In this country, we spend $1.4 trillion on health care every year, yet there are 40 million people who do not have heath insurance. That is a national disgrace. In the coming weeks, I will offer a comprehensive health care plan that will offer health insurance for every child, help small businesses struggling with health costs, and expand the range of choices in our health system.

But while we must expand health coverage, we also need to lower the cost of health care. Every year, the costs of health care rise far faster than inflation. And every year, millions of Americans lose their health insurance because their employers stop offering care or they stop being able to afford it.

To control the cost of health care, we have to overcome the culture in Washington that refuses to stand up to big insurance companies, the HMOs and the drug companies. I’ve tried to do that — with the patients’ bill of rights and legislation to speed up generic drug competition. But it’s never easy.

Take prescription drugs. Drug companies provide an important service to our country, and they deserve to earn a profit. Yet the reality is that rising drug costs continue to cripple consumers.

The recent prescription drug bill offered a golden opportunity to take action to bring the costs of prescription drugs down. And the Senate bill did contain one important step, a version of the patent reforms I helped author last year. Yet for the most part, we missed the opportunity to control drug costs in this bill.

Here’s one example. According to a recent study, 12 percent of the rise in prescription drug costs results from the rise in direct-to-consumer advertising. These ads are a multibillion-dollar expense for consumers. Yet many of these advertisements are highly misleading. They are misleading in tone — often showing images of children running in fields or couples dancing in the kitchen, even as a narrator describes dangerous side effects.

More important, the advertisements also often mislead in their details. According to a Consumer Reports survey, advertisements have had “a broad and disconcerting range of misleading messages: ads that minimized the product’s risks, for example; exaggerated its efficacy; made false claims of superiority over competing products; promoted unapproved uses for an approved drug; or promoted use of a drug still in the experimental stage.”

During the debate on the prescription drug bill, I offered two amendments designed to reduce misleading drug advertising. The amendments would have reduced the flood of misleading drug advertising by requiring full disclosure of a drug’s harms and benefits, and equal treatment of a drug’s benefits and side effects. Unfortunately, these amendments met sharp opposition, and they failed. That is unfortunate.

There’s more we should do to control drug costs. We need to stop the backroom deals between drug makers and Pharmacy Benefits Managers. We should crack down on drug companies who are cheating taxpayers by overcharging Medicare and Medicaid. The states have been fighting this for some time, but it is time for the federal government to take the lead, starting with a top-to-bottom review of price-fixing in the drug industry.

Finally, when it comes to drug patents, we need an honest investigation of our patent system — whether it is truly serving consumers by encouraging not only incremental improvements and “me-too” drugs, but true breakthroughs that cure diseases and save lives.

I know how important health insurance is. When my father lost his health insurance, my mother went to work at the post office so that she and my dad could have quality health insurance. We need to make sure every American — just like my mom and dad — can have access to health care. Taking on the pharmaceutical companies is a tough job but if we are ever going to rein in health care costs in this country, this fight is one we must begin.

Sen. John Edwards (N.C.) is a candidate for the Democratic presidential nomination.