If there is one section of the working population most impacted by the nation's inefficient and expensive health care system, it is those that work at small businesses. Since 1999, premiums for employer-sponsored health insurance have more than doubled, rising to $12,680 annually for family coverage in 2008. For businesses with thin profit margins, it's been a struggle to keep up. According to the nonpartisan Kaiser Family Foundation, only 59 percent of companies with fewer than 200 employers offer health insurance to their workers, compared to 99 percent of larger firms. Of those that are covered, employees on average pay $3,354 out of their paychecks to cover their share of the cost, including big deductibles.

David Borris, the proprietor of Hell’s Kitchen Catering in north suburban Northbrook explained the toll health care costs are taking on his business during testimony in front of the House Committee on Ways and Means on Wednesday:

BORRIS: Beginning around 2002, though, we began to experience a series of annual premium increases that, taken together, now have us paying double per employee what we paid then. In 2004, it was a 21% increase; in 2005,10%; 2006, 16%; 2007, 17% and a change in carriers to avoid the quoted 26% increase. And in 2008, we were finally forced to ask long time employees to recontribute as the 17% increase was simply too much for us to absorb. I currently insure only 13 of my 25 full time employees – the other 12 cannot afford the 50% in the first year – and we could not afford to maintain our current structure if they all opted in. I spent almost 13% of my covered employees’ payroll on health insurance premiums last year ($79,494 / $625,448) – and have no idea what the annual renewal will look like when it comes due this November. Undoubtedly, we will be forced to increase employees’ contributions once again – an effective pay cut only further reducing their disposable income in an already critically contracted economy. This is no way to run a growing business.

Both Republicans and Democrats want to solve this problem, although they approach it in very different ways. Lawmakers like Rep. Mark Kirk -- a supposed champion of small businesses -- want to keep taxes low while maintaining the status quo. President Obama and congressional Democrats want to provide a public plan to offer consumers greater choice, increase the bargaining power of small businesses, and restrain the relentless growth in health care premiums. Republicans like Rep. Dave Camp (MI), who is playing a leading role in the House, have laid down the gauntlet, calling the public option "a bright line for us."

If Kirk and Camp were actually listening to the concerns of small business owners, they might change their tune. According to a survey by the New American Foundation, 53 percent of small businesses that currently pay for some portion of their workers' health insurance said they would support an approach requiring that at least one public plan and one private plan be offered to all employees. In nearby Ohio, over half also agreed that the government should play a bigger role in regulating the health care market. So does Borris, who added this strong endorsement of the public option at the end of his testimony:

BORRIS: As small businesses, we desperately need more choices – good choices – in health care.  We already have enough bad choices – high-deductible, low-benefit plans that are barely worth the paper they’re written on.  We need good choices.  That’s why I believe we should have a choice between private and public health insurance plans. Let us decide what works for us: keeping what we’ve got, or opting for something new. For businesses that don’t have good options now, offer the choice of a public health insurance plan. This will give us greater bargaining power and encourage competition among insurers to make costs affordable.

Leaving cost containment and quality improvements solely in the hands of the private health insurance industry – we’ve tried that and it’s failed.  As a small business, the success of my business is built on trust.  But the insurance industry has broken our trust.  And so for me, the solution is clear. We need a public plan that will reenergize true competition in the marketplace, set the bar for comprehensive benefits and cost controls, provide a backup if the private market doesn’t offer something that works for us, and push private insurers to reexamine their profit models.