POLITICO Nightly: The growing distrust of the American health care system

 

By Joanne Kenen Prescription drugs displayed at NYC Discount Pharmacy in Manhattan on July 23. | Spencer Platt/Getty Images 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 .   A message from American Beverage: America’s beverage companies – The Coca-Cola Company, Keurig Dr Pepper and PepsiCo – are iconic American companies making American products with American workers in America’s hometowns. And we’re committed to doing our part to address today’s health challenges. We’ve taken real steps for more than a decade to transform the beverage aisle, like offering smaller portion sizes, more zero-sugar options and putting nutrition information right up front. Explore more at BalanceUS.org.   What'd I Miss? — Biden threatens to veto bill that would have given Trump new judicial appointments : Donald Trump is eager to appoint dozens of new judges once he becomes president. Joe Biden has other plans. The president threatened to veto a bill to expand the number of federal judges because he doesn’t want to give the president-elect new appointment opportunities, one of the outgoing president’s closest allies said in an interview. The move dooms legislation spearheaded by Sen. Chris Coons (D-Del.), who had spent months pushing for the creation of 63 new judgeships. — Time magazine to name Trump ‘Person of the Year’: Donald Trump is expected to be named Time magazine’s “Person of the Year” — and to celebrate the unveiling of the cover, the president-elect will ring the opening bell of the New York Stock Exchange on Thursday morning, according to three people familiar with the plans granted anonymity because they were not authorized to divulge the plans. Trump was also named Time Person of the Year in 2016 after he won the presidential election. He joins 13 other U.S. presidents who have received the recognition, including President Joe Biden. WHILE THE ASSAULT IN INEXCUSABLE, REP. NANCY MACE HAS BEEN PROVOCATIVE & HATE FILLED IN HER COMMENTS...THE REST OF THE WORLD IS FILLED WITH UNISEX BATHROOMS...MAYBE NANCY MACE NEEDS TO TRAVEL MORE.... — Capitol Police arrest person in alleged assault on member of Congress: The U.S. Capitol Police have arrested 33-year-old James McIntyre for an alleged assault on Rep. Nancy Mace on Tuesday night in the Rayburn Office Building, according to the department. Capitol Police, in a statement, said they responded to an incident reported by a member’s office just before 6 p.m. on Tuesday. McIntyre is facing a misdemeanor charge for assaulting a government official, according to the department, though charging decisions are ultimately up to the U.S. attorney’s office.   Billions in spending. Critical foreign aid. Immigration reform. The final weeks of 2024 could bring major policy changes. Inside Congress provides daily insights into how Congressional leaders are navigating these high-stakes issues. Subscribe today .     THE NEXT ADMINISTRATION KASH PATEL NEEDS FBI BACKGROUND CHECKS & SECURITY CHECKS....lots of issues are not being addressed! WRAY OUT — FBI Director Christopher Wray, who has faced withering criticism from President-elect Donald Trump and Republican lawmakers, announced today that he plans to resign next month . Trump announced late last month that he intends to nominate former National Security Council official and GOP congressional aide Kash Patel to serve as FBI director. If confirmed by the Senate, he would replace Wray, who was appointed by Trump in 2017 and is serving a 10-year term that expires in 2027.   A message from American Beverage:   AROUND THE WORLD Poland's Prime Minister Donald Tusk delivers a statement to the media with French President Emmanuel Macron as part of a meeting at the Elysee Palace in Paris in February. | Pool photo by Christophe Petit-Tesson POSTWAR PLANS — French President Emmanuel Macron will discuss with Polish Prime Minister Donald Tusk the deployment of a postwar peacekeeping force in Ukraine when the two meet in Warsaw on Thursday, a European Union diplomat and a French official told POLITICO. The meeting of the two EU heavyweights comes amid increasing fears that the incoming administration of Donald Trump will force the Europeans to pick up more of the military responsibilities in Ukraine. “It is true,” confirmed the EU diplomat when asked about a Polish media report in the Rzeczpospolita newspaper claiming the two countries were talking over a potential 40,000-strong peacekeeping force composed of troops from foreign countries. The diplomat did not elaborate on which countries the soldiers might come from. FOOL ME ONCE — Emmanuel Macron told leaders from across the political spectrum he will not appoint a new prime minister whose survival depends on the far-right National Rally after it spurned Michel Barnier and voted to bring down his government