With Democrats on the verge of pushing a $940 billion health care reform measure through

Congress and toward the desk of President Obama, under a self-imposed deadline, the major

issue for health care in America remains unsolved. Insurance coverage will expand ... and so,

probably, will health care costs, already a sixth of the American economy.

This health care reform does far too little to rein in the crisis of escalating insurance

and care costs. Democrats take heart in Congressional Budget Office projections ... some based

on future moves that Congress may or may not make ... that the new law will reduce federal

deficits by $138 billion over the next ten years. But the expansion of coverage is estimated

to cost an additional $200 billion per year by 2019 and some of the planned cost-offsetting

measures already already are questioned, such as a tax on "Cadillac" health insurance plans

now being softened under pressure from organized labor, a traditional pillar of Democratic

Party support.

Even the insurance industry is wary, complaining that Congress has done little in this bill

to slow the growth in costs.

Many of the provisions in "Obamacare" also are in the Massachusetts health reform plan

often cited as a model for universal coverage. Under that state expansion, though, costs

haven't worked out the way they were supposed to. The program is $47 million over budget and

costs are 27 percent higher than the national average. Health insurance premiums are

increasing at the rate of 30 percent a year. Hospitals are in turmoil and three of the state's

four major health insurers lost money.

And if access and waiting times are issues in Canada, so too in Massachusetts ... doctors are

reluctant to accept new patients, and the average wait for an appointment is now 44 days. That

doesn't offer much support for the argument that sick people will use expensive emergency

rooms less often because universal coverage will give them access to a doctor.

Nationally, the major public concern over health care has been the annual sharp increases

in insurance premiums. There is no evidence, under this measure, that slowing those increases

will happen. There are mandates and regulations likely to increase costs, not diminish them.

Universal health insurance coverage is a good moral goal, as are the bill's measures to

create high-risk insurance pools and ban denial of coverage for pre-existing conditions. But

expanding coverage is a goal that should follow cost controls and not, in an era of staggering

governmental deficits and debt, worsen the cost problem for taxpayers and businesses,

especially small businesses.

There are three major cost-offsetting measures in the Democrats' bill: trimming Medicare

and other federal health programs by $500 billion, increasing taxes on individuals making more

than $200,000 and families making more than $250,000 a year, and the union-alarming tax on

expensive health care plans. The goal is to make that pay for coverage expansion, adding some

32 million Americans (of about 45 million now uninsured) to the ranks of the insured through

individual and employer insurance-purchase mandates, expansion of Medicaid eligibility for

low-income Americans and tax credits for middle class households.

But the bill delays implementation of many provisions so initial-year costs won't cause

"sticker shock," and the Senate version to be adopted also includes several programs that call

for Congress to provide unspecified, open-ended funding "such as may be deemed necessary."

There's also no reform to discourage the overuse of expensive medical practices just to avoid

potential lawsuits, and the expansion will lead more people to use medical services, taxing

the ability of the current system to deliver them and perhaps driving up cost.

Drug companies, hospitals, doctors and insurers would gain millions of new customers,

although hospitals will need to be more efficient to absorb new Medicare regulations and

insurers will see more federal regulation.

Buoyed by CBO projections, Democrats have grown increasingly confident of gaining the 216

votes needed to "deem and pass," probably on Sunday, the package of older bills and new

amendments that would send this reform to the White House. That will not end the debate. There

are 38 states already poised to sue the federal government if residents are forced to buy

health insurance, the real impact on costs will emerge over the years ... and the politics will

heat up again, in November.