As federal officials try to pinpoint the number of uninsured Americans in preparation for debates about how to solve that problem, local business leaders complain bitterly about how fast health care costs are growing.

The nonpartisan Congressional Budget Office reported Monday that as few as 21 million Americans lack health insurance year-round, but as many as 59 million are uninsured at least briefly during a given year.

Regardless of the actual number of uninsured - short or long term - local business leaders suggest federal intervention may be needed.

"If a company is spending $200 a month for an employee for health care insurance, on a density of 200 square feet per employee, that is approaching the cost of Class C office space," said Nick Clark, partner in the real estate development firm of Clark & Clark. Class C refers to low-cost office space.

"It's amazing when you look back historically (at) how the cost of health care has been climbing, compared to occupancy cost," he said. "Given the growth rates that have taken place, there will be a point in time when health care costs exceed occupancy costs, and that is evidence of some type of dysfunction, in terms of what our nation is doing. There's something that's not working right."

Clark was among three local business executives to participate in a recent economic roundtable discussion with editors of The Commercial Appeal's business news department. Joining Clark were Calvin Anderson, vice president of Blue Cross Blue Shield of Tennessee, and Phil Trenary, president of Pinnacle Airlines, which does business as Northwest Airlink.

"We won't be able to get out of this box, whether it be health care or airlines, without the government playing a vital role," Trenary said. "But we have to be very careful how they help us."

The last concerted effort at controlling health care costs came during the early years of the Clinton administration, when then-first lady Hillary Rodham Clinton led a task force that proposed national health insurance.

The effort failed. The nation's strong economic performance during the period, in effect, outgrew the problem. As more jobs were added, more people received health insurance coverage.

But as Anderson pointed out, employment declined in the past year. And as jobs decline, workers and their families lose health coverage and either switch to Medicaid or stop seeking treatment, thus increasing public health risks and costs. Also, when those uninsured people do receive health care, the cost of that care is shifted to people with health insurance.

"There is no single silver bullet," Anderson said.

President Bush and several candidates who hope to succeed him have proposed methods to increase the percentage of people covered by health insurance.

Bush proposes a tax credit that would subsidize as much as 90 percent of health insurance for low- and middle-income people.

U.S. Rep. Dick Gephardt (D-Mo.) wants to repeal all of Bush's prior tax cuts and use the money to cover nearly all uninsured Americans.

Former Vermont Gov. Howard Dean proposes tax incentives to companies that provide coverage and tax credits for people who can't afford even reduced premiums.

U.S. Sen. John Kerry (D-Mass.) plans to offer his health care proposal on Thursday.

Clearly, the issue of rising health care costs will be a dominant theme in the 2004 election, as it is a grave concern for businesses nationwide.

"We have seen our costs increase exponentially every year," Jeff Presley, president of Custom Data Solutions, said in an E-mail.

Bob Palmer, president of the Data Guidance Group, said, also via E-mail, that his company has tried to keep coverage levels and costs down by bidding insurance every year.

"Lately, if we can reduce our health insurance cost increase to about 20 percent, we consider ourselves lucky."

In a recent survey of members of the Society of Entrepreneurs, here's how one person responded to a question about how they respond to such rate increases:

"First, we cry a lot! Then we assess whether we can feasibly increase the deductible to decrease the price. If not, we ask our agent to 'shop' our policy with other providers for comparisons. Then we cry again!"

Lifestyle choices, such as obesity, excessive drinking, tobacco use and insufficient exercise, add to higher health care costs, Anderson said.

"There could be some incentive put in place for those who do practice some sort of change in behavior," he said.

But the economic boom of the 1990s prompted companies to adopt plans with small co-payments for each service, Anderson said.

"The view on the part of the consumer is, 'What's all the fuss about?' " he said.

Anderson favors seeking some way to bring home to the consumer how much more health care is costing. Charging a percentage of a procedure's cost, vs. a standard co-payment, might accomplish this, he said.

"Technology becomes another (issue)," Anderson said. "We are wanting more and more and getting more and more. An X-ray that costs $70 is falling away to an MRI (magnetic resonance imaging procedure) that costs $700. . . . As you try to do something on the uninsured, you have to do something about costs."

- Mark Watson: 529-5874