Kaiser Permanente’s History of Nondiscrimination

posted on July 24, 2015

Lincoln Cushing
Heritage writer

Final essay in a series on Kaiser Permanente’s 70th anniversary

Lobby at Richmond Field Hospital, circa 1943

Lobby at Richmond Field Hospital, circa 1943

One of Kaiser Permanente’s key features is that it is an “Integrated health care system” – meaning it seamlessly provides care and coverage together and provides a wide range of services under one roof, whether in a Kaiser Permanente medical office or hospi­tal or at a contracted facility. But in 1945 “integrated” also held another important meaning when the health plan was opened to the public – it reflected a deep commitment to being one of the first health care providers in the United States to have racially integrated hospitals and waiting rooms, as well as an ethnically diverse workforce, including physicians and allied health professionals.

During World War II, compliance with federal law (such as the Fair Employment Practice Committee) as well as decent best practices meant that employees were treated without institutional discrimination. An estimated 20,000 African Americans, along with many Chinese Americans, Native Americans, and Hispanic Americans, worked in the Kaiser shipyards. Kaiser Industries took great pride in this ethnic and racial diversity, featuring stories in the shipyard newsletters. A caption for a photo of an elegantly attired African-American female shipyard worker launching the Liberty ship S. Hall Young boasted: “How’s this, Adolf? It’s Richmond’s answer to your efforts to split America into warring racial groups.”

Industrial health care covered all workers, and the affordable supplemental health plan that Sidney Garfield, M.D. created for workers and their families in the Kaiser shipyards were equally open. In a time when the Civil Rights movement was just coalescing, racism in America was pervasive. Access to health care was no exception, yet the Permanente Foundation Hospitals took the high road.

Journalist Nick Bourne wrote about the Permanente Health Plan in the San Francisco News on October 7, 1943. He noted:

Illness knows no color line here. Red-helmeted men, women welders, Negroes lined up for a checkup by the busy young doctors. In one double room was Miss Katherine Rossi, shipyard loan office employee, here from Duluth, Minn., for six months; ill six months from skin trouble. A Negro woman was in the adjoining bed. “So help me!” declared Miss Rossi. “I’ve been in hospitals before, but never one like this. It’s sure swell. I don’t know what I would have done.”

The International Longshore and Warehouse Union newspaper The Dispatcher favorably remarked in 1945:

“The hospital’s facilities are open to all groups with no segregation of patients because of creed or color.”

Nurse attending shipyard worker, Oakland hospital, circa 1943

Nurse attending shipyard worker, Oakland hospital, circa 1943

In 1946, the year after the Health Plan was opened to the public, several local policemen visited the Oakland hospital with an eye to join. Permanente medical economist Avram Yedidia recalled the event:

“. . . The police chief said to me, ‘You know, when we walked through, I saw that you had some Negroes and whites in the same room. I don’t think we like that.’ “As I can recall, I responded, ‘Do you know this plan started that way, with blacks and whites in the shipyards, and that’s the way it goes. They worked together, and they were sick together.’ ” I told the police chief: ‘Those who don’t like it shouldn’t join the plan.’ ”

Diversity and inclusion continues to be a guiding principle at Kaiser Permanente. In 2013 Diversity Inc. magazine ranked Kaiser Permanente third in their “Top 50” national corporations, noting a workforce that at all levels reflects high percentages of women, Blacks, Latinos and Asians and has a diverse board of directors. Ronald Copeland, MD, Kaiser Permanente’s chief diversity and inclusion officer, recently affirmed the organization’s progress and challenge:

We must robustly, and in a systematic way, embrace multiculturalism and differences of our workforce and our member population to make sure that everybody’s meaningful needs are met in a personalized way…That is a journey we have been on for nearly 70 years and much progress has been made, but we still have a ways to go in order to become truly inclusive.

It’s about understanding and owning your own talents and vulnerabilities, and being comfortable and humble enough to share with and learn from others. It is about seeing and respecting the value in other people who are different than you and expecting them to do the same in return.

