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Support for universal health insurance drops to 38 percent if it is suggested that the cost of health insurance would increase, and to 36 percent if taxes went up. And only 33 percent said the United States should guarantee health insurance for all its citizens, if the federal budget deficit would increase as a result. (See related article on overall results of the poll on health care.) Forty percent say it is not the federal government’s responsibility to provide health insurance for all Americans. Opposition to universal health insurance declines to 29 percent when respondents are reminded that about 46 million people would continue to be without health insurance.

Most Americans, 56 percent, are at least somewhat concerned that if the government doesn’t create a system of providing health insurance for everyone, that they will be without health coverage at some point in the future. But that’s down from 66 percent in July. Almost two-thirds of those who are anxious about their own future coverage say the federal government should guarantee health insurance for all. At the same time, close to 6 in 10 of those who have little concerns about their insurance prospects, do not support universal health insurance. In addition, Americans are evenly divided over whether or not the government is morally responsible to guarantee health insurance: 47 percent say the United States has the moral responsibility to promise health insurance to all Americans and 48 percent say it does not.

Kitzhaber's open discussion of rationing brings up questions about what individuals are willing to sacrifice to make sure the health care system as a whole is viable. Last year, this point propelled cancer patient Barbara Wagner into the headlines. She received a letter from the Oregon Health Plan denying her cancer treatment because it had less than a 5 percent chance of success. The same letter offered payment for the state's physician-assisted suicide program. The drugmaker eventually gave Wagner the medication for free, but she died a few months later. Despite difficult situations like Wagner's, Kitzhaber says Oregon is a good place to have this public conversation. "I do think Oregon has a history of innovation in medical care," he says. "And we've had discussions on how you prioritize — and limits and rationing — that most states haven't had."Kitzhaber predicts that within a few years, most people will realize the fix being crafted in Washington right now won't work. And policymakers will then look to states like Oregon as models to craft a national policy that will work.