There is relentless pressure on Congress to pass a health care reform bill now. The details of this program are vague, except that it will be universal, affordable and focused on quality. The president has declared that health care reform is a critical portion of the economic recovery.

The focus of reform is universal coverage, but the real issue that faces the United States (and indeed the world) is the continuing rise in health care costs. Universal coverage will not control costs. There are two obvious examples in the United States. Medicare is virtually universal coverage for those over age 65, but it is facing runaway expenses. This is not due to enrollment of baby boomers, but to 21st-century technology and pharmaceuticals.

Lack of cost control has also been demonstrated by the Massachusetts health plan. For political reasons, Massachusetts chose first to achieve universal coverage and then to attack cost. Since implementation in 2006 the rate of non-elderly uninsured has dropped to 2.6 percent, but overall costs rose 42 percent by 2008 and have continued to increase, according to the Wall Street Journal.

The explosion of new technology has caught up with the National Health Service in Britain and with the Canadian health system, resulting in serious waiting times to attempt to control costs.

The price tag for universal coverage is enormous, and the promise of coverage for everyone is far from certain. The Congressional Budget Office analysis of Sen. Ted Kennedy’s proposal concludes that only a net 16 million of the estimated 46 million uninsured would be covered, at a cost of $1 trillion for 2010-2019.

A March 2009 report by Mathematica Policy Research studied the effect of Massachusetts-style reform in Washington state. As in Massachusetts, most of the currently uninsured would be covered, but individuals aged 55-64 would bear a large burden of higher insurance premiums. In fact, Mathematica predicts that while the number of uninsured in Washington state would fall from 542,000 to 152,000, 85 percent of the uninsured would be people who had lost their insurance because they could no longer afford it.

There is no evidence that adopting health care reform is necessary for economic recovery. In fact, the tax increases proposed to pay for universal care will delay economic recovery. Cost savings from preventive care are an illusion: very few preventive measures save money for a community (even though they save a life for an individual).

While the electronic health record offers certain safety features and may help coordinate care, in our small office the conversion expenses of hardware, software, training, and maintenance added substantially to our monthly overhead.

Instead of embracing universal care, we should carefully monitor and begin to implement the successful cost control measures that have been tested in different parts of the nation.

Employers are promoting wellness and controlling insurance premiums by offering incentives to employees who change unhealthy behaviors. Legislation passed this session in Olympia will encourage pilot projects to study whether the medical home, combining team health care with changes in reimbursement, can offer improved care and cost savings.

Legislators should review the laws that mandate everyone have insurance coverage for conditions that affect a fraction of the population. In Massachusetts spending on mandates accounted for 12 percent of insurance premiums in 2005, the Wall Street Journal reports. Washington state has 57 insurance mandates compared to 52 for Massachusetts, 13 for Idaho and 40 for Oregon.

Finally, liability reform is needed to reduce unnecessary defensive medical testing, which costs billions of dollars a year nationwide.

From 1988 to 2006, the rate of nonelderly uninsured in Washington state fell from 17 percent to between 9 and 11 percent. Progress is slow, but the issue has caught the nation’s attention. The political pressure should be used to implement proven and effective ideas that will control costs while expanding coverage.

Dr. Barbara K. Gehrett practiced primary care internal medicine in South King County for 28 years before retiring in 2008.