WARNING SIGNS — Long before a gunman pumped bullets into a UnitedHealthcare executive and was hailed as a folk hero by a startling slice of the American public, the longtime head of the American Board of Internal Medicine found himself increasingly aware of — and alarmed by — the creeping distrust of American health, science and medicine. Dr. Richard Baron had been a primary care doctor for years, in rural Tennessee and then in a racially and economically mixed neighborhood in Philadelphia. He had felt deeply connected to his community, and the word “community” comes up often in his conversations. But as president and CEO of ABIM and its affiliated foundation, he saw how Americans’ wariness about the health care system was growing, part of a growing sense of distrust and disconnection throughout the country. “What happens to medicine when the members of the society believe no one has your best interests at heart?” he asked. “It’s a pretty tough place to be.” Particularly when the health care system was growing more corporatized — and more disconnected from communities, he told Nightly in a conversation that took place just as police were closing in on the suspect in the murder of UnitedHealthcare executive Brian Thompson. Soon after taking the top job at ABIM, Baron had to deal with the organization’s own struggles, after an outcry over changes in how it tested and certified doctors. His efforts to restore trust, combined with his prescient pre-Covid observations about the crumbling of trust in medicine, led him to start a multi-year ABIM Foundation initiative on exploring, researching and repairing trust. Baron worked on disinformation, which has turned into a mighty online river since Covid. ABIM has also spotlighted how racial inequity in health care — historic and contemporary — has eroded trust, which became more widely recognized during the pandemic. And he’s stressed how the fear of medical debt — a side effect of the opacity of corporate health care decision-making and pricing — deters some patients from seeking needed care. “Patient-centered care” has become a buzzword in health but for many patients, it feels money-centered. In fact, in shooting suspect Luigi Mangione’s alleged manifesto, he decried big companies like UnitedHealthcare that “abuse our country for immense profit.” Early on, Baron realized that relying on facts alone to push back on the damage was not going to cut it. “People were willing to give up what I’ll call a fact- based understanding in favor of a kind of emotional relationship-based understanding,” he said. “And the messengers haven’t been paying a lot of attention to their relationship with the communities that they’re trying to message to.” If you tried to diagram distrust, it would have a whole lot of intersecting arrows pointing in every possible direction. A big cluster of arrows would point to insurers who have merger-and-acquisitioned themselves into a handful of big firms that are the arbiters of what kind of care a patient can access — or not. Others would point from doctors and nurses to the money-guys calling the shots at their health care system or practice. From minority communities toward providers. From patients to their doctors — particularly when the physician recommends against a treatment on solid evidence-based grounds but the skeptical patient thinks the doc is in the insurer’s pocket. Arrows would aim at drug companies that develop life saving medicines but with eye-popping prices — and to the subset of pharma firms and drug distributors who flooded communities with opioids while falsely promising that they would do no harm. Baron retired a few months ago, but trust and communication initiatives he started are ongoing. He knows some of the challenges are unique to medicine. Others reflect larger changes in an angry, polarized country. “Medicine swims in the same ocean that the rest of the culture does,” said Baron. Attacks on health care personnel in the workplace, both verbal and physical, have become far more common. Last week, on the streets of New York, an angry young man didn’t just point an arrow. He pointed a gun. Welcome to POLITICO Nightly. Reach out with news, tips and ideas at nightly@politico.com. Or contact tonight’s author on X (formerly known as Twitter) at @JoanneKenen.
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