Archive for August, 2017

Dr. Sidney Garfield on Medical Care as a Right

posted on August 15, 2017

Lincoln Cushing
Heritage writer

This post introduces a podcast, our new channel for sharing Kaiser Permanente history. Given the rich set of audio materials in our archives, it makes sense to let viewers hear our stories as told by those who were part of it. With these podcasts we will explore audio sources including World War II shipyard launchings, speeches by key figures, and interviews.

So, without further ado, let’s hear our founding physician talk about what he learned about building a medical plan, starting in 1933.


Podcast fulltext for “Dr. Sidney Garfield on Medical Care as a Right”

Hello, I’m Lincoln Cushing. Welcome to Kaiser Permanente’s “Earful of History”

Today we’ll hear from our founding physician, Doctor Sidney Garfield. He had some interesting things to say about medical care as a right – and also about the origin of what we now call Permanente medicine.

Dr. Garfield’s talk comes to us from a 1972 lecture he delivered to community medicine students at the University of Southern California Medical School.

Let’s go way back to the Great Depression, when America’s industries were in shambles, people were out of work, and things were really tough.

Dr. Sidney Garfield at Contractors General Hospital, 1935.

In 1933, Dr. Garfield was fresh out of medical school, and he’d set up a small practice in Southern California’s remote Mojave Desert. He was providing industrial medical care for the workers on the Colorado River Aqueduct project.

Dr. Garfield:

I soon found myself in rather serious financial difficulty. Knowing nothing about medical economics, I had tackled the impossible job in those days of trying to take care of a group of workers with none of the usual crutches. There were no rich to pay for the poor. No subsidy. No philanthropy. There wasn’t even a county hospital to which we could send our charity cases.

Dr. Garfield’s problem was the standard business model of industrial medicine where he got insurance reimbursement for treatment after a worker was sick or injured. So he worked out a new deal with the insurance carrier. Dr. Garfield was prepaid a fixed amount per worker, and in turn he guaranteed he’d provide their needed medical care while on the job. This was a win-win solution. It assured Dr. Garfield a steady income to run his clinic, but more importantly, it gave him the incentive to keep the workers healthy instead of making money when they got injured.

The aqueduct project ended in 1938. He was going to go into private practice, but history intervened. Dr. Garfield went up to care for the workers at industrialist Henry J. Kaiser’s huge dam project on the Columbia River in Washington. Grand Coulee Dam, the largest concrete structure ever built.
[Woody Guthrie sings; he was hired by the Bonneville Power Administration to promote the wonders of the new dam].

Mason City hospital (Grand Coulee Dam) after Dr. Garfield’s upgrade, circa 1939.

Dr. Garfield, reluctant at first, became excited at the prospect of fixing up the decrepit local hospital and bringing in a top-notch staff. There, he learned a lesson – a prepaid health plan for whole families can be effective and affordable.

Dr. Garfield:

In the beginning, we took care of the workers with the health plan. And we took care of the families on fee-for-service.

And we soon found out that it didn’t work at all. It was too painful of a situation. The workers could get their care so easily through their health plan. And they had such problems paying for the care for their wives and children. It bothered not only the workers, it bothered the employer. It bothered the unions. It bothered our physicians. And so pretty soon we were being pressured on all sides to start a family plan… fifty-cents a week for the wife, and twenty-five cents a week for each child. [We] started a family plan.

And that worked beautifully too. From then on we had no concern. No problems taking care of the women and the children. But that rounding out of our employee plan to a complete family plan was Coulee’s contribution – greatest contribution to our lessons in medical care.

Bear in mind that until this point in history, health insurance plans didn’t really exist. If you got sick, you hoped you had enough money to pay a doctor, and you often delayed that until things got really bad.

Dr. Garfield:

Prior to the family plan, walking through the corridors of our Coulee Dam hospital, you would see a fair amount of very sick women and children. Terminal pneumonia. Ruptured appendices. Diphtheria cases and so forth. After the plan had been in operation for several months, that picture changed. The level of illness of these people changed. Walking through the corridors now you would see simple appendices, and early pneumonias. And diphtheria disappeared completely with the immunizations we offered with our health plan. And the solution to that was simple. The barrier of cost being removed, these people were coming in earlier for care. We were able to treat them earlier and prevent them from getting complications. And I’m sure preventing many of them from dying. That was a lesson that we’ve never forgotten.

This was the origin of what we now call Permanente medicine. Speaking to the roomful of community medicine students, he reflected on the important medical model he’d developed through his association with Henry J. Kaiser and the efficiencies of the Kaiser Permanente Health Plan:

Dr. Garfield:

In conclusion, in view of our commitment to medical care as a right in this country, this is – comprehensive health services, of high quality, to every person, the importance of this research and potential benefits is self-evident. We can never achieve the goal of medical care as a right without a delivery system that matches the demand of that right.

