The federal health care reform law has only begun to be implemented and it remains one of several contentious campaign topics this fall. After more than a year of political bickering, most Americans are in no mood for more talk of health care reform.

But a lawsuit filed by the federal Justice Department this week in Michigan might provide an important opportunity to revisit one of the biggest failings of the health care reform effort — costs and competition.

The lawsuit against Blue Cross Blue Shield of Michigan filed on Monday alleges that the Blues cut secret deals with hospitals that forced competitors' prices to be higher and therefore reduced competition.

The Justice Department argues that actions by Blue Cross Blue Shield of Michigan kept other insurers out of the market, reducing competition, which forced Michigan residents and employers to pay higher costs for health care coverage.

In Michigan, the Blues dominate the health insurance industry with about 60 percent of the market. The market power of the Blues in Michigan is about nine times larger than the nearest competitor.

In Pennsylvania, the market domination of the Blues, including Pittsburgh-based Highmark, is at a similar level, and the lack of competition in health insurance here is clearly a factor in rising health care costs.

The federal lawsuit in Michigan alleges that in some cases Blue Cross boosted payments to hospitals in exchange for those hospitals charging other health insurers up to 40 percent more. The result of this practice effectively priced the competition out of the Michigan market and raised prices for consumers and employers across the state.

Creating competition in the health insurance market is one area where the health care reform law might provide future benefits through the creation of insurance exchanges. But the impact of yet-to-be-formed exchanges on bringing down health insurance costs is not yet known.

In order to get its top legislative priority passed, the Obama administration cut backroom deals with the health insurance industry, as well as big pharmaceutical companies and hospital and physician groups. These political calculations resulted in a law that most experts agree does very little to control costs.

Any discussion of health care reform cannot ignore the fact that the United States spends nearly twice as much, per capita, on health care as most other advanced nations. The lack of competition in the health insurance industry is clearly one of the reasons for that huge disparity in costs.

While the legal process in Michigan moves forward against Blue Cross Blue Shield, it's reasonable to expect that similar Justice Department actions will be seen in other states.

In Pennsylvania, the Blues' domination of the health insurance industry led to an investigation by the state Insurance Department that began earlier in the year and is reportedly ongoing.

Most reports suggest that Pennsylvania has one of the least-competitive health insurance markets in the country. Given that the market dominance of the Blues here is similar to the Michigan figure, health insurance consumers in this state, including individuals and companies providing health care coverage for their employees, probably are paying more than is necessary.

In recent years, the debate over the Blues in Pennsylvania also pointed to the cash reserves they hold, which, as of a few years ago, stood at about $3 billion. This remains an issue.

Even with the passage of the health care reform law, many issues, particularly cost control, are far from resolved. Health care costs continue to rise much faster than inflation, which in this election is hurting Demo-crats who passed a bill promising affordable health care.

The legal action in Michigan could be helpful in eventually creating a more competitive market for health insurance. Examining the business practices of the Blues should lead to a broader exploration of the role of for-profit health insurance companies and how much they contribute to the continuing increases in health care costs.