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Upstart Health Plans Vs. the Medical Establishment in the 1950s

posted on September 14, 2017

Lincoln Cushing
Heritage writer

 

Part 2 of 2: The Permanente Health Plan responds to legal charges by the medical establishment and the similar experiences of Group Health (originally called Group Health Cooperative of Puget Sound) in Washington state. In 2017, Kaiser Permanente acquired Group Health, making Kaiser Permanente Washington our newest region, the first in over 30 years.

During the late 1940s the medical establishment tried mightily to eliminate health plans that it saw as competition. As we saw in part 1 of this article, two of the biggest targets were the Permanente Health Plan (Kaiser Permanente) and Group Health.

Henry Kaiser speaking in New Orleans, 1957.

 

Henry J. Kaiser takes the high road

During these challenges with the medical establishment, Henry J. Kaiser consistently took the high road. When he spoke to a group of physicians in San Francisco on June 9, 1948, he let them know he was “… astounded and horrified to be informed by our attorneys that a group of Alameda County doctors have declared war on the Permanente health program.” He outlined his many legal options, but then offered a more cooperative path because “… we must be sobered at thinking what an all-out fight on the issue of more medical care for more people could mean.” He sought an amicable solution:

I want to believe that tonight is the beginning of a real conscientious effort on the part of everyone here to strive to fulfill the common objectives not only for group medicine, if it be lower in cost, but for that type of medicine which so many want, called private medicine, although it is higher in cost … until the earning power of the nation is greater, all the people cannot participate in private medicine.

His appeal to civility fell on deaf ears. Rather than accept the olive branch, fee-for-service practitioners rolled up their sleeves to knock out the competition.

A legendary event etched into Kaiser Permanente history was the 1953 competition for plan sign-up by 4,000 United Steel Workers of America members in Pittsburg, Calif. Local private practice physicians mounted an all-out campaign, which included provocative leaflets, newspaper ads, billboards, and even a sound truck. On September 3, 1953, the union members voted overwhelmingly for the Kaiser Foundation Health Plan.

Henry J. Kaiser defends Dr. Sidney Garfield, 10/26/1947.

That December, delegates at the annual California Medical Association meeting tried the carrot rather than the stick approach by announcing a pilot prepaid plan to compete with Kaiser Foundation Health Plan. They offered the 9,000 members of the International Association of Machinists at Santa Monica’s Douglas Aircraft plant “free choice of physician and hospital to its subscribers” through the California Physician’s Service. The CMA had established the CPS in 1939 as statewide prepaid medical care organization.

The proposed plan would cover hospitalization and surgical care for all workers earning below a certain salary threshold, charging more for those earning above it. (Newspaper coverage noted that the Kaiser plan had no income ceiling provision.)

Private practice physicians were on the ropes. Dr. Francis Rochex of San Francisco was quoted as saying “Organized medicine has lacked vision in anticipating the extent of penetration of political and socialized pressure groups.” But measures to develop a comprehensive alternative stumbled; CMA delegates were unable to agree on a plan which would cover both prepaid medical care and still observe “the doctors’ traditional independence and maintain professional standards.”

By 1960 the “Long Beach Physicians Health Plan” through CPS had been adopted for all Douglas aircraft workers throughout the world, and Long Beach city employees and school district employees came under the plan in 1959. On its own terms it was successful; the Long Beach Independent bragged that it was “the only plan that has had wide acceptance by so large a number of the people who are seeking a workable medical insurance plan under the free enterprise system.”

 

Group Health Cooperative wins ruling against local medical establishment, 11/16/1951.

The experiences of Group Health

A letter to editor in the Port Angeles Evening News April 16, 1965, presented the story from a proud member’s perspective:

As a member of the Group Health Cooperative of Puget Sound during the Forties, I well remember the efforts of the AMA to put Group Health out of business. Methods used included, denial of membership in local medical societies to Group Health doctors, denial of hospital privileges to Group Health doctors and their patients, and plenty of good old fashioned slander. Needless to say, as a true cooperative, the services of Group Health physicians were not being ‘sold at a substantial profit by a third party.’ Convicted of criminal conspiracy under the antitrust laws, the AMA fought the case to the U. S. Supreme Court — and lost.

The landmark legal decision in this fight was Washington Supreme Court case of Group Health Cooperative of Puget Sound et al., Appellants, v. King County Medical Society et al., November 15, 1951. Group Health fought back after it experienced “unfair and illegal fetters placed upon its service and growth.” In November 1949, it brought this suit asking for an injunction and damages.

