Enough with the political commentary on Frank Luntz. Let's talk substance. In his memo, Luntz boils down his advice to using what he calls "words that work":

If you can’t get the treatment you need, when you need it, there is a crisis.  

If you are denied the ability to choose the doctor or hospital that’s best for you, then it is a crisis.

If you can’t afford the coverage you need for you and your family, then you have a crisis.

We need to stop looking at it from a global perspective and restore the humanity to healthcare.  We need to focus more on people and less on the system.   

Hey, that's good advice. I happen to agree with those sentiments. But are they arguments against the sort of health reforms Obama and his (mostly) Democratic allies want? Or for?

Let's look more closely at two of those statements.

If you can’t get the treatment you need, when you need it, there is a crisis.  

If you can’t afford the coverage you need for you and your family, then you have a crisis.

As you know, around 47 million Americans have no health insurance. Many more have insurance but find it doesn't provide the coverage they need. As a result, many Americans can't get coverage when they need it because they can't afford it. How many exactly? Around a third of all Americans, according to this survey from the Kaiser Family Foundation:


Now, Luntz and the Republicans channeling his advice would have you believe that reform will only make this problem worse. The proof, they'll say, is in the access problems you find in other countries. But access to medical care in those countries isn't more difficult! If anything, it's easier.

Start with the obvious: In countries with universal coverage, cost rarely creates the barriers to care that it does here. You can see this in recent survey questions by the Commonwealth Fund (which, full disclosure, has financed some of my own research abroad):


Luntz and the Republcians would have you believe that universal coverage systems reduce cost barriers only by rationing care; in other words, they make it affordable but making it less available. But that's not true, either.

In a 2008 Commonwealth Fund survey of adults with chronic illness, just 26 percent of U.S. respondents said they could get a same-day appointment--tied for lowest among the countries surveyed. (Canada was the other.) Twenty-three percent said they had to wait at least six days, or never got an appointment at all--which was better than in Canada and Germany but worse than in Australia, France, the Netherlands, New Zealand, and the United Kingdom.  


Having spent some time in some of these countries recently, I can tell you this isn't a statistical anomaly. The Dutch, for example, have set up a nationwide after-hours coverage system. If you get sick in the middle of the night, you just pick up the phone and dial your local urgent care center. If you can't take care of your problem over the phone, you can go to the care center or, if you're unable, the doctor will come to you. In other words, you'll get a house call. (If it's a more seroius emergency, obviously, you can go still to the real ER--or have an ambulance take you there.)

The same survey does suggest that specialty care is more immediately available in the U.S..


On the other hand, this is a slight shift from previous surveys, when Germans actually got more immediate specialist care than the U.S.--which suggests, at the very least, that immediate specialist care is hardly incompatible with a reformed system that makes coverage universal. 

More important, it's far from clear that this is a good thing overall--or that, even if if were, it would more than outweigh the difficult access Americans have getting primary and urgent care. But more on that later. 

--Jonathan Cohn