Most small business owners across the country agree especially on one thing when it comes to U.S. health care: the current system is broke. And the fix, they say, must take on a three-pronged approach.No. 1: Cost, cost and costWhile politicians, pundits, insurers and doctors clog the air and Web waves with their “answers” to the health-care debate – what say the small business owners? What are their top concerns? For many, the answer is “cost, cost and cost” – no matter what part of the country they’re in.On average, small businesses see their insurance premiums skyrocket 15% each year, meanwhile they pay 18% more than big businesses do for the same insurance plans. Many that would like to offer health coverage simply can’t afford it, while some that do, in return, pay lower wages. Others offer it only to upper management, because of cost.“I know a lot of people who are ashamed, really, that they can’t provide it. They feel it’s something that’s their duty to do,” said Jennifer Barbee, CEO of the Texas-based Jennifer Barbee Internet consulting firm.There’s a lot to find fault with in the current system, the nation’s entrepreneurs argue. Many worry that if Congress fails to address their concerns in the expected system overhaul, they won’t be able to afford insurance at all, and some may be driven out of business altogether.“The real issue for small business is that the status quo is absolutely unsustainable,” explained Small Business Majority CEO John Arensmeyer. “More and more small businesses are having to drop … or cut back [health] coverage,” and costs are impeding their ability to grow.“The situation, due to exploding costs and in some cases, inability to get insurance based on preexisting conditions … is just unacceptable,” Arensmeyer said.No. 2: ChoicesBesides cost, the quality and accessibility of coverage– which includes ensuring even people with preexisting conditions - rank up there in terms of small business owners’ top concerns.Liz Parker and husband Steve run a family business, the Tulsa Rib Company, in Orange, Calif. Many managers and kitchen staffers have been there for at least 25 years. Always working to “take care” of their workers, they said they now pay almost $100,000 a year to insure 15 full-timers and their families. And in the last 10 years, they complain, they’ve experienced a dramatic increase in premiums and drop in quality.“We hate that we have to make the choice for them – and it comes down to dollars and cents,” said Liz Parker. “We have to run the risk of providing such horrible health care … we offer them a worse product where they have less choices, where they have to pay more out of pocket than they did 10 years ago.”“My job is to provide the best ribs in Orange County,” she added. “[The government’s] job is to provide us and small business with options.”Philadelphia Trolley Car Diner owner Ken Weinstein agrees that cost is the No. 1 concern, with accessibility and quality of coverage following close behind. He said five to 10 of his 60 employees have only catastrophic coverage that won’t cover preventative care, so some end up taking health risks. Universal health care would alleviate many of those problems, he argued.“It’s frustrating [when] employees don’t show for work because they’ve been avoiding taking care of health-care concerns because they can’t afford it,” Weinstein said. “If all of our employees have good health care coverage, they’ll be able to come to work more often [and] won’t end up behind the 8-ball in terms of paying their bills. They’ll be better employees and better people.”Lee Robinson, who owns Allen & Palmer True Value hardware store in Northville, NY, provides health insurance and health savings account plans for his 15 employees. His advice for Congress is to require a co-pay for all government-funded health care. He argued that as little as a $10-per-visit fee could cut down on the number of unnecessary doctor/emergency-room visits and resulting excessive costs to taxpayers. He also said employees should be responsible for seeking out their own health coverage.“Do not require business owners to offer health insurance as that would put many out of business, and do not make us pay the increased taxes that would be the result of a government health-care plan,” he said.For Barbee, who is trying to grow her two-year-old Internet-marketing startup that has a staff of 10, passing health-care reform so that it’s more affordable for small business is vital to her expansion. She said she also wants to ensure maternity care is available for those who need it.“I’m definitely concerned about cost. I’m adding more and more people. As we grow, there’s a tipping point of affordability,” Barbee said.She offers health insurance to any employee there more than 90 days. She said it took her company two years to find a plan, and they changed providers twice. “It was a mess,” she said. But at a cost of $300 a month per employee, times 10 employees, that’s $3,000 a month going just to employees’ insurance.”Barbee said she is all for a public option, as long as it makes coverage affordable to everyone. And if it’s anything like the military version of health care she enjoyed for two years – even better, she said. Ten years ago, while she was covered under her husband’s military plan, she paid $23 to have her baby, versus the $10,000 she later paid in the private system to have her second child.“Everything was really taken care of … it was very different from your private system,” Barbee said.No. 3: CompetitionThe inability to negotiate for competitive policy rates is another disadvantage facing small business.This is where the proposed exchange – or marketplace that would offer a more-thorough choice between competitive options -- could be a huge help to small business, according to Josh Bivens, an economist with the Economic Policy Institute. He said it could be particularly big for those in more rural areas, giving them direct access to the densely populated insurance market.“I think the problem that they can’t drive a good bargain is a national problem,” Bivens said. “If we had a system like exchanges that worked well, it would be irrelevant whether small business provided it directly or employees got it through an exchange because an exchange provides to both – now we have an uneven playing field, some businesses do provide, some don’t.”Bivens said exchanges could potentially lead to a small business boom.“I really do think [exchanges would bring] a big unleashing of more small businesses, more entrepreneurs, and I think that will be a big help to the economy,” he said.