While voters are skeptical of the health care reform plan working its way through Congress, most believe that major changes are needed in the U.S. health care system.

The latest Rasmussen Reports national telephone survey finds that 54% of voters believe major changes are needed while 45% disagree.

Those figures include 14% who say the entire system needs to be scrapped and rebuilt. At the other extreme, four percent (4%) say no changes are needed while 41% say only minor changes are necessary.

Despite the majority's support for reforming the health care system, just 41% of voters favor the comprehensive plan proposed by President Obama and congressional Democrats, the lowest level of support yet measured. Fifty-six percent (56%) are opposed to the plan.

(Want a free daily e-mail update? If it's in the news, it's in our polls). Rasmussen Reports updates are also available on Twitter or Facebook.

Most women see a need for major changes in the health care system while most men do not. Those under 40 are more likely to support major change than their elders.

Sixty-one percent (61%) say it’s important for Congress to pass health care legislation this year, including 44% who say it’s Very Important.

However, by a two-to-one margin (59% to 30%), voters prefer passing a series of smaller reforms that address specific problems rather than a comprehensive overhaul of the health care system.

Government workers are fairly evenly divided on which approach is best. Entrepreneurs, private sector employees, retirees and those not in the work force all strongly prefer a series of smaller reforms.

Most liberal voters and the majority of Democrats prefer a comprehensive approach. Most ideological moderates and voters not affiliated with either major party favor passage of a series of smaller reforms. Republicans and conservatives overwhelmingly oppose a comprehensive effort. Full demographic crosstabs are available for Premium Members.

Forty-four percent (44%) of voters now rate the U.S. health care system as good or excellent. That’s down slightly from 48% in early August. In May, just 35% of adults nationwide rated the system as good or excellent. A year ago, only 29% of Likely Voters viewed the system in such positive terms. It is interesting to note that confidence in the system has improved as the debate over health care reform moved to center stage in the national dialogue.

Recent polling has shown that cost, not universal coverage, is the top concern about health care.

Please sign up for the Rasmussen Reports daily e-mail update (it’s free) or follow us on Twitter or Facebook. Let us keep you up to date with the latest public opinion news.

See survey questions and toplines. Crosstabs and are available to Premium Members.