Fixing health care really depends on the economy

Recently, I was back in the United Kingdom for a short trip home. It happened to be the week of the general election, and after a long campaign the country finally went to the polls on Thursday.

For those of you unfamiliar with U.K. politics, for the last five years there’s been a coalition government between David Cameron’s Conservatives and the Liberal Democrats (the first coalition government for 70 years). The main opposition, the Labour Party led by Ed Miliband (the same party previously led by Tony Blair), were battling to return back to power.

Most opinion polls for the last few months had the Conservatives and Labour neck and neck. The electoral math, however, appeared to favor the challengers. The Conservatives had campaigned on a message of continued economic stability and preserving the Union, painting the Labour Party as the reason why the country was in dire economic straits when they first came to power in 2010.

They also pressed home the message that in order to form the next government, the Labour Party would need to form an unholy alliance with the Scottish National Party — leading to unfair influence from Scotland into English affairs. The Labour Party, on the other hand, campaigned on a platform of fairness and equality, painting the Conservatives as a party who hurt the working classes with their austerity measures and favored only the rich. (Sound familiar in U.S. politics too?)

Before the election, nobody appeared to know which way the country would vote. I performed my civic duty and cast my vote at our local polling station in the afternoon. When the polls closed at 10 p.m., the first network predictions surprised everyone: The Conservatives would comfortably be the largest party. As the results started coming in, the trend was obvious, and there were considerable percentage swings away from Labour to the Conservatives. In the end, the Conservatives outperformed even their own wildest expectations, gaining a working majority in the House. By the following morning, David Cameron was on his way to meet the queen and declare that he would be able to form the next government. The three other main party leaders had all resigned.

So what happened? Pundits agree that a couple of main factors were at play. By far the most important, however, was that the U.K. economy had stabilized, and people generally felt like the current administration had been solid in this area. It had posted satisfactory growth rates, was adding jobs, and was generally seen as the envy of Europe. In the end, this trumped everything else. In fact, David Cameron became one of the few sitting prime ministers in history to increase both his vote share and win more seats.

Years ago, Bill Clinton’s campaign strategist James Carville coined the phrase “It’s the economy, stupid.” The saying has since gone down in political folklore, and the U.K. election perfectly illustrated the reasons why this statement is so true. Simply put, the economy trumps everything else. Outside of any unusual situation, such as a war, people’s economic security will decide how they are going to vote. It’s a simple fact of life. This holds true for everyone, whether you are on benefits or a multi-millionaire. In fact, I would go as far to say that a leader or party can be unpopular in almost every other way, but if they preside over a booming economy — their position is secure.

Let me draw a parallel with the situation that health care systems face (at a time when virtually every system across the world is facing challenges). When we debate health care and talk about new policies, budget constraints, and future philosophies — they all also ultimately boil down to one thing: How much health care can the economy afford? The National Health Service, a cornerstone of the U.K. and a huge political issue, featured relatively low on the agenda this time round compared to the economic debate.

In the United States, those of us in health care like to point fingers and take our sides, but the reality is that we are totally at the mercy of the economy. It’s pretty certain that the majority of our problems over the last few years are a direct result of the economy tanking in 2008. These include a general feeling of increased scrutiny, a heavy push towards value-based care (with “value” often appearing to be more important than the “care”), and health care consolidation. When the economy is doing well, things tend to take care of themselves. This may sound like a gross oversimplification, but if the monetary squeeze is present, the pressure piles on and filters through to all levels of medical professionals. We may want to assign blame to individual politicians, policymakers, and small systems for many of our daily frustrations in health care. But really, it’s the economy, stupid.

Suneel Dhand is an internal medicine physician and author of Thomas Jefferson: Lessons from a Secret Buddha and High Percentage Wellness Steps: Natural, Proven, Everyday Steps to Improve Your Health & Well-being. He blogs at his self-titled site, Suneel Dhand.

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