Does the British election hold lessons for the United States about what is on voters’ minds? Absolutely. But one of the main concerns may surprise you. It is not immigration or social issues - or even Brexit. It is health care.

Nothing scares the British more than the possibility of losing their cherished National Health Service, known for short as the NHS. It guarantees health care for everyone and inspires devotion that has been likened to a kind of religion. Scarier yet for the British is the prospect of moving toward American-style health care, with more of the system in private hands.

In the final days of the election campaign, those concerns took center stage. While Brexit got most of the attention in the United States, the candidates were increasingly focused on voters’ anxiety over the future of their health care.

England created the NHS just over 70 years ago as part of the country’s rebuilding after World War II. Like reforms throughout Europe, the NHS guaranteed access to health care for all citizens. However, unlike its European neighbors, the British government did not simply promise to cover the cost. The NHS provides services directly through government-owned hospitals and employed physicians.

Many Americans look at the NHS and see socialized medicine with waiting lists for some procedures and rationing of others. Many British look back at the United States and see a system that leaves large numbers of people uninsured, even under the ACA. They also see private coverage with high deductibles and narrow networks of providers and surprise medical bills that can reach thousands of dollars. And they see a clear culprit – a large private, profit-driven health care sector.

The Labour Party, traditional champion of the NHS, played on those fears, charging that Conservative Prime Minister Boris Johnson planned to sell off the NHS, if re-elected. Party leader Jeremy Corbin released what he claimed were leaked documents describing the plan.

With health care threatening to become a liability for conservatives, Johnson vigorously denied the existence of such a plan and declared that the NHS is “not up to for sale or negotiation.” To demonstrate the depth of his commitment, he parried back with a promise of substantial new NHS funding. That seemed to assuage many voters’ concerns.

Now that he has won, will Johnson be true to his word? The English are wondering where he will find the money. Of greater concern is whether he can navigate threats that Brexit poses to British health care, which is tied to Europe in numerous ways. For example, British citizens can receive care on the continent, and European doctors can work in British hospitals. European Union laws also protect the confidentiality of British patients’ medical data.

The British could be in for an even greater jolt as Johnson negotiates a new trade agreement with the United States. American companies are eager for a larger foothold in the English health care market, and a new deal could ease their entry. It could even help them make inroads that lead to the dreaded privatization of some NHS services.

Boris Johnson won not just by promising to get Brexit done. He also assured voters that the cherished NHS would be in safe hands. His political fortunes may depend on whether he can deliver on that promise, as well.

Health care is also very much on the minds of American voters as they look toward the 2020 election. Of course, most are more concerned with seeing reforms than in preserving the status quo. But one way or another, they want to know that health care will be there when they need it. As we just learned from the British, that concern can be a powerful political force.

Robert I. Field is a member of The Inquirer’s Health Advisory Panel and a nationally known expert in health-care regulation and its role in implementing public policy. He holds a joint appointment as professor of law at the School of Law and professor of health management and policy at the School of Public Health at Drexel University.