Over the past 70 years Kaiser Permanente’s commitment to nondiscrimination has moved well beyond race and ethnicity, to include gender, generation, sexual orientation, physical, and cognitive abilities in the pursuit of equality without exception. And, as a testament to the acceptance and support for such practices, 10 million people have chosen to “join the plan.”

Happy 70th anniversary, Kaiser Permanente.

 

Short link to this story: http://k-p.li/1MpkWJE

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Kaiser Permanente’s Innovative Spirit of Prevention and Health

posted on July 23, 2015

Lincoln Cushing
Heritage writer

Fourth in a series on Kaiser Permanente’s 70th anniversary

 

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“Patients hospitalized at the Northern Permanente Foundation Hospital received a meal and all medical care as part of their 50 cent weekly premium.” Circa 1943.

“Problems are only opportunities in work clothes.”
– Henry J. Kaiser.

Innovation has been a part of Kaiser Permanente’s culture from the beginning. While many people think of a new technology or exotic surgical device when they hear the term “medical innovation,” Kaiser Permanente’s view is much broader.

From its very beginnings, Kaiser Permanente proposed a radical – and innovative – shift in the delivery of health care.

When Henry J. Kaiser and Sidney Garfield, MD., were taking care of the almost 200,000 workers on the Home Front during World War II, few of them had ever experienced routine medical care. People feared the expense of seeing a doctor, and delayed seeing caregivers, thus guaranteeing a more difficult treatment and a less positive result. But because the prepaid Permanente Health Plan was affordable and run under the same system that was already handling their industrial care, it changed how people accepted early treatment. Dr. Garfield himself was amazed by this phenomenon during his “dress rehearsal” of medical care for worker families at Grand Coulee Dam in 1938:

One of the most impressive lessons we learned was, prior to the family plan, you would go walking through our hospital and you would see quite a few very sick women and children – ruptured appendices, bad pneumonias and so forth, even diphtheria cases. Once the plan was in operation for a while, that changed. You no longer saw ruptured appendices, we saw early [inflamed but not ruptured] appendices. Never saw bad pneumonias, we would treat them early. And diphtheria entirely disappeared. In other words, people, once the barrier of cost was removed, were coming to us earlier and we could treat them earlier and keep them from getting complications and, I’m sure, keeping them from dying.[i]

Later, in the World War II shipyards, Dr. Garfield experienced the same conditions but on a much larger scale. He reflected on the challenges of treating the rookie workers:

Some of them were in such bad condition we jokingly would refer to our shipyard workers as a walking pathological museum. But in spite of all of that fact, they really built ships and built ‘em fast. And not only that, but our plan was able to succeed and work and be sustaining with that tremendous load of all those sick people to take care of. It was a tremendous demonstration of the merits of our health plan and of its value of its economics.[ii]

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Sample page from Physical Demands and Capacities Analysis, published by the Region XII War Manpower Commission, Bureau of Manpower Utilization, Division of Occupational Analysis and Manning Tables, San Francisco, CA, and the Permanente Foundation Hospitals; May 1944

Other preventive features of the shipyard health care plan included a rigorous process for assigning workers to suitable job classifications, training for the women in the industrial workforce, and extended child care services. And during the war, some of the more conventional medical innovation took place as well – such as Morris Collen, MD’s groundbreaking work on using penicillin to treat pneumonia cases.

Fast forward to the present, and Kaiser Permanente is continuing to promote preventive health services while also conducting high-quality, innovative research. Kaiser Permanente is coordinating a national health initiative to improve colon cancer screening rates to 80 percent by 2018, with a special emphasis on screening minorities and those without health insurance. And when a screening does detect cancer, a progressive Oncology Clinical Trials program selects promising new medications and techniques for members to consider, even before they are FDA approved and commercially available.

In Portland, Ore., Kaiser Permanente led a study showing that mailing test kits to patient homes improved colon cancer screening rates by 40 percent in underserved communities. Sometimes basic delivery systems — like the U.S. mail — can deliver innovative health care solutions.

