Controlling soaring health care costs is the biggest challenge facing Congress and the president as competing reform bills near final negotiation.

It's up to the U.S. Senate - including Wisconsin Sens. Russ Feingold and Herb Kohl - to get this done in a smart and cost-effective way.

Doing nothing is the most expensive option.

Yet ignoring or hiding costs, as the House seems willing to do, destroys public trust and bloats U.S. debt, making our nation less competitive.

A report last week by a major U.S. business group suggested America's current health care system will cost a staggering $28,500 per employee in just 10 years if left unchecked.

That's more than double today's cost.

The Business Roundtable report stressed the need to pay health providers for quality care and good results, rather than for the number of tests and procedures completed.

This change to health care incentives is a must. And to his credit, U.S. Rep. Ron Kind, D-La Crosse, pushed to include some of this language in the House bill.

The business report also stresses the need to improve prevention and give patients more incentives to live healthier lives.

That should be a no-brainer.

The report is more supportive of the Senate Finance Committee bill, which does a better job of controlling the price tag of reform.

Significantly, the Senate Finance bill doesn't include a "public option," which isn't needed to extend coverage to virtually all Americans or to force greater competition or to require that patients are treated fairly.

The House barely approved its bill on a 220-215 vote, suggesting it doesn't stand a chance in the Senate. The bill would cost $1.055 trillion over 10 years. And that doesn't include more than $200 billion needed to avoid huge cuts in Medicare payments to doctors.

The House bill accomplishes close to universal coverage and would subsidize insurance for those who can't afford or otherwise get it. The House bill would forbid denial of coverage based on pre-existing conditions.

Those provisions are solid.

Yet the House bill makes a lot of assumptions on saving money without strong cost-control mechanisms in place. Many businesses that offer health insurance to employees in the Madison area worry costs under the House bill could significantly outpace projections.

Moreover, many of the innovative pilot programs in the bill focus on Medicare, rather than integrating those reforms with the private sector. The House bill also fails to discourage "Cadillac" insurance plans that lead to overuse of medical care.

In summary, the House bill includes a lot of hope but not enough hard numbers.

The Senate has shown more fiscal discipline. Feingold and Kohl, for example, bucked Senate Majority Leader Harry Reid, D-Nev., in pushing with the GOP to properly account for the more than $200 billion needed to avoid a huge cut in Medicare payments to doctors.

The Senate needs to push harder for real savings, better incentives and assessments so private employers and their employees can afford quality health care far into the future.

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