Three-quarters of American adults want fundamental changes or complete rebuilding

of the nation’s health care system. Two-fifths of them report experiencing unsafe, wasteful or poorly coordinated health care. And half of middle-income and lower-income families face stress and trouble in paying for health care and insurance coverage.

These are among the findings of a national survey recently completed for the Commonwealth Fund Commission on a High Performance Health System.

While Maine’s blue ribbon commission prepares a report on how to expand and improve our Dirigo health plan, the Commonwealth Fund is tackling health care as an urgent national problem. Its telephone survey of more than 1,000 adults, conducted by the firm of Harris Interactive, revealed widespread concerns about the affordability of health care, access to quality care, and the safety and efficiency of care.

The survey disclosed that Americans are looking to the president and Congress to ensure that all Americans have adequate and reliable health insurance, to control the rising costs of medical care, to lower the cost of prescription drugs and to keep Medicare financially sound.

An accompanying report said flatly: “The U.S. is on the wrong track … Patients want a genuine system of health care – one where care is coordinated, no one falls through the cracks, and everyone is secure in the knowledge that the best of American med-icine will be there for them.”

The 18-member commission, comprising leaders from all parts of the health care system, is working toward a consensus on charting a fresh course. The chairman, James J. Mongan, M.D., has been an outspoken critic of Bush administration policies. He has assailed the proposed health savings accounts as a tax break for the rich and healthy and a “poison pill for the poor and sick,” who can ill afford to put money aside and would be pushed into cheaper but high-deductible insurance policies.

The fund president, Karen Davis, who spoke at a recent Picker Institute meeting in Camden, praised Dirigo -while noting its high overhead – emphasizing fundamental change in the national system. She warns that a Canadian-style single-payer plan would be too disruptive and too much of a departure from the current system.

The commission’s executive director, Dr. Stephen Schoenbaum, says the 18 members have not been polled on their views. He predicts that the study will end up advocating major change but a public-private system rather than an all-tax supported system. He cites broad opposition to an all-tax plan and the failure of the Clinton health plan.

Whatever their specific formula, we can hope that they will propose a system that will be as good as those of Australia, Canada, Germany, New Zealand and Great Britain. All

of them, says the fund, far outrank the U.S. system in patient safety, “patient centeredness,” efficiency and equity – and at half our per-capita cost.