Susan Bennett, a retired high school English teacher from Mesquite, Nev., thinks the health care system needs to be fixed. Just consider her brother-in-law, diagnosed with cancer only to find that his insurance coverage won't pay for the $3,000-to-$4,000-a-month drug his doctor has prescribed.
"On the other hand," she worries, "I'd hate to have my insurance (costs) go up."
That's the dilemma for President Obama as he tries to push a health care bill through the House and Senate over the next month or two. In a USA TODAY/Gallup Poll taken Friday through Sunday, nearly everyone agrees the system has problems — just 2% say it doesn't — but there is considerable anxiety about the impact that legislation to change it would have.
Sara David, 26, of Lawrenceville, Ga., opposes Obama's proposal. "I am concerned that the quality of health care will go down," she says.
Americans are almost evenly divided, 50%-47%, over whether they would urge their representative in Congress to vote for or against a bill, and the views of those against it are more firmly held than those who are for it.
Obama's address to Congress last week "wasn't the huge game-changer some had hoped or thought," says Charles Franklin, a political scientist at the University of Wisconsin who studies public opinion.
If a bill passes this year, 40% predict it will improve health care coverage, but 37% say it will make things worse. When it comes to the overall costs and quality of health care, Americans are inclined to say the legislation will cause more harm than good.
Support for a bill plummets to 26% if expanding coverage means higher taxes for the middle class, and to 20% if middle-class Americans will have to pay more for health care than they do now.
Whatever the strains on health care, the findings also reflect Obama's considerable popularity.
By 3-1, those surveyed say he is "willing to make hard decisions." By 2-1, he is seen as a strong and decisive leader. Two-thirds say that he can get things done and that he understands the problems Americans face in their daily lives. A majority rate him as someone who can manage the government effectively and shares their values.
By 53%-45%, those polled say Obama can fix the major problems facing the country.
"He is trying, and I think that's what we need," says Eva Nauman, 58, a warehouse worker in Lebanon, Pa., who was among those surveyed. "Now, whether he's going to succeed or not, I don't know, but at least he's trying to help the little guy."
The survey of 1,030 adults has a margin of error of +/— 4 percentage points.
The health care debate reflects the nation's sharp partisan divide: 83% of Democrats support passing a health care bill; 84% of Republicans oppose it.
The president's popularity hasn't prevented a slide in his standing on individual issues. For the first time, a majority disapprove of the way he's handling the economy. His approval rating on the situation in Afghanistan has fallen seven percentage points, to 49%, since July. Nearly six in 10 disapprove of his handling of the federal budget deficit.
In response to another question, 60% say Obama's proposals to address the country's biggest problems call for too much government spending, and 51% say he's called for too much expansion of government power.
In response to an open-ended question, the top reason cited by those who oppose a health care bill was concern about big government. The cost of a bill was also high on the list.
"I think everyone should be entitled to insurance, but I am so concerned about this deficit," says Nina Giacobbe, 51, a stay-at-home mom in the Chicago suburb of Homer Glen. "We are trillions of dollars in debt now, and I just can't see it. Where is it coming from?"
Among those who support a health care bill, more than a third say the main reason is the need to cover the uninsured.
When President Clinton delivered an address to Congress on health care in 1993, his approval rating jumped 10 points in the USA TODAY/Gallup Poll, though that gain largely dissipated within three weeks.
Obama saw no change in his 54% approval rating.
"This was not the home run predicted from the Clinton experience," says Robert Blendon, a professor of health policy and political analysis at Harvard. The public's continued concerns "will make it harder to sway members of Congress on the fence about voting for the current bill."
Other issues down the line also could be affected, he says.
"If he takes a bad beating on this, it's very hard for him to get momentum on issues that don't have the same levels of support for major change," such as energy and immigration. On the other hand, "if he came out of health care and did something really significant that people felt good about, it would give momentum for some of the other issues that will be controversial."
Even a victory may have to be followed by a "pause" in White House ambitions, says William Galston, a domestic policy aide in the Clinton White House, given "the amount of political capital expended and the amount of administration energy expended."
That suits Adam Davis, 32, a software engineer from Turnersville, N.J., who was called in the survey. "No doubt things need to change," he says, "but for me personally it's too much, too fast."