Small-business owners and self-employed entrepreneurs are concerned deeply about the adequacy of the current U.S. health insurance system and believe government should provide a public alternative to private coverage, a new survey says.

They also would like to see increased oversight of private insurers, and are willing to contribute to make the health-care system work if they believe the system design makes good financial sense, financial responsibility is spread fairly, and dollars go to provide needed care rather than third-party profits, the survey shows.

The findings were released recently in a report titled "Taking the Pulse of Main Street" published by the Main Street Alliance, a national network of small-business health-care organizations, including the Seattle-based Washington Small Business for Secure Health Care Coalition. The survey included responses from nearly 1,200 small-business people from Washington, Oregon, Idaho, Montana, and eight other states in the Midwest or eastern U.S.

When asked to choose between a reform proposal with a public insurance option and a proposal with expanded private market options, 59 percent of responding businesses in the 12 states selected a proposal with a public option, compared with 26 percent who selected more private market options.

"Small-business owners find themselves at a disadvantage because of the way our private health insurance markets function," the report says. "By virtue of their size, large businesses can better spread risk and administrative costs among a larger pool number of employees. They also use bargaining power to get lower rates."

Since small businesses have limited means for purchasing insurance and limited bargaining power, they are more likely to go without insurance and often receive less coverage in the plans they purchase, it says.

In Washington, 207 small businesses participated in the survey, most of them located in Eastern Washington cities such as Spokane, the Tri-Cities, and Walla Walla.

Among Washington respondents, only 27 percent offered coverage to their employees, and 34 percent had obtained coverage for themselves through their businesses. That was worse than in Idaho, where 29 percent offered coverage to their employees, and 49 percent had obtained coverage for themselves through their businesses.

Tonya Ray, a survey participant and owner of G U Look Great, a hair salon at 1415 N. Hamilton, says she's been without health insurance for a number of years due to the cost.

"It's just too expensive," she says. Ray recalls that when she fell off of a six-foot ladder and landed flat on her back two years ago, she couldn't afford a doctor's visit and had to "shake it off" and continue working to provide for her family, which includes her husband, Ron, and three children.

She believes the government needs to "step in" and offer health insurance alternatives for self-employed people like her, and the survey report says a majority of Washington's small-business owners agree with her.

Sixty-three percent of Washington respondents said the government should play a strong role in guaranteeing access to quality, affordable health care, while just 18 percent said access to such care should be left up to the free market. Fifty-four percent believed the government should provide a public alternative to private coverage, and 69 percent agreed that more public oversight of private insurers was needed.

Additionally, 67 percent of Washington respondents said they're willing to contribute financially to obtain quality health-care coverage for their employees, and 56 percent of self-employed entrepreneurs expressed interest in buying into a statewide or national health-care pool.

The top five health coverage priorities cited in the study by small-business owners in Washington were affordability of premiums, co-pays, and deductibles; coverage for all necessary medical services; the ability to keep insurance if employment changes; the choice of health insurance with varying coverages and costs; and the ability to choose their own doctor.

The report, available online at www.mainstreetalliance.org, concludes that the survey shows a clear need for health-care reform. It says small-business owners and their employees "will continue to be caught in a bind of paying unaffordable premiums and out-of-pocket costs, forgoing needed health care, and falling victim to mounting medical debt," unless changes are enacted.

The report lists five features that should be included in any health-care reform proposal. Those features are a commitment to shared responsibility between government, business, and workers; a guarantee that insurance will include coverage of necessary services; a focus on making sure insurance costs are affordable and predictable; a quality public health insurance option; and strong oversight of private health insurers.

"Small-business owners are willing to pay their fair share for quality coverage in a system of shared responsibility where government, business, and workers all contribute," the report says.