Americans want health reform. They want coverage expansion and insurance reform. As long as they can keep the health plan they have now, save money, and finance it all by taxing an upper income smoker. You know, like that guy on the Monopoly board.

They also want to fill the Medicare drug benefit doughnut hole, cover kids, and provide more care to our veterans. By taxing that same rich smoker.

 OK, we're exaggerating. The Kaiser Family Foundation did its traditional poll on the health care agenda for the new president and Congress. There was definitely some good news for those hoping for comprehensive health reform this year. A solid majority of Americans (61 percent) believe that during our economic meltdown "it is more important than ever to take on health reform now."

 But the poll also highlighted serious obstacles that reformers need to keep in mind. That includes deep partisanship and a huge amount of economic anxiety,  according to analysis offered at a Kaiser forum with three of our favorite health policy experts, Kaiser CEO Drew Altman, the foundation's public opinion research director Mollyann Brodie and Harvard professor Robert Blendon, who is an expert on health reform politics and public opinion. (webcast here, transcript in a few days)

 Blendon stressed — and we mean stressed, he said it forcefully and repeatedly — that it's hard to underestimate how worried people are about money in what he called a "near Depression." They are scared to death about paying their bills, and not just their health care bills. Raising their taxes to pay for health care isn't a solution for them (and, yes, they will notice if you start taxing their employer-sponsored health benefits). "Middle income people in something close to a Depression don't want to pay a lot of new taxes," he said.

 Altman believes that, obstacles notwithstanding, we do have a real shot at enacting health reform this year. As he wrote in a recent essay:

 Beginning this Spring, between expected approval of an economic stimulus package and the start of campaigning for the midterm election, there will be a rare window of opportunity for passage of major health reform legislation.  History suggests that momentum can be lost if policymakers do not move quickly to seize these rare openings when they occur. There is an opportunity now because the nation has a popular new president with political capital to burn who is making health reform a priority. Democratic leaders in control in the Congress want to deliver on health care. And a historic recession has transformed health care into a bread and butter economic issue of real salience to working people and the middle class, who are worried about paying their health care bills and about losing their jobs and their families' health coverage.

 But Altman has spent some time studying (not to mention living through) past health reform debates. The longer they last, the harder they fall. The public is fickle; ideas they embrace at the outset of an administration become tarnished if they hang out there long enough under attack by interest groups and opponents. Lots of things are different this time around. The public is engaged and truly does think of health care reform as an investment in economic recovery. The pro-reform groups are organized and have begun what Drew called the "rah-rah" phase. And President-elect Obama and his team are determined to learn from the mistakes of the past, particularly the 1993-94 failures. (See the charts with Altman's essay, linked above, on public opinion trends during the Truman and Clinton administrations)

 But ask just about any question about health care policy, or more specifically probe a little bit about the tradeoffs necessary for reform, and you'll quickly find partisan divides, Brodie said. Even on the relatively noncontroversial aspects of health policy, that schism looms. For instance, 62 percent of the Democrats but only 29 percent of the Republicans want more spending on SCHIP, the insurance program for children of the working poor. 

 (For those of you deep into this topic, the poll had a lot of detail on how the public views such things as comparative effectiveness, capping the tax exclusion, medical underwriting, and insurance profits) 

 Two final stray thoughts..First, the Kaiser poll found that 2 percent of those surveyed thought improving the country's economic situation is "not that important." Who are these people?

 Lastly Max Fine (I think that's how he spells it), who identified himself as the sole survivor of President Kennedy's task force on Medicare, was in the audience at Kaiser and he shared some really interesting lessons from the past. I'll pull out his comments and post them if there's a transcript available next week.