Introduction

It’s difficult to write or think about the 2020 election as something that happened, an event at a fixed point in time. From where we are now, it feels like that election started very long ago and will continue very long into the future. What that means for healthcare may not be immediately clear, given how little attention the non-COVID-19 parts of the industry were given in the election discourse.

What does our political culture mean for healthcare going forward, as the pandemic eventually recedes and the politics remain? We look ahead through two lenses: One, the government’s work and the policy conversations that will have a direct impact on how health systems function and are perceived (The Politics). Two, the national climate and increasingly toxic culture we’ve created – and its impact on how institutions and leaders can exert influence (the politics).

Context

While healthcare delivery was notably absent from much of the fall’s presidential election conversation, it was extremely prominent in the Democratic Party’s nominating contest, back in the faraway Pre-COVID Age. It would not be an exaggeration to say that healthcare was the principal divide between the insurgents – Bernie Sanders, Medicare For All – and the institutionalists – Joe Biden, a public option someday maybe – that defined that primary.

So ignore the insurgents at your peril. They’ve already moved the playing field considerably since the ACA was passed in 2010. While the pandemic and its effects mean Biden won’t be expected to deliver on a public option right away, it’s become a broadly popular position after very recently being considered far too toxic to include in the ACA. We’ve seen over the intervening decade that while healthcare is a defining issue for the Democratic Party, it’s not a space where the Republicans really want to focus their energy or policy.

In that context, proposed solutions will continue to come largely from the left as the Democrats define the terms of the debate.

Lessons Learned

Trust counts

There’s no shortage of issues – from price transparency and CURES Act to ACA rule changes and hospital consolidation – that are directly tied to the political environment right now. While trust in hospitals and health systems is high at the moment (trust in hospitals sits at 83 percent today), it will only take a couple of missteps to compromise the public goodwill that’s been built over the last year and reduce your organization to just another institution in an anti-institutional age.

Reasonable transparency pays

And while many healthcare organizations get dragged along with these compliance issues kicking and screaming, there’s an opportunity for systems that are willing to go beyond compliance and then educate the public about how their healthcare is delivered and paid for. Take price transparency. Yes, it’s a considerably more complex issue than people give it credit for. But, it’s also pretty easy to understand why not being able to answer to “What does it cost?” is an increasingly untenable position. Rather than checking the box for compliance with the federal government, now is the time to invest in building greater transparency and accessibility for patients. This is the sort of issue that only trends one way, so you may as well get out in front of it.

Be visible and in front of the story

While never an easy job, it’s fair to say that leading a health system used to be a little easier. You could take for granted your institution’s exalted public standing, speak with authority on any number of health and business issues and go about your work. Now we have a culture where institutions are viewed along a range of distrusted to hated, and simple facts have become increasingly difficult to communicate.

It’s a new culture, and we need to find new ways to communicate and adapt. Once we return to settings where people can move freely amongst one another, visibility from leaders is going to be an essential piece of the puzzle. People are increasingly distrustful of communications from faceless entities or brands, so we need to return to more retail politics within our organizations and communities.

We also should recognize that trust in our people – in the doctors and nurses delivering care – will have a much longer shelf life than the trust in our institutions. Partnering effectively with these internal groups and utilizing them as effective ambassadors for our ideas and vision will be a key component to maintaining our stature in the community.

You can’t sit this one out

One element of the permanent election that has a direct impact on healthcare leaders is that sitting out political issues – and they’re all political issues – is no longer an option. We saw any number of leaders stumble through trying to remain apolitical while addressing a range of intensely political issues. While this has been coming over the last several years, the pandemic brought the culture wars to the hospital’s front door.

This is an era that will require a new approach to leadership and a flexibility of mind and style that’s able to remind people of our commitment to a core mission of humans caring for humans and driving our efforts through that perspective. All politics is local, after all.