after just three months, according to the French president’s office. Toppling Barnier, Macron told his ministers today, “was a serious choice, a choice that will have consequences,” government spokesperson Maud Bregeon told reporters. Macron is expected to name a new premier by the end of the day Thursday to replace Barnier. Several names have been floated in the French press, but the leading rumor suggests he may appoint one of his earliest supporters, centrist François Bayrou. However, representatives from different left-wing parties have already made clear that they are against Bayrou’s potential appointment. UK BANS PUBERTY BLOCKERS — The British government indefinitely banned the use of puberty blockers by people under 18 years of age today after expert advice flagged an "unacceptable safety risk" in their use. Puberty blockers stopped being routinely prescribed to under-18s with gender dysphoria in the U.K. in March and were temporarily banned in May this year by the previous Conservative government. This prevented their prescription by European or private prescribers. National Health Service provision was restricted to clinical trials. The Department for Health and Social Care has now received advice from the government-ordered Commission on Human Medicines and today backed its recommendation to restrict their use and supply indefinitely while further work is done to ensure young people’s safety. An earlier U.K. review into gender identity services found that studies about treatment for gender dysphoria were unreliable and there was a lack of attention paid to patients seeking to halt or reverse the gender transition process. New legislation will make the ban indefinite and be reviewed in 2027.   Write your own chapter in the new Washington. From the Lame Duck Congress Series to New Administration insights, POLITICO Pro delivers intelligence across 22+ policy areas to help you anticipate and navigate change. Discover how a Pro subscription empowers you. Learn more today .     Nightly Number $135 million The amount in grants that the Environmental Protection Agency is awarding to California in order to help the state wean off fossil fuels and phase out big rigs that run on diesel, EPA officials announced today. MUST READ! EXCERPT: SAN FRANCISCO (AP) — The Environmental Protection Agency is awarding $135 million in grants to fund 13 projects in California to help the state wean off fossil fuels and phase out big rigs that run on diesel. The money will go to the state transportation department, cities and school districts, among others, to purchase 455 zero-emission vehicles to replace diesel-powered trucks, school buses and other large vehicles. It is part an EPA program that provides a total of $735 million to 70 projects across the country, officials announced Wednesday. The grants are paid for by the 2022 climate law approved by congressional Democrats. The law, officially known as the Inflation Reduction Act, includes nearly $400 billion in spending and tax credits to accelerate the expansion of clean energy such as wind and solar power, speeding the nation’s transition away from the oil, coal and natural gas that largely cause climate change. The funds, to be delivered in early 2025, “will reduce air pollution, improve health outcomes in nearby communities, and advance the campaign to tackle climate change,” EPA Pacific Southwest Regional Administrator Martha Guzman said in a statement. RADAR SWEEP AGE APPROPRIATE — As the migrant crisis worsens across Europe, border officials are increasingly turning to medical examinations to determine asylum seekers’ age . Through a series of medical assessments, they believe they can often figure out how old an asylum seeker without proper documentation is — most notably, they can decide if they are a child or an adult. But the practice of quickly trying to guess at someone’s age based on their medical information is deeply flawed. And inconsistencies within the system are often mixing up age groups and leaving legal children at the mercy of an adult asylum process. Unaccompanied children are regularly given asylum priority or distinct treatment — but as countries try to crack down on adults claiming they’re minors, other issues begin to arise. Will Coldwell reports for The Dial. Parting Image On this date in 1941: Speaker of the House Sam Rayburn (rear) presides over the House of Representatives as Irving W. Swanson reads President Franklin D. Roosevelt's plea for a declaration of war against Germany. The U.S. formally declared war against Germany and Italy three days after doing so against Japan. | AP Did someone forward this email to you?  Sign up here .   