Congress should be looking at easy ways to reduce health care costs as opposed to offering a public option.

Until recently, the fate of small businesses impacted by various congressional health reform plans was essentially ignored. But now that Congress and the president are discussing the need for small businesses to be covered by a health reform plan, they’ve ignored the key reality: the cost.

Unfortunately, the bill that House Speaker Nancy Pelosi got passed a week ago will tax even very small businesses at a rate of 8 percent if they cannot find affordable health care coverage. (Any small business with at least $750,000 of revenue will be forced to pay an amount equal to 8 percent of the wages of uncovered employees.)

According to liberal Sen. Ron Wyden (D-Ore.), who is leading the way on affordable health care, current proposals would require a family of four earning $66,000 to pay 19 percent of their income for health care, or almost $13,000 if they are not covered by an employer plan.

Recent Wall Street Journal-NBC polls have shown that a narrow majority of Americans favor a public option (48 percent in favor, 42 percent opposed). However good a public option may be, it is of no value to a small business if the estimated cost is, as Wyden predicts, $13,000 or more for a family of four.

Many businesses believe that if the question of a public option was presented more clearly, the American people would focus on cost reductions rather than on an expensive and highly partisan public option. That is, if the question was, “Do you favor a public option that will cost a family of four at least $13,000, even if their income is $66,000 or less?,” the response is likely to be overwhelmingly against the public option. In contrast, if the question was, “Should the government ensure that the cost of health care for a small business is no more than 5 percent of its payroll for any employee earning under $66,000?,” it is highly likely that there would be overwhelming support.

Change focus

Present health care costs have made the American health system the most expensive, and many contend, the most inefficient health care system in the world. Small businesses must therefore enter the dialogue with a different focus. Our focus should not be on the public option, given that it could cost as much as $13,000 for a family of four earning $66,000. Instead, we should focus on tough and effective measures to replicate health care efficiencies and cost reductions in developed nations where life expectancy exceeds that in the United States, for example, Switzerland, Canada and France.

As an organization that represents the types of small businesses that deeply believe in health care reform and believe that all employees should be covered at an affordable rate, we’d like to offer some suggestions to the president, House Speaker Pelosi and Senate Majority Leader Harry Reid. This comes as the Senate begins its contentious debate that could last into next year.

First, have the government directly bargain with the pharmaceutical industry to cut prescription drug costs in half by requiring prices similar to those in Canada, Great Britain and France. Presently, prescription drugs cost Americans $236 billion a year. If we cut this in half, we could save $120 billion a year or $1.2 trillion over the next 10 years.

Second, except for unusual situations and unique specialties, the taxpayers should not subsidize the extravagantly expensive and inefficient physician-led system of fee for -service. Instead, we should replicate the Kaiser Permanente model of well-paid doctors on a salary basis. This could easily save $150 billion or more a year.

Third, hospitals that claim non-profit status should be required to provide at least 20 percent of their care for the poor or risk losing their $13 billion in annual tax subsidies.

Fourth, given the relative shortage of doctors in the nation (less than 800,000, or far less than other developed countries) and the growing number of well-trained nurses (almost 2 million), federal legislation should require states, as a condition for receiving federal health funds, to empower well-trained nurses to provide a wide range of medical care now reserved exclusively for doctors. This could save $100 billion or more a year since nurses have accepted salaries that are one-fourth those of doctors, and in most cases, they are just as dedicated.

Fifth, the federal government should encourage and subsidize low-cost health care clinics for the 70 percent of Americans who live from paycheck to paycheck. This encouragement should not be limited to non-profits. Instead, it should be expanded to subsidize, for example, drugstore chains that are increasingly providing low-cost health care clinics. Besides the huge cost savings, we could save in a far more important way by reducing the spread of communicable diseases. Today, 12 million undocumented immigrants, who carry the same preventable communicable diseases as other Americans, are denied health care under pending health care reform legislation. In contrast, for-profit health care clinics that cater to those who live from paycheck to paycheck provide health care to the undocumented and are legally prohibited from discriminating against noncitizens.

If most of these reforms were enacted, the public option question that has created such a partisan divide would be unnecessary. More importantly, Republicans and Democrats could unite on a consensus plan that cuts health care costs to a level that even small businesses can afford. This could also help reduce our annual $1.4 trillion deficit.