An Associated Press news item in the Walla Walla (Washington) Union-Bulletin, November 16, 1951, “Court Ruling Hailed”:

Group Health Cooperative of Puget Sound Friday hailed as a “victory for free enterprise” a state Supreme Court ruling that King County Medical society policies toward the co-op violated the anti-monopoly law. The Washington Supreme Court ordered the King County Medical Society to stop boycotting Group Health Cooperative. Organized medicine was indicted for violating the Sherman Antitrust Act in its efforts to suppress Group Health.

Eventually, both plans established a more collegial relationship with their private practice peers. One of the founding Permanente physicians, Dr. Cecil Cutting, explained:

… the American Medical Association set up a committee to study provision of medicine in the country. They came out and examined us and gave a report that we were providing as good or better medical care as in the community. That sort of set them back a ways and now, we are fully accepted and I think in many times envied because of the practice, the coherence, the fundamentals of our group practice pre-payment that has tested the time and I think proved an excellent way of practicing medicine.

Dialogue about the “best” form of health care remains a vibrant topic of national conversation. Physicians, staff, and resources of the now-joined pioneering health care organizations Kaiser Permanente and Group Health are leading the conversation.

 

Part 1 of this article
Short link to this article: http://k-p.li/2y1SWZj

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Lights, Camera, Action: Kaiser Shipyards Play a Starring Role

posted on September 6, 2017

Lincoln Cushing
Heritage writer

 

“Man from Frisco” movie poster, 11×14″, 1944.

“Action!”

When Hollywood descended on the sprawling, bustling Kaiser Richmond shipyards during World War II it was sure to cause a buzz. Beside the standard patriotic Home Front promotion films of shipbuilding, such as the classic documentary “We Build Tankers,” the entertainment industry also tapped into the natural energy of the yards for two major motion pictures.

The first was “Man from Frisco.” It was based on the script “Man from Brooklyn,” written by George Carleton Brown and directed by Robert Florey (1900-1979). Brown would later write screenplays for the 1960s TV comedy series McHale’s Navy.

The second major wartime film shot in the Kaiser shipyards was “Since You Went Away,” released June 1944. It was written and directed by David O. Selznick and starred Jennifer Jones, Claudette Colbert, Joseph Cotton, Shirley Temple, and Lionel Barrymore.

Stills from “Man from Frisco” in Fore ‘n’ Aft, 5/19/1944.

“Man from Frisco” was a fictional story based on the iconic industrialist Henry J. Kaiser, named Matt Braddock in the film and played by actor Michael O’Shea. Other leading roles were played by Gene Lockhart, Dan Duryea, and Anne Shirley.

The plot involved upstart Kaiser and his innovative shipbuilding practices locking horns with a veteran local competitor. The first clues of the film surfaced December 7, 1942, when Republic Studios announced their most ambitious motion picture, initially titled “Victory Fleet.” News accounts noted that “It is with ships, and more ships, that Uncle Sam will avenge the Japanese sneak on our fleet at Pearl Harbor. Certainly, no man stands out in our defense effort more colorfully than Kaiser, who believes in getting ships out first and talking about it later.”

Alas, the film did not do well with many critics. The New York Times reviewer Bosley Crowther sniffed “…Some of the shipyard scenes are vibrant, and the documentation of building is good. But you can’t expect much from a picture that is so obviously propped up on clichés.” The Hollywood Reporter reviewer termed the picture “disappointing” due to its “melodramatic Hollywood treatment,” despite it containing “numerous absorbing shots of the great shipyards at Richmond, Calif., and along the line a fund of extremely interesting information is given concerning the high-speed operation and how they evolved.”

Photos of filming of “Man from Frisco” in Fore’n’Aft, 11/19/1943.

Some reviews were more positive, focusing on the patriotic message of home front workers:

There are thousands of “extras” in Republic’s dramatic new picture who receive no screen credit. These “extras” are the Americans who are employees of a shipyard in Richmond, where much of the background material for the screen plays was filmed. Those men and women are the people about whom the story is concerned. Working twenty-four hours each day, they keep American ships sliding down the ways to the sea to take food, men, and equipment to the battlefronts of the war.