A message from American Beverage: America’s beverage companies are committed to delivering families the freedom to choose the beverage that’s right for them. And it’s working. Thanks to our innovation, nearly 60% of the beverages Americans buy have no sugar or calories. Our commitment to helping Americans find the right balance for them includes: · Offering more than 600 brands with less sugar or no sugar at all. · Putting clear calorie labels on the front of every bottle, can and pack. · Encouraging consumers to think about balance with signs on coolers and displays in store. · Voluntarily removing full-calorie beverages from schools through our National School Beverage Guidelines, which cut beverage calories in schools by 94%. In fact, the USDA Smart Snacks in Schools Beverage Guidelines were largely based on these guidelines. Learn more at BalanceUS.org.     Follow us on Twitter Charlie Mahtesian @PoliticoCharlie Calder McHugh @calder_mchugh   Follow us

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POLITICO Nightly: The most influential person in Europe

By Aitor Hernández-Morales Italian Prime Minister Giorgia Meloni delivers a statement at the UNFCCC COP29 Climate Conference on Nov. 13, 2024, in Baku, Azerbaijan. | Sean Gallup/Getty Images SEISMIC SHIFT — POLITICO Europe’s annual ranking of the most influential people in Europe is out today and the list is marked by a conspicuous absence. The familiar faces who typically dominate the power corridors — like the French president or German chancellor — didn’t make the cut. In a continent reeling from economic malaise, wars at its doorstep, the resurgence of the far right and a looming cold shoulder from its longtime ally in Washington, many of Europe’s traditional power players find themselves sidelined. Others — often from unexpected or unconventional quarters — are stepping in to fill the void. When the United States inaugurates Donald Trump again in January, he’ll be faced with a fragmented Europe that looks very different from the last time he took office in 2017, when the continent was still coming to terms with the consequences of Brexit. Trump will have to turn his attention to shifting power centers in 2025. The list of those poised to shape European politics and policy in the year ahead is divided into three categories: Doers (those most adept at imposing their will), Disrupters (those shaking up the status quo), and Dreamers (whose bold ideas are driving the conversation). Together, the 28 power players in those categories are revealing. They show the eastward tilt of Europe’s center of gravity. Four Poles made this list, underscoring Warsaw’s growing relevance. Prime Minister Donald Tusk, last year’s top-ranked figure, has helped shepherd Poland back into the political mainstream. The country’s rise has been further buoyed by a healthy domestic economy and a new European focus on defense and security that seems especially prescient following the reelection of Trump. Sharing a border with Ukraine and Russian ally Belarus, Poland and Tusk have been among Ukraine’s staunchest supporters since 2022 — a stance seemingly not shared by the incoming Trump administration. Tusk said today that he hopes peace talks will begin this winter, and that Warsaw will be heavily involved in any discussions of peace. The list captures another continental trend: the ascent of right-wing populists and ultranationalist figures. These leaders, who have undermined civic rights and targeted minorities and asylum-seekers, have gained traction as centrist leaders flounder. Their presence on this year’s ranking is a stark warning: When traditional politicians fail to provide credible alternatives, populism fills the void. The leader ranked as the most powerful person in Europe this year might come as a surprise — Giorgia Meloni, prime minister of Italy . In less than a decade, the leader of the right-wing Brothers of Italy party has gone from being dismissed as an ultranationalist kook to being elected prime minister and establishing herself as a figure with whom Brussels, and now Washington, can do business. Even as she has tacked to the center, Meloni has been on the forefront of a wave that is dragging European politics toward the far right. Indeed, since her election in 2022, the Italian prime minister has introduced policies on issues like migration and LGBTQ+ rights that would once have drawn condemnation from Brussels. Instead, the reaction from European Union leaders has ranged from indifference to approval, with many accepting Meloni as the palatable representative of the ever-more-radical zeitgeist blossoming on both sides of the Atlantic. You can read more about Meloni and the most influential people in Europe here , and the methodology behind this snapshot of power. Welcome to POLITICO Nightly. Reach out with news, tips and ideas at nightly@politico.com . Or contact tonight’s author at ahernandez@politico.eu or on X (formerly known as Twitter) at @aitorehm .   