And now, back to Frank Luntz and his arguments about health care. (I could do this all day!)

Luntz suggests the Republicans focus on the sanctity of the doctor-patient relationship. I couldn't agree more.  So let's see how the U.S. system stacks on that metric--again, with the help of the Commonwealth Fund's surveys of patients in different countries.

One way to measure the sanctity of the doctor-patient relationship is whether you get to keep seeing the same doctor, year after year. That's particularly true for people with chronic disease. But relative to patients in other countries, Americans are less likely to keep seeing the same doctor:

In addition, Americans with chronic disease are less likely than counterparts abroad to even have a regular source of medical care:


All of this speaks to one of the inherent disadvantages of our health care system--one that, strangely enough, doesn't get nearly enough attention in the debate over health reform. American health care features a lot more "churning" than systems abroad: People are constantly changing insurers and, all too often, going in and out of coverage altogether.

This would be fine, even preferable, if the volatility were primarily a function of consumer preference--i.e., if people were changing insurers because they thought it would get them better care. But often people are switching because of changes beyond their control: Their employer switched plans, the plan to which they'd subscribed suddenly became a lot more unaffordable, or they lost access to insurance altogether.

Universal coverage systems tend to be a lot more stable. And that means the doctor-patient relationship tends to be a lot stronger.

--Jonathan Cohn