Economists and health care experts have long agreed on the problems that ail the health insurance system in America. It leaves too many people out. Even those who have coverage may be one diagnosis away from financial catastrophe. On the other side of that same equation lie the waste and excess created by paying doctors and hospitals for the quantity of treatment they provide rather than what works best. By some estimates, as much as 30% of the more than $2 trillion Americans spend on health care each year goes toward treatments that are unnecessary and even harmful. And what does the U.S. get for that staggering investment? Shining hospitals packed with cutting-edge technology but also a population whose health and life expectancy lag behind those of most other industrialized democracies. (Emphasis added)

Will these reforms turn all that around? We won't know for years, probably not for decades. The most ambitious element of the new health care law — the expansion of coverage to an additional 32 million Americans — won't even take effect until 2014. "It'll take four years to implement fully many of these reforms because we need to implement them responsibly," Obama said as he prepared to sign the legislation. "We need to get this right."

And expanding coverage is just the beginning. [snip] The big question is how well these theories will work in the real world.

[snip] Says Oregon Governor Ted Kulongoski, a Democrat: "I wake up worrying how I'm going to get from 2010 to 2014."

The bill Obama signed, in short, is far from a finished product. In fact, say health experts, it is only a start. "Of course we'll fuss with it," says Karen Pollitz, who directs Georgetown University's Health Policy Institute. "But we'll have something to fuss with, as opposed to nothing." The trick, however, is this: for any part of this new system to work as well as it should, it all has to. Here are five big elements to watch:

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