MADISON – To say small business owners in Wisconsin are nervous about the outcome of the debate over health-care reform is like saying a football quarterback is jittery just before a 300-pound defensive end grinds him into the turf. Both know what’s coming – and both can only hope to get back on their feet once it’s over.

Representatives of small business have become persuaded that, no matter what version of the health-care bill is adopted by Congress, they will pay more to provide health care to employees. Those same small business owners believe neither the House nor the Senate bill address spiraling costs, the core problem from an employer perspective. They also believe Congress will ratchet up already burdensome costs in two main ways – through expensive new coverage requirements and by forcing the nation’s insured to pay more to cover the uninsured.

There’s no doubt the federal debate has been about reforming access to health care, rather than controlling costs. Most health-care reformers in Congress want to see the nation’s 46 million uninsured – more than 15 percent of the population – protected by a safety net. They contend it costs the United States billions of dollars in lost productivity, social woes, family bankruptcies and more for so many people to go without health insurance.

While access to health-care poses real problems, so does a system that consumes 17 percent of the Gross National Product and which forces employers to choose between hiring another worker or salting away money for the next double-digit increase in health-care premiums. 

A recent actuarial analysis by Wellpoint Inc., the parent company to Blue Cross & Blue Shield of Wisconsin, concluded the most likely compromise of the bills pending before the House and Senate would increase premiums by 17 percent for a small business with eight workers of average age and health status. That’s on top of increases already coming, with or without reform.

Skeptics might say such estimates are more insurance company “spin control,” but even discounting the self-interest of the insurers it’s safe to say Congress and the White House have thought far more about improving health-care access than controlling costs.

Here are some suggestions for addressing the cost side of the equation, and keeping more money in the hands of small businesses that create the bulk of the nation’s jobs.

n  Focus on wellness, disease prevention and ways to better manage chronic illnesses, such as diabetes and heart disease. Chronic illnesses account for 75 percent of U.S. health care costs.

n  Provide incentives to hospitals and clinics in crossover markets to collaborate where possible, rather than compete over every service. Cost increases in health care can be slowed when health-care organizations avoid service and facility duplication. Hospitals and clinics may make more money on specialists, but primary care keeps customer costs down because those medical professionals stress wellness, prevention and disease management.

n  Accelerate the movement toward digitizing medical records, which first gained federal support when former Wisconsin Gov. Tommy Thompson was secretary of Health and Human Services. President Obama is right about moving this idea ahead. Electronic health records will provide a long-term foundation for higher quality care while reducing errors and giving medical professionals better data. It’s a ready example of how technology can help patients.

n  Pass the Comparative Effectiveness Research Act of 2009. The basic idea behind “comparative effectiveness” is to create a national database to share information about how new or different therapies, treatments and diagnostics work for patients. Medical professionals would have near-instant access to that information.

n  Allow small businesses more, not less, leeway in buying coverage plans that fit their employees. Such plans might cover mostly catastrophic cases, preventative care and child medical care, with relatively high employee-paid deductibles for everything else.

Health care reform is inevitable because the current U.S. system has its flaws. In the rush to improve access, however, let’s not forget that rising costs will create a new and more serious crisis if small businesses stop creating jobs.

Still is president of the Wisconsin Technology Council. He is the former associate editor of the Wisconsin State Journal.