Now that most Democrats in Congress, and most Americans for that matter, have moved on from health care reform to tackle financial reform and climate change, the message from Washington is that health care is done.

But anyone who followed the year-long partisan debate on health care understands that while the insurance reforms expanding coverage and prohibiting companies from dropping customers who become sick or denying coverage to people with pre-existing conditions were appropriate reforms, the bill is deeply flawed, especially when it comes to its failure to reduce costs.

A reminder of that surfaced last week as news reports explained that Congress is once again struggling to deal with the "doc fix," an annual vote to reduce payments to doctors treating Medicare patients that was mandated by Congress in the 1990s. If the 21.3 percent cut in payments to doctors is rejected by this Congress, as other mandated cuts have been in recent years, the cost of the health care reform package passed by Congress earlier this year will jump in cost by $200 billion or so.

Not only is that a significant number, but the more important message is that Congress and the Obama administration were not being honest when costing health care reform.

During the heatlh care debate, cost estimates from the Congressional Budget Office came in at about $1 trillion for the next 10 years, and President Barack Obama vowed to keep the cost below that figure.

To make that happen, Congress had to play games. And one of those games was to remove the "doc fix" from the health care debate, and suggest it was a separate issue.

Many observers believed health care reform supporters gamed the system by shifting the "doc fix" outside of health care reform to keep down the cost of providing free or taxpayer-subsidized health insurance coverage to an additional 30 million uninsured Americans.

Shifting the "doc fix" out of health care reform was just one of several gimmicks used to keep the program's esimated cost under $1 trillion. Others include generally underestimating costs of expanded coverage and generally overstating cost savings, such as the promise to find $500 billion in Medicare cost savings over the next decade.

The creative accounting by backers of health care reform in Congress can be seen as something of a bait-and-switch maneuver that kept the estimated cost of health care artificially low, assuming that later, when the true costs emerge, the attitude will be "it's already passed; we just have to accept the higher costs."

Just a few months following the passage of health care reform, most experts already see it going well above $1 trillion in added costs.

That's not to say that health care reform was not, and is not, necessary. What's most bothersome is the dishonest way in which reform was pushed through by congressional Democrats and Obama. The failure to seriously address costs was admitted by Obama within weeks of signing the bill into law.

The fact that pharmaceutical companies will continue to charge Americans much more for drugs than those same companies charge patients in other countries is another example of health care reform's failure to address costs.

The White House cut secret deals with drug makers, as well as groups representing doctors and hospitals, that it believed were politically necessary to keep those groups from lobbying against health care reform and launching ad campaigns to turn public opinion against the plan.

The price of selling out to so many special interest groups that make so many billions of dollars of profit in the current American health care system will not be known for years.

Americans should keep an eye on Washington to see how Congress handles the "doc fix" and other inconvenient truths about health care reform that were glossed over during the national debate in the interest of the political importance of passing something that could be called health care reform.