Reaction to plans by California health insurer Anthem Blue Cross to raise rates for some customers by as much as 39 percent should focus attention on an aspect of health care reform eluding Congress and President Barack Obama — cost control.

In California, the state attorney general's office has subpoenaed financial data from Anthem to determine how the company spends its money.

Such a review, planned for the seven largest insurance companies in California, should expand to health insurance companies across the country. Americans need to understand why the United States spends nearly 18 percent of its gross domestic product (GDP) on health care while other advanced nations provide universal coverage for almost half the per-capita cost, spending about 10 percent of GDP. In addition to spending less money per person, the people in these countries generally are healthier and live longer than Americans.

When congressional Democrats and Obama talk about health care reform, the focus is on expanding coverage to the 30 million Americans without health insurance. But nobody in Washington, D.C., has a plan to address out-of-control costs in America's health care system. And that is a serious threat to the nation.

Renowned investor Warren Buffet put the spotlight on costs recently when he described rapidly rising health care costs as an "economic tapeworm" that is hurting U.S. businesses and individuals by diverting money from other, more productive, uses.

Buffett says he hopes Congress will craft a new health care reform plan that holds down costs better than any of the current plans.

California's examination of health insurers will look at how much the companies spend on actual health care, compared with how much they spend on salaries, marketing, lobbying and general overhead. The probe also will look at the salaries of the top 10 executives at each company.

Making these figures public is appropriate, especially since health care plans in Congress call for mandating everyone to have health insurance — meaning the government will force 30 million or more people to buy health insurance, many, or most, with the help of taxpayer-funded subsidies.

At one level, such a mandate makes sense because it expands the insurance pool to include more healthy people, and premiums from more healthy people will cover the costs incurred by sick people. But if a basic health insurance policy is to be mandated, it's important to know about the finances of those companies that stand to benefit from 30 million new customers. The public should know about insurance company profit margins, marketing costs, executive salaries and general overhead expenses — everything that is not spent for health care.

Those uncomfortable with for-profit insurance companies gaining 30 million customers by virtue of a government mandate might consider an approach taken by Switzerland. In that European nation, private insurance companies sell the basic, mandated health insurance policies as a nonprofit venture. The health insurance companies in Switzerland can, and do, make a profit on supplemental insurance policies that provide higher levels of coverage. But the basic plan, which is government-mandated, is sold in a non-profit, regulated environment.

Such a hybrid system might work in America, where there is broad opposition to a government-run health care program, despite the general satisfaction with Medicare, a government-run program with low overhead expenses.

Author and commentator Robert Kuttner wrote about his ideas for health care reform, focusing on the economic damage of "escalating premiums eating into both corporate profits and worker take-home pay."

The answer, according to Kuttner, is to take commercialism out of health care. Many people question the role of profits in health care, such as health insurance companies boosting profits by denying care and finding ways to drop customers who get sick.

Still, Kuttner suggests, lawmakers don't seem to have an interest in such a non-profit approach because of the "immense power of the medical-pharmaceutical-insurance complex, combined with a failure of political leadership."

As Buffett and others have argued, controlling costs should be the first priority of health care reform.

Clearly, it's a tragedy that millions of Americans lack health insurance. But current cost trends of health care spending in this country could very well destroy the United States, an even greater tragedy.

Obama and Congress should refocus on reforming health care in a way that brings U.S. spending in line with other countries'. Why should Americans pay more for less?

Adding 30 million people to a system that is twice as costly as health care systems in other advanced nations is not reform — it's a prescription for disaster.