Filming in the Richmond shipyards (and nearby Point Richmond) caused quite a buzz. The weekly Kaiser shipyard newspaper Fore ‘n’ Aft wrote about it November 19, 1943, with photos [above, right]:

Republic’s Director Robert Florey points the camera at a bit of Yard One. The film -“Man from Frisco” – is about the guy who brings prefabrication to shipbuilding. Naturally, you’ll want to see it. Paramount gets Yard One’s main drag and home-bound workers. So, you’re in pictures!

When it opened May 18, 1944, in Oakland, Richmond, and San Francisco, Fore ‘n’ Aft carried this commentary:

If this is the way we look to Hollywood – and it apparently is, since Stephanie Bachelor ploys a woman shipbuilder in Republic Pictures’ “Man from Frisco” – then all we can say is, “Gosh!” Background shots for this movie of the life and loves of a shipbuilding executive were obtained in our own yards. That dazed look in Stephanie’s eyes is the result of not wearing flash goggles.

“Man from Frisco” got a rousing revival in the summer of 2010 when it was shown at the recently refurbished S.S. Red Oak Victory ship at Kaiser Richmond shipyard #3 with historical context provided by Kaiser Permanente Heritage Resources consultant Steve Gilford.

Film stars Jennifer Jones and Anita Colby in the Kaiser Richmond shipyard, in Fore ‘n’ Aft, 8/9/1944

In ”Since You Went Away,” the shipyards were merely a backdrop to the poignant home front story about a housewife who struggles to care for their two daughters and a pair of lodgers while her husband is off in the war. NYT’s critic Crowther bemoaned its almost 3-hour length and thin plot. But at the 1945 Oscars it won Best Music, Scoring of a Dramatic or Comedy Picture.

Again, Hollywood stars in the shipyards were a welcome bonus during the grueling frenzy of war production. Fore ‘n’ Aft, September 8, 1944, published a photo [right] with the caption:

Wearing a becoming backdrop of 5,000 Yard Three workers, movie star Jennifer Jones visited Richmond last week. Inset, Anita Colby of Selznick Studios, who caused the Big Wind of 1944 hereabouts when she appeared with Jennifer. You know, whistles.

Whistles, indeed!

 

Short link to this article: http://k-p.li/2xbLlLo

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A More Perfect Union: How Labor Paved Way for Employer-Sponsored Health Care

posted on August 30, 2017

Lincoln Cushing
Heritage writer

 

The factory’s got a good medical plan
And, cousin, I’m a union man.
-Warren Zevon, “The Factory,” 1987

 

“Permanente’s First and Largest Coastwise Group,” Planning for Health, Fall 1951.

For more than 60 years, millions of Americans have gotten health care insurance through their work. Despite employment changes in the American economy, that sort of coverage is still enjoyed by more than half of the non-elderly population. But it wasn’t always that way. The hard work of organized labor was instrumental in making employer-sponsored health coverage a cornerstone of the human services safety net.

Henry J. Kaiser’s workers at the Grand Coulee Dam (1938-1941) enjoyed a well-run prepaid health plan as part of the job, and after the unions insisted, their families were able to join. The same benefits later applied to Kaiser’s 190,000 defense workers during World War II.

But this was an anomaly. Most American workers had nothing remotely close to a nonindustrial health care plan, even in the booming years after the war. That would change in 1948 and 1949 with two key labor law rulings, W. W. Cross & Company, Inc. v. United Steelworkers of America, CIO and Inland Steel Co. v. National Labor Relations Board, which established a precedent for union contracts regarding hospital and surgical benefits for employees and their dependents.

The first case involved the union at Pacific Coast Steel Co., Local 1069, in the San Francisco Bay Area, which selected the Permanente Health Plan (now called Kaiser Permanente) for its members and requested that employers provide payroll deductions for health care. Bethlehem Steel Company (which acquired Pacific Coast Steel in 1930) disputed their right to make such a decision. The union brought the issue to court, and won.

Permanente pediatric clinic at 515 Market St, San Francisco – nurse giving Patricia Nisby, daughter of ILWU Local 10 member Wiley Nisby, a shot. ILWU Dispatcher, 10/13/1950.

With the Inland Steel case, trial examiners from the National Labor Relations Board ruled that the employers were guilty of unfair labor practices in not consulting the Steelworkers Union when they put insurance and pension plans into effect. The examiners in both cases directed the companies to bargain with the union on the type and extent of these plans.

