President Bush has made "consumer-directed" health savings plans a cornerstone of his policy for addressing runaway medical costs, and he plans to push them again in the State of the Union address next week. But so far there is little evidence that the approach is helping many consumers come to grips with the high price of health care. 

In a way, the early results do offer some hope. More than two million people have signed up for the plans, which were created as part of Medicare overhaul legislation in 2003 but were not an option for many people until the health insurance sign-up season last fall. While that is a tiny fraction of the 180 million Americans with health insurance, some experts say the numbers show a notably fast adoption rate for a complicated new consumer program. 

By other measures, though, workers and employers have been slow to embrace health savings plans, which are intended to reduce corporate health care costs while giving individuals more control of their medical spending. 

In essence, health savings plans are high-deductible insurance policies that people can obtain through their employers or buy independently from insurance companies. In exchange for paying at least the first $1,050 of their medical expenses each year (or for families, a deductible of the first $2,100, consumers are supposed to benefit in two ways: lower monthly premiums and the ability to put pretax dollars into a savings account that grows tax-free. 

Those savings, in theory, could be used toward the deductible in future years and help pay additional health bills not covered by the underlying insurance policy. As with a 401(k) retirement account, the health savings are the individual's to keep when changing employers - a portability feature that Bush administration officials like to cite.

But in many cases, people have evidently signed up not because they are eager to direct their own medical spending but because the plan looked cheap or they had no other insurance option. And at least half of those enrolled have not put money in their health savings accounts. So there will be no money building up for next year's out-of-pocket expenses - a big selling point for these health plans. 

In addition, many employers have been slow to offer the plans. And companies that do so have been reluctant to encourage worker participation by contributing money to the savings accounts. The employers figure that "portability" means that their money will go out the door with workers who leave. 

"That is our main concern," said Eric Airola, benefits director of J. B. Hunt Transport Services, a trucking company based in Lowell, Ark. "Turnover in the truckload industry as a whole is very high," he said.

As the plans were conceived, people using their own money could be expected to spend less on health care, switching to lower-cost drugs, for example, and adopting healthier lifestyles. Employers were promised savings as they shifted responsibility to workers for thousands of dollars in costs. Uninsured employees of small companies and self-employed people would be able to set aside pretax dollars for low-cost, limited coverage. 

But for those who criticized the idea of health savings plans from the start, the early results simply confirm their gloomier forecasts. The critics say this approach is increasing many people's out-of-pocket expenses and warn that it will make them less likely to seek routine preventive care that might stave off bigger problems down the road.

Pat Schoeni, executive director of the National Coalition on Health Care, a group seeking better, more affordable medical care, said, "The savings accounts are not designed to help people pay for health care; they are designed to help employers unload their health care costs." 

Mr. Bush, in his weekly radio talk last Saturday, said he would call on Congress in the State of the Union speech to make the plans "more available, more affordable and more portable." Among other steps, White House officials say, he will propose raising the tax-free contribution ceiling, which for 2006 is $2,700 for individuals and $5,450 for families.

Frank McArdle, a health policy expert in Washington for Hewitt Associates, the big benefits-consulting firm, predicted that "expanding health savings accounts to make them more attractive to employers and their people will be a hot issue in Congress this year." 

For people with modest incomes who are hard put to save for medical needs or much else, raising the contribution limit may be a moot point. But for those who have the money to set aside, the savings accounts can be attractive.

Eric Kok, 32, a printing and packaging company manager in Lancaster, Pa., says he will put part of his pay this year into a tax-free health savings account. 

"Because I'm young, I'm still maxing out my 401(k)," he said of his retirement plan at the Banta Corporation. He calls that Step 1. "Step 2 is opening a health savings account and trying to put as much into it as possible." 

He and his wife, Susan, who has her own insurance from her employer, together have a six-figure income. Mr. Kok said that when he retires, he can use the health savings tax-free for care and for premiums in the company's retiree health plan. If he dies with a balance in the account, his survivors can inherit the money, as with a 401(k) account. 

Stacy Ryan, the benefits manager at Banta, said the company saw the plan as "the new wave of health care." Banta added health savings accounts and eliminated company-subsidized health benefits for its 4,000 nonunion workers this year. 

She said the health savings plan had already had "a huge impact" on employees' actions. They are "making better decisions, such as not going to the emergency room if it is not an emergency." 

Based on the acceptance of health maintenance organizations in the 1980's, some industry analysts predict the pace of people signing up for the plans will continue to grow quickly. Forrester Research, a market research firm, projects that nearly 22 million people will have health savings plans by January 2008 - about 12 percent of those with insurance. 

While nonunion employees of Banta have no insurance alternative, workers at large companies that still offer a choice have been slow to abandon coverage like H.M.O.'s and preferred-provider networks. 

At I.B.M., only "a very small number" of employees have selected the health savings account option, according to Marianne E. DeFazio, the director of global health benefits, who declined to provide a specific figure. Industry experts estimated that 3 percent of I.B.M. employees had signed up for the savings plans, which the company has offered for the last two enrollment periods. 

UnitedHealth Group, the largest provider of the savings plans, says that of the 24 million people insured under its various types of policies, 654,000 now have health savings plans. But so far, only about half have started setting aside money, a spokesman, Daryl Richard, said. 

Among UnitedHealth's policy holders, a larger number - 846,000 - are still covered under an older type of policy that, like health savings plans, has low premiums and high annual deductibles. But instead of employees' setting aside money, the employer contributes to an account that gradually grows in value and is available for the employee to draw down for health expenses. 

The money in these plans, known as health reimbursement accounts, reverts to the employer when workers leave their jobs. That is one reason some large employers are sticking with this older form of insurance.

Schneider National, a big trucking company in Green Bay, Wis., went further last year and chose such a plan as its only insurance option. 

A happy beneficiary of Schneider's insurance plan is Lara Hobbs, 36, of Spring Hill, Fla. Ms. Hobbs, who drives 18-wheelers cross-country, has the liver disease hepatitis C. "It's terminal and deadly unless you cure it," said Ms. Hobbs, who is being treated with an expensive drug, a form of alpha interferon. "I've already been tested," she said. The hepatitis was not detectable. "They are hoping that I've beat it." 

Last year, Schneider contributed $750 to Ms. Hobbs's health reimbursement account. She paid $1,500 more herself. But beyond that, her insurance covered 100 percent of weekly injections and six pills a day, whose total cost exceeded $50,000 - more than her annual income. 

For Schneider, the first year was "pretty challenging," a spokeswoman, Janet Bonkowski, said. "There was a lot of learning that goes on. Our associates had to become much more involved and active in their care." But Schneider saved money and intends to continue the program, she said, though it is also considering whether to offer the savings plans.

At the White House, the deputy press secretary, Trent Duffy, said the president had no preference between the older health reimbursement plans and the new savings accounts he has been promoting. 

But these days, Mr. Duffy said, people change jobs so frequently that they need a health plan they can take with them when they move. Mr. Bush, he said, believes "that the health care system that worked 30 or 40 years ago isn't working."