Most Americans think there is something wrong about the state of U.S. health insurance, but they disagree on what to do about it.

A study released Tuesday by the National Opinion Research Center at the University of Chicago found that 80 percent believe the current system of employer-based coverage and government programs for the poor and elderly is problematic.

Most Americans support employers expanding health coverage (88 percent) or the government providing coverage to all (61 percent) — even though the two solutions are contradictory.

A majority also disagree that individuals should pay more for routine costs and leave insurance for more catastrophic expenses. Only 42 percent favor that approach, the study said.

"Americans have high standards on what they want in terms of access and quality, but they're generally not willing to pay more," said Marc Berk, a senior vice president at the National Opinion Research Center.

"There is little evidence of self-sacrifice," the center's Daniel Gaylin added.

The trade group representing insurers on Monday proposed to provide health insurance to all children within three years and 95 percent of adults within 10 years. Such a plan would cost about $300 billion over the next decade.

Rep. Nancy Pelosi, D-Calif., and likely the next House speaker, commended the trade group's efforts. She said she endorsed the aspects calling for expansion of Medicaid and the State Children's Health Insurance Program.

But Pelosi disagreed with the idea of letting people set aside more money tax-free for an account that would be used to pay insurance premiums.

"This nation needs a healthy debate on how we lower the number of uninsured, and I urge other stakeholders in the health care arena to come forward with proposals that address this urgent problem," Pelosi said.

The researchers' findings, which were detailed in the journal Health Affairs, confirm past opinion polls that show no clear consensus on how to finance health care improvements.

For example, 87 percent say everyone should pay the same for health insurance coverage regardless of health status or age.

But more detailed questions revealed that viewpoint was not so clear-cut.

Sixty percent believe that people who smoke should pay more for health insurance. Another 29 percent said the obese should pay more. Only 12 percent believe it's appropriate for people with family histories of heart disease or cancer to pay more.

Researchers said they asked the questions about smokers or obese people paying more because they wanted to see whether Americans really subscribed to the principle of insurance, which is sharing risk across the population, Berk said.

Currently, there are 46 million uninsured people in the United States. When asked whether Americans should be required to have basic health insurance, just as they're required to have car insurance if they drive, 52 percent believe it should be mandatory.

However, a major exception to that belief was among the uninsured. That suggests that many people don't believe it's in their best interest to purchase health insurance, Berk said.

The study, which involved interviews with 1,500 people, was conducted in July. The margin of error for questions was plus or minus 4 percentage points.