Additionally, while broad numbers express concern about the impacts of reform, fewer go so far as to predict it will impact their care negatively: Thirty-one percent think that if the system is changed, their own health care will get worse.
A challenge for proponents of change is that this is nearly twice the number who think reform will improve their care, 16 percent. The rest, 50 percent, don't think it'll either help or hurt. Proponents, then, can say that a combined total of 66 percent think reform will make no difference to their care or improve it. Critics, though, can counter that this depends on what shape reform actually takes -- and on that there is broad concern.
MANDATES -- As can be expected with such a fraught issue, support for federal mandates depends to a large extent on the specifics. As noted, Americans divide evenly on a law requiring that all Americans have insurance. Support soars, however, to 70 percent if that law included aid to help low-income Americans pay for insurance, 68 percent if it required insurers to cover pre-existing conditions and 62 percent if it required employers to offer health insurance or pay into a government insurance fund.
However, support falls to 44 percent if such a system meant that working people who don't get insurance from their employer or on their own would have to pay into a government health fund -- another element of plans under discussion in Washington.
What's likely to be decisive in public attitudes is which of these elements makes it into a final plan, in what form -- and who wins the war of perceptions on the plan's impact on matters including quality, cost, coverage and choice in health care.
GOV'T ROLE -- The broader question of creating a government-supported health insurance alternative also produces divergent views, not least because of general skepticism about the role of government in society. Fifty-four percent of Americans say that overall they prefer smaller government with fewer services to larger government with more services, an attitude that weighs heavily in views on health care reform.
Given that sentiment about the role of government, support for a government-funded plan, as noted, dives from 62 percent to 37 percent if it would put many private plans out of business. And in another result, Americans who support a government-run alternative say by a 2-1 margin that it should be run by an independent organization with government funding and oversight, rather than by the federal government itself.
Interestingly, there's another area for reform that a majority supports, but where Obama himself has been unwilling to go. Fifty-seven percent of Americans say they'd support limiting medical malpractice awards; 53 percent say they'd support it even if it meant limiting the amount they themselves could collect in such cases.
POLITICS -- The push-and-pull nature of views on health reform are what make it so tricky politically, as well as the fact that negative arguments retain particular resonance. No wonder the president heads into this debate with a fairly tepid 53 percent approval rating for handling health care, including just 50 percent from independents, the indispensable political center. That's 15 points below approval among independents for his job performance overall.