This new delivery system [I just described] does just that. It provides increased capacity, increased accessibility, appropriateness of service, comprehensiveness of care, continuity of both health care and sick care, efficiency of resource utilization, and is cost-effective. Its new services are relatively easily staffed, and it promises ready transferability and adaptability to most all forms of practice and geographical areas.

It’s impressive that an industrial health plan from the Great Depression would evolve into a robust and effective model of health care for all Americans.

It’s a testament to the persistence of mission and the dedication of thousands of physicians, staff, and administrators, starting with Dr. Garfield.

Thanks for joining us in this Kaiser Permanente Earful of History.


This audio is from a 1972 lecture Dr. Garfield delivered to Community Medicine students at the USC Medical School, recorded by Dr. Robert Tranquada and donated to Kaiser Permanente Heritage Resources.
Podcast producer: Juan Aguilar.

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Rosies Rocked Richmond Again

posted on August 14, 2017

Lincoln Cushing
Heritage writer

The third annual Home Front Festival and Rosie Rally was held in Richmond, Calif., on Saturday, August 12. The event honored those who contributed to the World War II home front, especially the women who stepped up – as they always do.

The highlight is always the contest for number of people dressed as Rosie. This year’s certified attendance of 2,229 didn’t top our own Guinness-record-setting count of last year, but we kept our lead over our counterparts at the Willow Run plant in Michigan. Whew.

Thank you, Rosie the Riveter Trust, staff at the National Park visitor center, and all the women who showed up. It was truly inspiring.


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‘Good Medicine Brought Within Reach of All’

posted on August 10, 2017

Lincoln Cushing
Heritage writer


“Tomorrow’s Health Plan – Today!” by Paul de Kruif, The Reader’s Digest May 1943.

“Tomorrow’s Health Plan – Today!”

That was the title of Paul de Kruif’s seminal article in The Reader’s Digest (also called simply Reader’s Digest) May 1943 edition. The bright red subhead proclaimed “Henry Kaiser and California physicians are proving that ‘good medicine’ can he brought within reach of all.”

Reader’s Digest was founded in 1922 by DeWitt Wallace, and its distinct format of condensed and rewritten material from a wide range of publications became very successful; it is currently the largest paid circulation magazine in the world.

This was the first national article on the industrial health care plan organized by Sidney Garfield, MD, for the 190,000 workers at Henry J. Kaiser’s six West Coast shipyards and his steel mill in Fontana, Calif. The plan was still new – it had only been started just over a year earlier, in March 1942 – but already it was making waves. That same year de Kruif devoted an entire book to the Kaiser health plan, Kaiser Wakes the Doctors, where he coined the description of the plan as the “Mayo Clinic for the common man.”

Paul de Kruif, from cover of The Sweeping Wind: A Memoir, 1962; photo circa 1926.

De Kruif (1890-1971) was quite a character. Born in the Netherlands, he moved to the United States and received a degree in microbiology. But his passion was policy change, not medical research. He published Our Medicine Men in 1922, followed by The Microbe Hunters in 1926. He spoke and wrote passionately about health care reform, railing against the limitations of private practice and fee-for-service. The Associated Press quoted him in 1939 as saying, “The essential principles of the proposed health law articulated by Mr. de Kruif would call for the establishment of adequate medical care as the ‘fifth human right,’ taking its place alongside the rights to food, shelter, clothing, and fuel.”

Initially a proponent of socialized medicine, by the early 1940s de Kruif came to favor the alternative model practiced by Henry J. Kaiser and Dr. Garfield. His four-page article in Reader’s Digest glowed about the efficiencies of the health care offered to the Kaiser shipyard workers:

All medical and surgical care is centralized under one roof. That’s the reason for both its effectiveness and its economy. The doctors are all handy to the laboratories, X-ray, surgeries and to each other.

Reviewing the Permanente Health Plan (now called Kaiser Permanente) at the early stage that he did, he noted that it did not include workers’ families. Although Kaiser and Garfield had developed and run a successful prepaid family plan a few years earlier at Grand Coulee Dam, the incredible pace of expansion in the shipyards after the Japanese attack on Pearl Harbor made it impossible to cover nonindustrial care for employees (a hugely popular option offered starting August 22, 1942) for anyone but employees. De Kruif noted that this gap was taken up by the California Physicians Service.

May 1943 issue of The Readers Digest

Created in 1939, the CPS (later called Blue Shield of California) was run by the California Medical Association and became the state’s first statewide prepaid plan. By mid-1943 shipyard families were admitted into the Permanente Health Plan, and the relations between private practice physicians and those working for Dr. Garfield begin to fray. The hostility of the medical establishment accelerated as the war ended and the Permanente Health Plan was opened to the public.

De Kruif’s opening salvo touting the benefits of the Permanente Health Plan was the first in Reader’s Digest, but certainly not the last. Permanente physicians continue to be quoted in their articles – just this year we saw “15 Ingredients Medical Doctors Always Add to Their Meals,” “Stomach Hurt? 12 Things Your Stomach Is Trying to Tell You,and “13 White Foods that Are Way Healthier Than You Thought.”


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