A sweeping change to the American health care industry, such as a wholesale move to a system based on defined contribution, is not favored by most people, according to a national survey that seems to reflect a conservative mood regarding medical coverage and a prescription drug benefit for the elderly.

Today's attitude reflects the change-it-slow mindset of the late 1980s much more than the stance of the early 1990s, when most wanted the system totally overhauled, according to the findings of the Kaiser Family Foundation, National Public Radio, and Harvard University's Kennedy School of Government.

That could take some of the fuel from any drive to create a defined-contribution system, as well as the push to offer all Medicare beneficiaries prescription drug coverage.

The findings result from a nationwide telephone survey of 1,200 adults conducted between March 28 and May 1.

"When asked which comes closest to their overall view of the American health care system, 20 percent said it works pretty well and only minor changes are necessary, 57 percent said there are some good things about it but major changes are needed, and 23 percent said that it has so much wrong with it that we need to completely rebuild it," according to the survey's authors.

"This parallels views seen in the late '80s more than those seen in 1992, when Americans called for completely rebuilding the system."

In addition, though 67 percent believe Medicare should be expanded to cover drug costs, respondents are divided on whether such a benefit should apply only to low-income elderly beneficiaries, and how much older Americans would have to pay from their own pockets.

"Americans disagree over whether a drug plan for the elderly should cover a large share of the cost for the lowest-income elderly (44 percent) or cover a smaller share at all income levels (46 percent)."

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