Sick About Health Care

Others say businesses are just too cautious to make the jump into politics.

"There is a lot of interest among large employers to better understand the implications of these political solutions to the health care morass," said Peter Lee, chief executive, Pacific Business Group on Health, which represents West Coast companies. "But there's also concern that we don't have a clear policy answer out there."

Darling said part of the problem is that neither Bush nor Kerry is emphasizing policy options that business groups believe will hold down costs -- for them and the taxpayer. For instance, the federal government, as the largest consumer of health care, could mandate that it will no longer purchase services from hospitals, doctors and other providers that do not immediately adopt uniform, efficient technologies, such as online medical records and billing.

"And don't take the argument that they don't have the money to comply," she added. "They're building new hospitals, buying expensive new equipment. That's just an excuse."

Similarly, the government should purchase health care only from providers that track and publish information on health care quality, such as the rate of infections acquired in the hospital or the number of unanticipated complications a doctor confronts.

The National Institutes of Health could develop a set of reasonably priced medical insurance packages, complete with a list of tests proven to be cost-effective and reasons for hospitalization, that businesses and insurers could adopt nationally.

"It's hard to get on board with something that you don't think is a solution," Darling said. "That goes for everybody's plan so far."

Labor unions have a different explanation for business's political skittishness: Employers already have a solution, foisting rising costs on employees. Just this week, SBC Corp. employees went on strike over efforts by management to increase employees' medical co-payments, while Microsoft Corp. cut back its prescription drug benefit. A nearly-five-month supermarket strike in California last fall and winter centered on health insurance costs.

"The reason they are not seeking a legislative solution is that most workers don't have the protection of a union, so most employers have been successful at shifting the cost," said Richard Bank, director of the Center for Collective Bargaining at the AFL-CIO. "They don't see a need for a long-range remedy at this point."

Indeed, a new trend has developed called "consumer-directed health care," in which employees are given large deductibles, or even a limited pot of money each year, and encouraged to shop for the best health care deal they can find. A recent survey by the consulting firm Watson Wyatt Worldwide found that enrollment in such plans will grow from 169,000 in 2003 to 478,000 this year.

Companies "are getting employees prepared should they cut the cord" in the future and drop health coverage, said Ted Chien, global director of group and health care consulting at the firm. "If costs don't abate, the likely possibility is that employers will just want to get out of the business."