As Henry Kaiser noted, not all medical innovations need to come forward as bright, shiny objects. Some of the most important ones appear in simple work clothes.

 

Short link to this article: http://k-p.li/1KmGi87
[i] “Sidney R. Garfield in First Person: An Oral History,” by Lewis E. Weeks, Hospital Administration Oral History Collection, 1986.

[ii] Dr. Sidney Garfield interview by Dan Scannell, 9/1978.

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Kaiser Permanente as a National Model for Care

posted on July 22, 2015

Lincoln Cushing
Heritage writer

 

Third in a series on Kaiser Permanente’s 70th anniversary

Microsoft Word - National Health Care Proposal 1945

Cover, “Proposal for a Nation-Wide Pre-Paid Medical Plan Based on Experience of the Permanente Foundation Hospitals,” March 3, 1945

At the end of World War II the huge challenge of civilian social services was being reviewed at the highest levels of government. When Harry S. Truman took office in 1945, following the death of President Roosevelt, he did so as a supporter of national health insurance. President Truman made this plea in a speech to Congress on May 19, 1945:

Healthy citizens constitute our greatest national resource. In time of peace, as in time of war, our ultimate strength stems from the vigor of our people. The welfare and security of our nation demand that the opportunity for good health be made available to all, regardless of residence, race or economic status.

At no time can we afford to lose the productive energies and capacities of millions of our citizens. Nor can we permit our children to grow up without a fair chance of survival and a fair chance for a healthy life. We must not permit our rural families to suffer for lack of physicians, dentists, nurses and hospitals. We must not reserve a chance for good health and a long productive life to the well-to-do alone. A great and free nation should bring good health care within the reach of all its people.

Such sentiments were not only echoed by Henry J. Kaiser, he believed that he could contribute to the dialogue. The World War II Permanente Health Plan was so efficient and effective that Kaiser proposed it as a model for national health care. His “Proposal for a Nation-Wide Pre-Paid Medical Plan Based on Experience of the Permanente Foundation Hospitals” dated March 3, 1945, began with this bold statement:

It is maintained that the greatest service that can be done for the American people is to provide a nation-wide prepaid health plan that will guard these people against the tragedy of unpredictable and disastrous hospital and medical bills, and that will, in consequence, emphasize preventive instead of curative medicine, thereby improving the state of the nation’s health.

"Health Insurance Fact Sheet," 4/28/1947; courtesy Truman Presidential Library

“Health Insurance Fact Sheet” outlining national problems 4/28/1947; courtesy Truman Presidential Library

The San Francisco Chronicle reported on July 20, 1945 that a Senate subcommittee was considering Kaiser’s plan for a volunteer health insurance system to be created through government financing, permitting establishment of voluntary systems for national prepaid medical care through facilities of the Federal Housing Agency. Legislation legalizing the plan was prepared by Kaiser for introduction in Congress by Senator Claude Pepper (D., Fla.).

The bill was an outgrowth of Kaiser’s experience in providing group health insurance to 125,000 employees monthly through the Kaiser Permanente Foundation. Sen. Pepper’s legislation and support for what would become the National Health Insurance Act of 1949 (Senate Bill 1679) was strongly supported by President Truman.

However, Truman’s proposal was immediately attacked by conservative groups, including the American Medical Association. The JAMA editorial on May 7, 1949 put forward their position:

Obviously the propaganda agencies that are devoted to the cause of compulsory sickness insurance provided the thought, if not the language, for President Truman’s address. Here are many of the same old misrepresentations that have characterized their previous statements on this subject. Lacking only is reference to the “socialization of medicine;” apparently the proponents of nationalized political medical care have learned that the American people are exceedingly distrustful of socialism. No doubt the most important objection to medicine socialized by nationalization of its control is the well-established fact that the taking over of medicine is but the first step toward nationalization of every interest and activity of the nation.

Truman’s plan failed to win enough support to pass, and Kaiser withdrew from the national health debate. It would not, however, be the last time that Kaiser Permanente would be part of the national dialogue around best practices in health care.

