Washington - Many Americans have been putting off doctors' visits, forgoing medical tests and taking expired medications to save money over the past year, according to a new poll by Consumers Union.

    The survey by the nonpartisan organization found that 51 percent of Americans have "faced difficult health care choices in the past year."

    Despite overwhelming concern about how to pay for health care, however, there's still no clear public or political consensus on how to overhaul the system.

    The Senate Finance Committee is expected to take a final vote on its plan later this week or early next week, with Democrats split over whether to create a government-run alternative to private health insurance or set up a system of co-ops, nonprofit member-run insurance companies.

    A McClatchy-Ipsos survey conducted last Thursday through Monday found that while 53 percent of Americans favored a public health-insurance plan "to make sure all Americans have access to quality health care," another 42 percent thought that sufficient changes could occur without a public plan.

    "People are really split," said Rebecca Sizelove, senior research manager at Ipsos Public Affairs.

    However, they're increasingly concerned about the state of their own health care. According to the Consumers Union poll, 28 percent have lost or endured cutbacks in coverage in the past year, and the trend has been widespread across income groups. Thirty-four percent of those with household incomes of less than $50,000 annually experienced those changes, but so did 21 percent of those with household incomes above $100,000.

    The Consumers Union survey of 1,002 adults from Sept. 17 to 20 found that among the ways people have tried to cut back on health care costs:

28 percent put off doctors' visits.

25 percent have been unable to afford medical bills or medication.

22 percent put off medical procedures.

20 percent declined medical tests.

20 percent skipped filling prescriptions.

15 percent took expired medication.

15 percent skipped scheduled dosages of prescriptions.

    The problems were more prevalent among households with incomes of less than $50,000, in which about two-thirds said they'd cut back on health care because of costs. Even where income topped $100,000, however, about one-third made similar decisions.

    The findings spurred Consumers Union to launch a television ad on a policy issue for the first time in its 73-year history.

    In the ad, Jim Guest, Consumers Union's president and chief executive, says: "Today, health care costs too much. Many Americans are one slip or major illness away from losing their coverage."

    How, or even whether, that concern will translate into specific legislation is another matter, though, and the McClatchy-Ipsos poll illustrates why.

    Asked their view of the most important problem the country faces today, 35 percent said the economy. Health care coverage lagged far behind, at 10 percent.

    "Though health care is dominating the news and what's going on in Congress, for most people the biggest concern is fear of losing their job and other economic issues," Sizelove said.

    To some extent, the two issues are intertwined, she added, because losing one's job often affects health care coverage, and salary and benefits cuts could affect health care decisions.

    The McClatchy-Ipsos poll found that consumers are still unsure about remedies, however. Forty percent said they favored the proposals being discussed in Congress, while 42 percent were opposed, a statistical tie.

    The latest McClatchy-Ipsos poll surveyed 1,296 people 18 and older and had a margin of error of 2.72 percentage points. For the Consumers Union poll, the margin of error is plus or minus 3.2 percentage points.