A message from American Beverage: America’s beverage companies – The Coca-Cola Company, Keurig Dr Pepper and PepsiCo – are iconic American companies making American products with American workers in America’s hometowns. And we’re committed to doing our part to address today’s health challenges. We’ve taken real steps for more than a decade to transform the beverage aisle, like offering smaller portion sizes, more zero-sugar options and putting nutrition information right up front. Explore more at BalanceUS.org.   What'd I Miss? — McConnell falls and sprains wrist but has been ‘cleared to resume his schedule’: Senate Minority Leader Mitch McConnell tripped and fell as he was leaving a Senate GOP lunch today, cutting his face and spraining his wrist, according to a spokesperson for the Kentucky Republican. “He has been cleared to resume his schedule,” the spokesperson added. McConnell walked out of the meeting himself alongside Sen. John Barrasso (R-Wyo.) and was attended by medical personnel in his office. He did not attend the weekly Senate GOP press conference, which he typically leads. — House task force releases final report on Trump Pennsylvania assassination attempt: The July 13 attempted assassination of Donald Trump was “preventable and should not have happened,” according to a final report from a House task force investigating the two attempts during this year’s presidential campaign. “The various failures in planning, execution, and leadership on and before July 13, 2024, and the preexisting conditions that undermined the effectiveness of the human and material assets deployed that day, coalesced to create an environment in which the former President — and everyone at the campaign event — were exposed to grave danger,” the House panel said in its report. FALSIFICATION OF BUSINESS RECORDS CASE! — Manhattan DA urges judge not to toss out guilty verdict in Trump hush money case: Manhattan District Attorney Alvin Bragg says Donald Trump’s imminent return to the presidency is not a reason to throw out the 34-count conviction that jurors delivered in the hush money case earlier this year. Bragg conceded in a court filing that Trump cannot be sentenced while he is president. But he said Justice Juan Merchan has a variety of options to put the case on hold during Trump’s second term — and then issue a sentence after he leaves office in January 2029.   Billions in spending. Critical foreign aid. Immigration reform. The final weeks of 2024 could bring major policy changes. Inside Congress provides daily insights into how Congressional leaders are navigating these high-stakes issues. Subscribe today .     THE NEXT ADMINISTRATION NEW BLOOD — President-elect Donald Trump is considering replacing Federal Trade Commission Chair Lina Khan with Andrew Ferguson . Trump has not made a final decision and is set to meet with Ferguson this afternoon, according to a person familiar with the meeting who was granted anonymity to discuss the potential nomination. A decision could come soon. If selected, Ferguson won’t need Senate confirmation since he is already on the commission. Ferguson, who did not immediately respond to a request for comment, is well-known in Republican circles. He previously did stints as chief counsel for Senate Minority Leader Mitch McConnell and Sen. Lindsey Graham (R-S.C.), and was the former solicitor general for Virginia. Ferguson was also a senior special counsel for incoming Senate Judiciary Committee Chair Chuck Grassley (R-Iowa). INTERNAL DISPUTE — The fight over the heart of Donald Trump’s sprawling legislative agenda is publicly pitting the House GOP’s top tax writer against pretty much everyone else . House Ways and Means Chair Jason Smith, a close Trump ally who is playing a lead role in drafting potential tax cuts, is facing off against incoming Senate Majority Leader John Thune over what should take priority once Republicans take back power next year. Smith wants to take one big swing at passing conservative priorities including changes to tax, border and energy policy. Thune, backed by incoming Budget Chair Lindsey Graham and incoming White House deputy chief of staff for policy Stephen Miller, among others, is trying to rally the party behind a two-step plan in which tax fights would be resolved at the end so they don’t hold up other items on the GOP’s wish list. JUDGE AND JURY — Robert F. Kennedy Jr. is the latest Donald Trump Cabinet pick facing trouble in the Senate . At least three closely watched senators are noncommittal about confirming the vaccine critic, who’s being considered to lead the Department of Health and Human Services. Those include swing votes like Sens. Susan Collins of Maine and Lisa Murkowski of Alaska, as well as Sen. Bill Cassidy of Louisiana, a physician who will chair a committee that could host confirmation hearings for Kennedy. Kennedy can afford to lose only three Republicans during his confirmation if all Senate Democrats vote against him. This group of senators closely resembles those who weren’t sold on former Rep. Matt Gaetz for attorney general or have questioned defense secretary pick Pete Hegseth.   