 

Short link to this article: http://k-p.li/1TQqHC5 

 

 

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Kaiser Permanente’s Early Support from Labor

posted on July 21, 2015

Lincoln Cushing
Heritage writer

 

Second in a series on Kaiser Permanente’s 70th anniversary

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Nurses Guild Local 699 (CIO), signing first Permanente Foundation hospital nurses contract. Labor Herald, August 23, 1946.

From providing health care to workers and their families at Grand Coulee Dam to the massive medical program in the World War II shipyards, Henry J. Kaiser believed that cooperating with labor was more productive than fighting it. This institutional philosophy had profound positive implications on the nascent public postwar health plan. As the war was drawing to a victorious close – Victory in Europe had been announced on May 8, 1945 – Henry J. Kaiser’s health plan began to prepare for a peacetime economy by expanding beyond its own employees. The plan would be opened to the public by late July.

Given Henry J. Kaiser’s support for labor, it was not surprising that labor unions would be among the early member groups. Bay Area workers – Oakland city employees, union typographers, street car drivers and carpenters – embraced the Permanente Health Plan and its emphasis on preventive medicine.

On June 7, 1945, the Stewards and Executive Council of the International Longshoremen and Warehousemen Union’s Oakland unit voted unanimously to make coverage in Permanente a part of its future negotiations with employers. The executive council also requested that employers pay for the plan’s premiums.

Founding physician Sidney Garfield, MD., reflected on that support:

So [the postwar health plan] gathered momentum… [In 1949] the longshoremens’ union came to us and said, “We would like you to take over all our members.” They had about thirty thousand here and the [San Francisco] Bay area. They said, “We won’t give them to you unless you do it up in Portland, Seattle, Los Angeles and San Diego. We want to give you the whole thing.”

Then Joe DeSilva of the Retail Clerks’ union called up and wanted to see me. He came up here and said, “I want you to set up a health plan for our workers in Los Angeles.” I guess he had about thirty thousand workers plus families of I don’t know how many. I told him that we would need facilities because we couldn’t depend on using other hospitals because some day they would boycott us probably. So he said, “I’ll pay you several months dues in advance if that will help you build a hospital.”[i]

Years later, Kaiser Permanente CEO David Lawrence would express that relationship succinctly:

“If not for organized labor’s active marketing support immediately following World War II, it is unlikely that Kaiser Permanente would exist today.”[ii]

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Permanente physician examines longshoreman in San Francisco, 1951.

But labor did not just mean health plan members, labor employees were also a key part of delivering health care. A year after opening up to the public, the Permanente Health Plan signed its first nurses contract – which also was likely the first such labor agreement in California.

On July 26, 1946 the Nurses Guild Local 699, affiliated with the Congress of Industrial Organizations, announced that they approved a contract covering wages and working conditions with Permanente Hospital of Oakland and Richmond (as well as medical staff at Kaiser Steel in Fontana). Lora Lee Swan, nurse consultant for the Guild, declared:

This is the first Alameda county hospital in which nurses have been allowed their democratic rights to a free election in choosing their bargaining agent. The precedent set here is truly a great victory for working nurses everywhere. [iii]

In 1997, after years of labor turmoil within Kaiser Permanente and competitive pressures within the health care industry, Kaiser Permanente and the Coalition of Kaiser Permanente Unions formed their groundbreaking Labor Management Partnership. Today, the partnership covers more than 100,000 union-represented employees in 28 local unions as well as 14,000 managers and 17,000 physicians in California, Washington, Oregon, Colorado, Georgia, Hawaii, Virginia, Maryland and Washington, D.C.

 

 

[i] “Sidney R. Garfield in First Person: An Oral History,” interview by Lewis E. Weeks, 8/22/1984.

[ii] KP CEO David Lawrence, “Tentative national partnership announced between AFL-CIO and Kaiser Permanente,” Newswire (KPNW) May 2, 1997

[iii] “CIO nurses approve pact at Permanente,” People’s World, August, 1946

 Short link to this article: http://k-p.li/1HOxTXU

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