to increase the ranks of nurses and physicians' assistants who are skilled to take over some of the tasks handled by physicians.

n Government and the health care system must move as swiftly as possible to a model that pays for results instead of procedures.

The reform act contains a number of incentives and pilot programs to encourage this shift. One provision pays a lump sum to doctors, hospitals and follow-up providers to work as a team to treat a patient. Another encourages assigning nurse practitioners to work with chronically ill patients on an ongoing basis. Still another penalizes hospitals for expensive, preventable infections.

These are all steps that most health policy experts have advocated for years. But many of them aren't scheduled to kick in for several years. The sooner they get up and running, the better the chances will be of reducing health care costs while delivering better care.