A message from American Beverage:   AROUND THE WORLD French President Emmanuel Macron attends a military ceremony Nov. 5, 2024, in Paris. | Michel Euler, Pool via AP READY TO GO — If the rebel forces that overthrew Syria’s regime start fighting among themselves, Qatar may step in to mediate , a top official indicated today. “We never say no,” Qatar Ministry of Foreign Affairs spokesperson Majed Al-Ansari said in an interview with POLITICO in his office in Doha when asked about the possibility. The toppling of dictator Bashar al-Assad last weekend has brought a wave of joy for the long suffering people of Syria. But there are fears, especially among neighboring states, that the factions that pushed out Assad in a lightning offensive could start battling each other for power, leading to new violence. Al-Ansari confirmed that Qatari officials are already in contact with groups in Syria, though he declined to name which ones. “We are in touch with all the relevant parties on the ground,” he said. His comments come after Reuters reported Monday that Qatar is in touch with the leading rebel group, Hayat Tahrir al-Sham. Qatar, an energy-rich Gulf Arab country, has a long history of acting as a go-between for feuding parties, including Israel and Hamas as they fight in Gaza. Serving as an intermediary in Syria could make Qatar an even more important partner for the United States, which often turns to it for help in dealing with adversaries. THE NEXT 48 — French President Emmanuel Macron is looking to name a new prime minister in the next 48 hours , he said at a gathering with leaders from across the political spectrum this afternoon. Lawmakers from the Greens and the conservative Les Républicains confirmed that Macron shared his self-imposed deadline during today’s meeting at the Elysée palace, which the president called as part of an effort to end the political crisis following Prime Minister Michel Barnier’s ouster on Wednesday. It is unclear who would succeed Barnier. Several candidates have been floated in French media, among them former Justice Minister François Bayrou and current Defense Minister Sébastien Lecornu.   Write your own chapter in the new Washington. From the Lame Duck Congress Series to New Administration insights, POLITICO Pro delivers intelligence across 22+ policy areas to help you anticipate and navigate change. Discover how a Pro subscription empowers you. Learn more today .     Nightly Number MUST READ! WIN FOR CONSUMERS! $25 billion The size of a pending merger between the grocery chains Kroger and Albertsons that a federal court blocked today, siding with the U.S. Federal Trade Commission in a victory for the Biden administration. RADAR SWEEP RAGE REVENUE — Creators are learning that more controversy equals more dollars . Winta Zesu, a 24-year-old social media influencer, has made $150,000 off posting alone — and she does so by purposefully seeking “rage bait”. Her method consists of “getting a lot of hate,” playing up being a New York City model whose biggest problem is being too pretty. Zesu is among a growing number of creators who spend their time producing videos, memes, and writing posts that orchestrate a sea of controversy for millions of shares and likes. For the BBC, Sam Gruet and Megan Lawton, explain how rage bait takes on many forms from outrageous food recipes, celebrity gossip, and even politics. Parting Image On this date in 1976: Novelist Saul Bellow laughs as his wife Alexandra adjusts his tie at a gala at Stockholm's City Hall in honor of Nobel Prize winners. Bellow won the Nobel Prize in literature.  | AP   A message from American Beverage: America’s beverage companies are committed to delivering families the freedom to choose the beverage that’s right for them. And it’s working. Thanks to our innovation, nearly 60% of the beverages Americans buy have no sugar or calories. Our commitment to helping Americans find the right balance for them includes: · Offering more than 600 brands with less sugar or no sugar at all. · Putting clear calorie labels on the front of every bottle, can and pack. · Encouraging consumers to think about balance with signs on coolers and displays in store. · Voluntarily removing full-calorie beverages from schools through our National School Beverage Guidelines, which cut beverage calories in schools by 94%. In fact, the USDA Smart Snacks in Schools Beverage Guidelines were largely based on these guidelines. Learn more at BalanceUS.org.   Did someone forward this email to you?  Sign up here .   Follow us on Twitter Charlie Mahtesian @PoliticoCharlie Calder McHugh @calder_mchugh   Follow us

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