A new Rasmussen Reports national telephone survey highlights both the opportunity and the challenge for those who want to reform the U.S. health care system. The survey found that just 31% of American voters rate the system as good or excellent. Twenty-eight percent (28%) say fair and 39% poor.

Even among those who have health insurance, just 32% say the system is good or excellent while 38% say poor (NOTE: 83% of those surveyed have health insurance). This supports survey data released last week showing that 62% believe major changes are needed in the nation’s health care system.

However, while unhappy with the situation overall, 72% of those with insurance rate their own coverage as good or excellent. Twenty-one percent (21%) say fair and only 6% say poor. Given these attitudes, the vast majority of voters will tend to be wary of any change unless they are completely assured that it will not impact their own insurance coverage.

Men are more optimistic than women when it comes to rating the overall health care system. However, the gender gap disappears when it comes to their own insurance—73% of men say their coverage is good or excellent along with 72% of women.

If given a choice between their current coverage and the opportunity to switch to a government administered program, 62% of voters would stay with their current insurance. Eighteen percent (18%) would switch while 20% are not sure. Seventy-eight percent (78%) of Republicans would keep their current insurance along with 49% of Democrats and 61% of those not affiliated with either major party.

Twenty-six percent (26%) of Democrats would switch to the government insurance program along with 8% of Republicans and 18% of unaffiliateds.

The biggest share of uninsured Americans can be found among adults under 30. Only 65% of this group say they are covered.

Interestingly, among those without health insurance, 23% rate the U.S. health care system as good or excellent. Twenty-five percent (25%) say fair and 48% rate the system as poor.

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