Is there any evidence to show that annual health care cost escalation has begun to “bend the curve”? Is there any evidence to that the Congress understands that the curve is supposed to bend downward rather than to be helped to continue upward?

The answer to the first question is a resounding no. The health consulting firm Hewitt Associates is projecting a sharp rise in health care costs for employees, up 10 percent in 2010, the largest jump in a decade. Employees will pay an average of $4,023 in out-of-pocket and premium costs. Projections of an increase in insurance premiums for 2010 range from 6 to 22 percent, depending upon geographical region, also the highest in a number of years.

The Federal Employee Benefits Program(FEHBP), providing insurance for most but not all federal employees, has seen an increase of 8.8 percent this year. Long-advocated as a consumer-directed insurance plan that could be a model for health care insurance more generally, FEHBP offers 100 competing insurance plans with the government paying 72 percent of their cost. Blue Cross and Blue Shield accounts for some 60 percent of the enrollees, and premiums and out-of-pocket expenses for its plans rose some 13 percent. FEHBP has had lower annual premium cost escalation than at present, but it has been consistently higher than the Medicare.

All of the major reform bills coming out of the various congressional committees give the private insurers a key role in employer-mandated coverage, and greatly expanded business for the insurance industry. It is a wholly hypothetical assumption that private sector competition will slow annual cost increases to any significant degree. But none of those committees has asked the Congressional Budget Office to come up with some projections of what the expanded competition will do for cost control, with or without a public choice plan option.

There has always been competition in the insurance industry and its success in controlling costs for more than a short time is nil. To be sure, there may be ways of improving that dismal record (such as the ability to buy health insurance across state lines). But it seems to me an enormous risk to use the entire private health care system as a place to test the cost-cutting hypothesis, an idea fueled by politics, hype, and hope for the most part.

My second question, about Congress’ willingness to confront the cost issue, can be answered with a decisive maybe so, maybe not, sometimes yes, sometimes no. The Senate Finance Committee has reportedly quietly recommended that Medigap insurance be changed to include new copayments for doctor’s visits after 2015. Opposition can be expected to that idea.

Opposition can no less by anticipated for as proposal to increase Medicare premiums by 15 percent, affecting some 12 million beneficiaries, or 22 percent of them. Kathleen Sibelius, Secretary of Department of Health and Human Services, has urged the House to approve a bill that would block the increase. It is hard not to guess that the Senate will go along, showing so far little inclination to be put extra financial burdens on Medicare beneficiaries.

The response of the Senate Finance Committee bill that would cut government subsidies for Medicare Advantage by $113 billion over 10 years has so far been mixed, but the proposal is still alive. An interesting point of opposition is that it would be wrong to deprive elders of a popular program, a principle that could no less well be used to oppose any and all established Medicare policies. Whether Congress can resist this kind of pressure is unclear but it is still a possibility.

The loss by Senate Democrats of a bill that would increase Medicare payments to doctors, and thus incurring costs of $247 billion over a decade, has its amusing side. By virtue of earlier legislation, doctors serving Medicare patients are scheduled for a 21.5 percent cut in reimbursements in 2010.

Congress has traditionally and annually overruled its own legislation calling for 5 percent annual cuts, and now is faced with the requirement of imposing a much larger cut. Faced with a predictable outcry by physicians, the Democrats did not take long to introduce a bill to get rid of the old legislation and increase, not cut, reimbursements. That move failed, running into Republican and even some Democrat opposition.

What is amusing about that? Well, it will be interesting (insofar as politics has some sport features) to see which side will stand its ground in the future. Will the Democrats try again to avoid alienating doctors by getting an increase passed, or will the Republicans stand fast, thus alienating the doctors?

Daniel Callahan is editor of the Health Care Cost Monitor and author of the new book, Taming the Beloved Beast: How Medical Technology Costs are Destroying Our Health Care System.