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By J. BRADLEY WILSON

Since becoming CEO of Blue Cross and Blue Shield of North Carolina in February, I have traveled the state listening to customers, employers and community leaders.

In these discussions, I am frequently asked two questions: "What is your take on health care reform legislation?" And "What do we need to do to get health care costs under control?"

People are surprised to hear that -- contrary to how Blue Cross has been portrayed -- we have always favored health care reform. This includes nearly all the key components of President Obama's reform initiative, particularly the central goal of getting coverage for as many Americans as possible. Insurers know that the best way to spread costs is by expanding the risk pool to include both young and old, both sick and healthy.

We have also been strong advocates of ending pre-existing condition exclusions and medical underwriting. Allowing family policies to cover dependent children until they're 26? We're already doing that.

We are glad that Congress has passed reform legislation. And we are ready to do our part in helping to build a more rational, sustainable health care system.

Much work remains before us, however, because most of the factors that have led to escalating costs are still in effect. Also, while reform will create more affordable options for many Americans, some of the new requirements will have the unfortunate effect of raising premiums for others.

Health reform does not address several factors that drive health care costs. The first is general inflation, which adds a few percentage points each year.

New technology that makes care better and more sophisticated also contributes a few percentage points to the increase.

Add a few more percentage points for the aging of our population, which inevitably leads to a greater need for care.

For years, health care economics has encouraged doctors and hospitals to provide additional services of limited value. Doctors who find the quickest path to a good health outcome aren't rewarded. This inefficiency contributes a few more percentage points.

And there's the effect of medical malpractice, which includes both the direct cost of lawsuits and the difficult-to-measure impact of defensive medicine.

All of these cost drivers were in effect before health care reform -- and are largely unaffected by health care reform.

Health care reform will have a fundamental effect on how health insurance rates are set. Before reform, premiums in the individual market were based primarily on health status. Post-reform, premiums for individuals and small groups will be calculated primarily for three groupings based on age (rates can also reflect family composition, geographic region and tobacco use). That's great news for some, but healthy people will pay more than they would have under the previous system.

And because the mandate to purchase health insurance lacks a strong penalty, there is a risk that healthy people will opt to pay a modest penalty rather than paying for coverage. Without a large enough pool of healthy individuals to balance the risk of the sick (who will now be guaranteed coverage), there would be nowhere for costs to go but up.

To make reform work, we have to move beyond simply reapportioning who pays and begin to slow the growth of total spending. This calls for bold and creative thinking.

BCBSNC will work as partners with doctors, hospitals and employers to pilot payment methods that reward the swiftest and most reliable paths to good health outcomes, not the number of medical procedures performed. We must leverage technology that cuts administrative costs and improves quality.

And we will look inside our own house to cut administrative costs wherever possible.

Let's get beyond reform's partisan battles and get to work. At Blue Cross and Blue Shield of North Carolina, we're committed to that effort and we invite everyone interested in improving quality and reducing costs to join us.

J. Bradley Wilson is president and CEO, Blue Cross and Blue Shield of North Carolina.