It’s the health care, stupid

The headline is directly inspired by the famous Bill Clinton presidential campaign unofficial slogan in 1992: “It’s the economy, stupid.” The economic recession at that time had had its expected effect on voter behavior, opening the White House doors to Clinton, who was competing with George H.W. Bush. I will not specifically discuss the economy but the satisfaction of Turkey’s citizens from life in general and from public services in particular, with a special focus on health provision during the rule of the Justice and Development Party (AKP). A background motivation of this article might be the search for an answer to a much-debated question: How did half the Turkish electorate become supporters of the AKP?

The Turkish Statistics Institute (TurkStat) published last week the results of a Life Satisfaction Survey (LSS) for 2013. These surveys have been carried out since 2003 — the year the AKP came to power — and aim to measure the subjective perception of happiness of individuals, in central areas of life such as health, education, income, law and order, and so on. The LSS was carried out for the first time at the provincial level in 2013. TurkStat uses two basic concepts: “happiness” and “satisfaction.” “Happiness” is defined as: “The state of mind characterized by lack of pain, sorrow and suffering and feelings of joy, cheerfulness and satisfaction,” while “satisfaction” — from public services, for example — as “the feeling arising from needs and desires being met.”

More than half of survey respondents (59 percent) declare that they are happy. This has not changed much over time. In 2003, 60 percent were happy. That said, according to a recent OECD publication (Society at a Glance 2014), the Turkish public’s experience of happiness is not enviable. Turkey is placed 31st among 42 countries, with the OECD average of happiness being close to 70 percent. This is not surprising, since a high correlation between the degree of happiness and the per capita national income as well as the degree of societal freedom is quite apparent. Brazil, Russia, China and Saudi Arabia are at the bottom of the ranking while Switzerland, Norway, Sweden and Denmark are at the top.

What are the sources of happiness? Good health appears the most important factor by far, since 68 percent of individuals place it in first place. Only 15 percent indicate love, 8 percent success and 4 percent money as the first-placed value providing happiness. As people say, money does not make you happy, while “in this world a spell of health is the best state,” as Suleyman the Magnificent said in one of his poems.

Here we come to satisfaction with public services. I would like to consider three of them as the most important ones: health, education, and law and order. The largest increase of satisfaction occurred in health services. The share of satisfied people jumped from 39.5 percent to 74.7 percent from 2003 to 2013 whiles the share of people satisfied with education and law and order increased from 48.7 to 69.7 percent and from 45.7 to 52.8 percent, respectively. The improvement in public services, particularly in health services during the AKP’s decade-long rule, is indisputable. The distribution of satisfaction among provinces is not equal, as expected, but the inequality is not too dramatic. The highest scores of satisfaction are observed in Isparta and Usak provinces (in the Aegean hinterland) with 89.1 and 88.6 percent and the lowest in Hakkari and Sırnak provinces (in the Southeast) with 54.6 and 57.5 percent.

No doubt, the important increase in the level of satisfaction in public services played an important role in the rising electoral support of the AKP, at least until the June 2011 general elections, in which it obtained almost 50 percent, while its vote share in 2003 was about 35 percent. This improvement was possible thanks to the dramatic decrease in real interest rates that allowed the government to spend much less on public debt service and spend much more on public services. Moreover, it is worth noting that the improvement in public services is not included in the almost 50 percent increase in the real income of poor people during the last 10 years.

That said, let me finish by remarking that since 2010 the degree of satisfaction in health services has been stagnating. In other words, the impressive improvement took place in the first years of AKP rule and seems to have reached a limit in the recent past. It will be more difficult for the incumbent party to continue improving public services in the future since the interest rate windfall has also reached its limit and, from now on, more social spending will require more income tax receipts.