In 2008 or 2009, in the years leading up to the Affordable Care Act, I was at a roundtable meeting in Washington, DC. Public discussion had not yet degenerated into the hyperpartisanship that arose in late 2009, so the meeting included a large assortment of prominent policy wonks from sundry think tanks and trade associations from across the political spectrum.

At some point, one of the participants began waxing lyrical about some celebrated healthcare systems—Minnesota’s Mayo Clinic, Utah’s Intermountain Health, and Pennsylvania’s Geisinger. These institutions, he argued, are remarkable in their achievements and are characterized by a very close and quite unusual partnership between doctors and patients. He argued that whatever sort of healthcare reform Congress adopted, it needed to use Mayo, Intermountain, Geisinger and the like as the template for the whole nation. I raised my hand and said something like:

“I deeply admire all those institutions, too. But let me ask a politically incorrect, but serious question. Can you name any such institution that isn’t located somewhere that isn’t predominantly Lutheran, Calvinist, or Mormon?”

There was, as I anticipated and intended, a somewhat stunned silence.

[Do we even have “trust communities” in medicine any longer? With the industry imposing ideological agendas other than health on its consumers — especially in regard to transgender “care” — I’d argue that medicine has largely abandoned the trust model, even in regions where trust goes a lot further. Providers burned those bridges over the last few years, including in the pandemic. Those bridges won’t get rebuilt in my lifetime either, especially while they ignore biology and attempt to demand that we use ‘gender’ as an alternative to the hard reality of biological sex. — Ed]