By DAVID HAYNES

After years of waiting, the Senate is expected to deliver a big gift to the American people on Christmas Eve — health insurance for millions of them.

For some Democrats in Congress, the bill emerging from the Senate is a disappointment. Their wish list included a public option. Republicans, on the other hand, believe the legislation is less a gift than it is a theft from the wallets of taxpayers. Both sides claim special interests are the real winners.

After months of bickering and tough negotiation, the frustration on both sides is understandable. But make no mistake, this is progress. The Senate should not forego the chance to help the people who need it most. Though this bill doesn’t accomplish enough in our view, it still accomplishes a lot.

The Senate bill would cover 31 million more Americans compared with current law. It would do that by extending Medicaid to people with incomes of up to 133% of the federal poverty level and offer subsidies on a sliding scale for those between 133% and 400% of poverty so that they could buy coverage on new insurance exchanges. The federal poverty level is now $22,050 for a family of four.

The bill would require everyone to carry insurance and proscribes penalties if they don’t. Employers with more than 50 employees would have to offer health insurance or pay fines. The bill allows states to set up compacts and sell insurance across state lines in the small group market on the new exchanges.

The bill taxes high-value insurance plans, which raises money for subsidies and discourages profligate plans that tend to cover almost anything without enough regard for effectiveness of treatments. The bill increases the Medicare tax for higher income earners and imposes new fees on health insurers, pharmaceutical companies and medical device makers. The bill envisions nearly $500 billion in cuts to Medicare over a decade.

The bill would set up a cornucopia of pilot projects aimed at controlling medical spending. Critics belittle these efforts, but the American way of health care is not sustainable without cost control, which makes such experimentation sensible. An independent commission would be set up to recommend efficiencies in Medicare — a program that wastes billions of dollars. And the bill wisely embraces comparative effectiveness research.

The Congressional Budget Office estimates that the Senate bill would reduce the federal budget deficit by about $132 billion over the decade; the bill would cost $871 billion over those 10 years.

We’re skeptical of those numbers because they rely on Congress actually following through on threatened cuts to Medicare, which lawmakers have never had the backbone to do. Other accounting gimmicks are at play here, too, which call into question the CBO estimate. For the math to work, Congress must stand firm in the face of what will be a furious storm of resistance from doctors, unions and other interest groups who will claim they are being abused. There also will be a thousand loose ends — especially given the way the bill was cobbled together in the waning days of the session.

We remain concerned that efforts to control medical spending — to bend the cost curve as the wonks like to say — will get short- shrift in the end. We’re concerned that expanding Medicaid will saddle states, which share the cost, with a burden they cannot bear.

And we’re annoyed at the rush of deal-making that was needed to persuade reluctant Democrats to line up — payouts to Sen. Mary Landrieu (D-La.) and Sen. Ben Nelson (D-Neb.) among others. But this is Congress. Deal-making is the name of the game — especially on big-ticket legislation.

We regret that Republicans chose to obstruct rather than contribute to the debate. Political calculus led them to sit on their hands while one of the most important national decisions of the past 40 years was made. Time will tell if that was time well spent. From our vantage point, we doubt that it was.

Democrats, especially in the House, have a choice of their own. We urge them to resist the temptation to repeat the mistake of pushing for more than the politics of the moment will allow. During both the Nixon and Clinton administrations, Democrats scuttled chances for health care reform with sheer obstinacy when passage of bills seemed possible.

Pressure will mount as the House and Senate versions of reform are reconciled in the coming weeks. Improvements can be made, of course, but liberals, in particular, must not sacrifice the good for the perfect on the altars of abortion rights or a public insurance plan.

The bill about to pass the Senate would protect millions of people. This is history. And in a season of giving, it is a worthy offering for America’s hardest-hit citizens.

The bill would set up a cornucopia of projects aimed at reducing medical spending.

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