By JACK FARIS

The pain is real. It began as a small twinge, but now it’s almost unbearable. For small-business owners, this pain is located in the area of the lower back – approximately where their wallets are.

What’s the cause? A health-care system that is very sick and must undergo major surgery if it is to survive. It’s so sick that doctors are staging walkouts and work stoppages to protest spiraling malpractice insurance premiums. Recently, hundreds of physicians in New Jersey refused to go to work, following the example of their peers in West Virginia, Florida and Nevada.

Their diagnosis? It’s a cancer called excessive litigation that’s relentlessly devouring our health system. With each outrageous jury award, it spreads, driving medical costs higher and pushing insurance premiums off the charts.

This unprecedented wave of lawsuits forces doctors to practice defensive medicine. The U.S. Department of Health and Human Services reports that nearly 80 percent have ordered more tests than they normally would, just to protect them from liability exposure. Some three-fourths have referred patients to specialists more often than they believed was medically necessary.

It’s time to put this legal liability system under the knife. President Bush, in his recent State of the Union address, called on Congress to pass medical liability reform. No one, he said has ever been healed by a frivolous lawsuit.

This ailment has already sent some doctors into early retirement and made others flee their states in search of fairer legal systems and affordable malpractice coverage. But for small-business owners and their employees, there’s nowhere to run or hide. Today, more than half of all uninsured workers are self-employed or working in a small business.

According to a study just released by the Employee Benefit Research Institute, nearly one-fifth of small employers that provide health insurance changed their benefits last year. A majority of these, nearly two-thirds, increased employees’ co-payments or deductables. Others, 30 percent, raised employee premium percentages and nearly as many trimmed back their health offerings. More than one in three switched insurers.

The message I delivered to the U.S. Senate’s Small Business Committee on Feb. 5, offered one antidote for this illness: Congress can help small business survive by allowing them to band together through their trade or professional associations to purchase health insurance at discounted rates. Large corporations and labor unions already enjoy economies of scale because of their size, but this advantage has not been available to those who create most of our nation’s new jobs.

Association Health Plans would save small businesses 15 to 30 percent of their premium costs compared with the cost of purchasing coverage directly from an insurance company.

But the real cure for our ailing health system will come only when lawmakers have the courage to decide that patients with true medical needs, not trial lawyers in search of big financial awards, are the ones who deserve the benefits. Until then, let’s hope we have no need of medical attention. There may not be a doctor in the house.

JACK FARIS is president of the National Federation of Independent Business, the nation’s largest small-business advocacy group.