It's hard to get much closer to the center of power on health-care reform than the U.S. Senate Finance Committee. It's currently drafting a bill that could reshape, for years to come, the way that every single American enters the world, stays healthy, receives medical care for the vulnerabilities of his or her body, and dies.

Senator Maria Cantwell landed a seat on this prestigious committee in 2006—making her the first representative from Washington State in 75 years to hold such a post (and only the second ever). You'd know this if you read Cantwell's press releases, because she bragged about her appointment to Finance at length at the time and promised that "this key committee assignment gives the Northwest a vital seat at the table." She vowed to use this opportunity to "fight" for health-care reform.

So what is Cantwell doing now that the Finance Committee is driving toward a compromise on health-care reform that alarms her constituents and, according to experts, won't be able to deliver real relief to a nation struggling under the weight of a broken health-care system?

She's going along with it.

Deferring to more-senior members of her committee—who are in a position to reward her in the future—Cantwell has been deliberately vague about exactly what type of health-care reform she supports. At the same time, she is talking up the committee's current proposal, which would try to fix what's wrong with American health care by creating a bunch of small health-care cooperatives around the country—the so-called "co-op compromise."

"Co-ops cannot drive down costs," said one furious Cantwell constituent, Jody Hall, owner of Seattle's Cupcake Royale and yet another employer who's desperate for better (and cheaper) health-care solutions to offer her employees. "There's no national bargaining power... they're going to basically be a nice gift to the insurance companies."

This is indeed what experts say about co-ops: nice idea, but not a big enough force to wade into the insurance market and compete against the big, established players to drive down costs. That's what the "public plan"—which Hall supports—aims to do: create a government-­backed insurance plan massive enough to do battle with Big Insurance on the brutal terrain of the free market. Most Americans support the idea, as does President Obama.

"It feels like Cantwell is afraid to step up and represent," Hall said. Which is an amazing statement coming from a person who is pretty much the likeliest of potential Cantwell supporters: a liberal, a female, an entrepreneur—just like Cantwell was before becoming a politician.

Molly Moon, owner of the popular Seattle ice-cream stores that bear her name, has the same frustration with Cantwell: "It's unfortunate that a woman coming out of the business world isn't really representing a lot of us progressive, female business owners on this issue," she said. In late May, Washington's other senator, Patty Murray, came to Moon's store on Capitol Hill to hold a press event and express support for the public option. Cantwell, on the other hand, "seems to not really be taking the lead," Moon said.

It's natural that small-business owners would be at the front of the fight for better health-care options. Nationwide, their employees account for about 40 percent of the U.S. workforce, and perhaps as many as half the uninsured people in America work at small businesses where the owner has looked at the numbers and decided that offering health benefits is just not affordable.

Hall is so fed up with the financial pinch that businesspeople like herself are feeling that she's willing to take the unusual step of throwing open her books in order to offer an object lesson. Since the first Cupcake Royale opened in Madrona in 2003, Hall's company has grown to include stores in Ballard, West Seattle, and (opening this month) Capitol Hill. After the new store opens, she'll be employing about 75 people. Her policy is that any employee who works more than 25 hours a week is eligible for coverage through Blue Cross Blue Shield. "Which I'm really proud of," she said.

Last year, Hall had revenue of several million dollars—but after operating expenses, her take-home profit was far less than that. "You've got payroll, rents, cost of materials, and then health insurance," she said. "Those are our four biggest line items. We will soon be paying in health insurance what we pay in rent for all of our locations."

In 2008, the overall tab for Cupcake Royale's health-insurance program, which covers 75 percent of its employees' medical expenses, came in at about $120,000. The cost is sure to go up again this year as Hall adds employees and as she shops for a dental plan to offer them, too. Two years ago, the cost of providing health insurance to her employees jumped by 40 percent. In a normal year, it climbs by at least 20 percent.

"I feel like I'm a hostage to private insurance," she said. "It's not sustainable for me to charge a 20 percent to 40 percent increase per year on my products. What is happening across the board is that small businesses are cutting their deductibles to get a better rate, or they're decreasing coverage, or they're dropping coverage altogether."

Hall, 42, didn't get into the cupcake business to become a health-care-reform advocate. But in April she traveled to the White House to tell one of President Obama's top health-care policy advisers that a public option is needed "so the big insurance companies don't have a corner on the market." She's testified before the Washington State Legislature. She's joined a local business group advocating reform. She's turned Cupcake Royale's blog into a platform for rallying the public on the issue.

She's considering stamping every cup of coffee she sells at Cupcake Royale with the phone number for Cantwell's office. She figures maybe that's the way to reach the senator, since it turns out that going to D.C. didn't accomplish much. The same day Hall was at the White House getting an audience with one of Obama's top aides, she also arranged to attend a meeting with Cantwell's staff to lobby them for real health-care reform. Cantwell sent a junior aide who wasn't a health-policy expert.

"She said that Cantwell understands the needs of small businesses," Hall recounted, still frustrated. "She basically made it sound like Cantwell supports a public option. But it turns out she hasn't."