Thirty-five percent (35%) of Americans rate the nation’s health care system as good or excellent. The latest Rasmussen Reports national telephone survey finds that 34% of the nation’s adults say the health care system is fair and 30% rate it as poor.

While those ratings provide plenty of room for improvement, the biggest challenge to health care refom is the fact that 70% of those with health insurance rate their own coverage as good or excellent.

Those findings—poor reviews for the U.S. health care system combined with positive reviews for personal coverage—have remained fairly stable for several years. Last summer, 29% of Likely Voters gave the U.S. health care system good or excellent marks. Surveys have repeatedly found strong opposition to any plan that would require people to give up their current health insurance.

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Adding to the challenge for reformers is the belief that government health care reform will drive the cost of health care up, not down. The Obama Administration believes the opposite is true. Peter Orszag, Director of the Office of Management and Budget for President Obama, wrote in the Wall Street Journal that “health-care costs are the key to our fiscal future.” He suggests a four step reform leading to a “high-quality, lower-cost system.”

Still, the latest survey shows that 45% of Americans believe health care reform will increase the cost of coverage while just 19% believe it will reduce costs. Democrats are evenly divided as to whether reform will increase or reduce costs. Two-thirds of Republicans and a solid plurality of unaffiliateds expect higher costs from reform.

The issue is both very important and very challenging. Sixty-three percent (63%) agree with President Obama and support affordable health care for ‘Every Single American’. But, the nation is divided over a key component of reform being discussed on Capitol Hill—41% favor establishing a government health insurance company to compete with private health insurance companies while 44% are opposed. Forty-three percent (43%) say creation of a government insurance plan will lower the quality if health care.

Politically, Democrats across the country see health care reform as their top priority. However, Republicans and unaffiliated voters say that deficit reduction is more important. Half believe that the President should delay health care reform until the economy improves.

Thirty percent (30%) of voters want to go much further and overseen by the federal government. create a single-payer health insurance plan

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