Few Americans rate their nation’s health care system very highly, according to a new survey.

The 2009 Health Confidence Survey by the Employee Benefits Research Institute finds 30% rate the nation’s health care system as fair, while 29% rate it as poor. EBRI, Washington, found only 6% rate it as excellent, while another 10% call it good.

Of those participating in the survey, 51% agreed with the statement, “There are some good things about our health care system, but major changes are needed.” And 14% think the health care system needs a major overhaul.

The 2009 Health Confidence Survey–the 12th HCS study conducted annually by EBRI–found that between 68% and 88% of Americans either strongly or somewhat support health reform ideas such as national health plans, a public plan option, guaranteed issue, expansion of Medicare and Medicaid, and employer and individual mandates.

As for a proposed tax-exclusion cap on health care benefits to help pay for reform, 47% would switch to a lower-cost plan if the tax exclusion were capped, and 38% would stay on their current plan and pay the additional taxes, while 9% didn’t know what they would do.

EBRI found 84% of those with employment-based health benefits are confident that employers would continue to offer such benefits. Only 45% were confident that they would be able to afford coverage on their own, even if employers gave them the money they currently spend on health benefits.

Among those reporting health cost increases, 32% said the higher costs have caused them to decrease contributions to a retirement plan. Moreover, 53% said they had cut back on other savings, while 29% have cut back on basic necessities and 37% have reduced other costs.

About 80% of those with higher out-of-pocket expenses for health care say these increased costs have led them to try to take better care of themselves and choose generic drugs more often, EBRI found.