Public's Health Care Preferences Elusive

WASHINGTON -- It's not easy figuring out exactly what voters want when it comes to health care.

A Gallup poll released early this fall offered a dozen separate ways to expand health insurance coverage. Each suggestion garnered majority support, including tax breaks for small businesses, 94 percent; requiring large companies to offer health coverage or pay into a pool, 81 percent; and federal subsidies for the poor, 76 percent.

The implication was clear: The public wants change.

But two weeks ago, Gallup released another poll. It showed most Americans are satisfied with their health coverage and with how much they pay for health care.

So what gives?

The polls demonstrate the long-standing conflict that has dogged every proposed overhaul of the health care system dating back to Harry Truman. Americans support the principle of extending coverage to millions of people, but only so long as they are not negatively affected by the potential trade-offs, namely higher costs or reduced access.

And that's the dilemma for the presidential candidates.

Expanding health insurance to the 47 million uninsured is projected to cost more than $100 billion annually. The candidates have to find a way to pay for that expense. But it could be a political death knell to suggest that the average voter pay for it.

Democratic presidential candidates have found one way to finesse it.

Former Sen. John Edwards would raise taxes for those households with incomes exceeding $200,000 a year. Sens. Hillary Clinton and Barack Obama would raise taxes for households with incomes exceeding $250,000 a year.

The median household income in the United States is $48,200, so the vast majority of voters would be spared.

"If you're in politics you can't go $1 below $200,000 on the income tax or you really start losing people," said Robert Blendon, professor of health policy and political analysis at Harvard University.