Now it’s the Senate’s turn. If Americans are going to have the health care reform they urgently need, it will be because the Senate does more than the House did to control the exploding costs of care.

The House narrowly passed a historic reform of health care earlier this month, and the bill contains many potentially useful components, including offering coverage to tens of millions of the country’s uninsured. But its efforts at cost control are woefully insufficient given the looming crisis.

Health care accounts for nearly 18 percent of gross domestic product and, absent some current or ongoing economic change, is on track to reach 20 percent in just a few years. That is to say that of every $5 Americans spend on anything, $1 will go to health care.

The system, if it can be called that, is caving in on itself. As costs skyrocket, employers are dropping health insurance as a benefit. No law requires them to provide it. The only factors are conscience and competition, but as insurance costs threaten the health of the companies, themselves, they will be forced to back away in even greater numbers.

Failure to provide health care to the uninsured is a moral failure and it carries potentially severe economic consequences for those people, their families and the nation in general—no one is denied emergency-room care, the most expensive form of treatment. But the spiraling of health care costs is the main out-and-out crisis. It threatens the health care system and the entire American economy. Without that component woven into the bill, any effort to extend coverage to the uninsured will ultimately fail, later if not sooner.

Instead of cutting costs, though, House Democrats partially fund their health bill with a 5.4 percent surtax on the income of wealthy Americans. The tax also will result in an increase of the capital gains tax from 15 percent to 25.4 percent. But past experience has shown such raises are counterproductive over the long term, with the adverse impacts on economic activity virtually wiping out the expected benefit of the tax increase.

Our biggest current problem with the economy is the continued loss of jobs. Employers faced with an increase in federal taxes, compounded in New York by a runaway Legislature’s increase in state taxes, can hardly feel governments have encouraged them to hire more employees.

And the House also missed a bet on cost containment. The wordage in the House bill does not save the millions spent annually by doctors for tests and procedures to cover themselves in the event of a lawsuit. It ignores the example of states that have adopted malpractice caps. Texas, as an example, did so several years ago, and the state has had a 50 percent drop in malpractice premiums, fewer lawsuits and a sharp increase in new doctors.

According to the Congressional Budget Office, the Senate’s plan will lower the federal deficit. That conclusion was echoed in a report done by the Lewin Group for the Peter G. Peterson Foundation. The report also says the plan would achieve budget neutrality in the first 10 years, maintain it beyond 10 years and slow the rate of growth in Medicare costs.

But the report also notes that the Senate plan, as well, fails the critical test of lowering the costs of health care. Or, as the foundation put it, “It does not bend the total health care cost curve downward as a percentage of the economy.”

So there is serious work to do. The Senate, true to the Founders’ conception, is approaching this critical legislation more dispassionately than the House. That could be good news for all Americans and the companies that offer them health insurance if members keep their eye on the ball. Lower costs, extend coverage, in that order. If they can do that, worries about the “public option” will vanish like a bug that’s run its course.