From Burger King to the Back Street Boys, Americans expect to have it their way. Given the choice, we'll have our cake and eat it too. So when you poll Americans on health care reform, the results can require a careful reading.

In a New York Times/CBS News poll released this past weekend, 72 percent of respondents favored the creation of a public health insurance plan to compete with private insurers. A Wall Street Journal/NBC News poll found that 76 percent of those surveyed believed the choice between public and private plans was either extremely or quite important.

Half of the respondents to the Times poll believed the government would do a better job than private insurance companies of providing medical coverage. Close to 60 percent believed the government would do a better job of holding down costs.

Yet at the same time, respondents expressed concerns that growing government involvement in health care could limit their choice of doctor and access to treatments, while potentially lowering the quality of care.

More broadly, 85 percent of respondents said the health care system needed to be fundamentally changed or completely rebuilt. Yet, 77 percent said they were very or somewhat satisfied with the quality of their own  health care. A majority of those surveyed believed unnecessary medical tests and treatments were a problem, but an even greater majority (87 percent) felt that that inability of people to have the needed tests and treatments was a serious problem.

The paradoxes of public opinion reflect the complexity of health reform. As the Times notes, such conflicting opinions create significant challenge for President Obama and congressional allies "as they try to address the health system's substantial problems without igniting fears that people could lose what they like." But they also reflect an opportunity for lawmakers to shape the debate and define health reform in terms of the public interest.

A recent policy paper from RWJF looks at specific proposals for delivery system reform such as primary care, prevention, and health information systems. In general, the public views such concepts positively, but the support for specific proposals can very greatly—particularly on issues affecting patient choice. Comparative effectiveness research is a classic example and the authors would argue: "The root question, in terms of public opinion, is how can policymakers craft reforms, and then explain them to the public, in ways that convince enough people that the reforms are in their best interests?"

At the same time we hammer home the costs of doing nothing, reformers must make clear the benefits of reform. For example, Health CEOs for Health Reform, has been at the forefront of showing what's possible by highlighting the examples of high-value care already in practice. To see how such examples could be applied to the whole system, check out the recommendations in HC4HR's latest white paper.