Inland Steel appealed, but on September 23, 1948, a higher court affirmed the NLRB position and ordered Inland Steel to bargain with the CIO union concerning retirement pension plans. This ruling applied to all unionized companies engaged in interstate commerce.

The door to employer-sponsored health care plans had been opened, and hundreds of thousands of working people benefitted. This was a major step forward in building public expectations that medical care be affordable and accessible. The two rulings fundamentally shifted organized labor’s role in defending and expanding workers’ rights.

In a key example of the ruling’s impact, the International Longshore and Warehouse Union approached the Permanente Health Plan in 1949 about covering their membership. Permanente was attractive to the ILWU for its racially integrated facilities and labor-friendly record during the war. The January 6, 1950, ILWU newspaper The Dispatcher announced the new health plan, and by year’s end, 90 percent of eligible members had signed up.

Thank you, organized labor — you not only brought the weekend to our regular work week, you brought us the employer-sponsored health plan. And on this particular Labor Day weekend, let’s remember and honor the gains made by unions.

 

Special thanks to ILWU archivist Robin Walker, who has put their newspapers from 1932 to present online.

A longer version of this article appears in The Stansbury Forum.

Short link to this article: http://k-p.li/2xyBU5r

 

 

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Mid-Century Struggle for Health Care: Standing Up to the Medical Establishment

posted on August 25, 2017

Lincoln Cushing
Heritage writer

 

Part 1 of 2

Kaiser Foundation Health Plan brochure, 1945

Health care was a hot-button topic in the years after World War II. And two of the biggest targets were the then Permanente Health Plan (now called Kaiser Permanente) and Group Health Cooperative of Puget Sound.

Henry J. Kaiser and Sidney Garfield, MD, had paired up to provide health care for Kaiser’s 190,000 West Coast home front workers in 1942, and the plan opened to the public in 1945. Group Health began in 1947 and, as of 2017, is now part of Kaiser Permanente. Both were models of care, featuring the common-sense principles of prepayment, prevention, and group practice.

The traditional private practice fee-for-service medical establishment wasn’t too keen on competition, especially when it became clear that these new affordable plans were popular. Professional groups such as local medical societies and the American Medical Association, tried to shut down these upstarts. Physicians were frequently shunned and denied access to practice in local hospitals.

Access denied

Kaiser Permanente medical economist Avram Yedidia recalled that in San Francisco in 1948, when about 1,000 city employee family members joined the plan, the Permanente Foundation had to rent a building at 515 Market Street and purchased a small hospital because “…we couldn’t get hospital privileges for our doctors in any San Francisco hospital.” Yedidia further explained:

“One of the major obstacles that programs such as ours faced at that time was the unavailability of hospital privileges for their physicians. This remained a national problem for years to come. One of the most effective tools for stifling the growth of group practice prepayment plans was to withhold hospital privileges from physicians associated with them.”

515 Market St (at First St ) – Permanente’s first San Francisco clinic site 1948-1955

Until 1954, San Diego County Medical Society bylaws stated that physicians engaged in prepay medical practice were unethical and therefore were ineligible for membership, and hospital bylaws required physicians be members of the county medical society to secure privileges to hospitalize patients. In Oregon, Kaiser Permanente lawyer Robert Ridgely described having to threaten an antitrust lawsuit against the Marion County Medical Society for conspiring to refuse privileges to the Permanente doctors. And Scott Fleming, Senior Vice President of the Kaiser Permanente Central Office, noted in an oral history that as late as 1969, when Kaiser Permanente expanded to Colorado, physicians were only allowed to use two of the four hospitals in Denver.

It was ironic that Henry J. Kaiser, a fervent anti-communist and one of America’s preeminent capitalist industrialists, found himself defending his health plan from charges that it was “socialistic.” He genuinely believed that his plan was simply the best.

Fending off legal challenges

For Permanente, things came to a head in October 1947 with a legal battle started by the Alameda-Contra Costa Medical Society. After a two-day hearing the California Board of Medical Examiners found Dr. Garfield, at the time the sole proprietor of the medical group, guilty of “employing unlicensed physicians and unregistered interns.” The Board placed Dr. Garfield on probation for five years and suspended his license for one year, but withheld the suspension provided he abided by state law.

Five of the six charges against Dr. Garfield involved hiring doctors at the Oakland Permanente hospital who were not licensed to practice in California. The sixth charged him with keeping a doctor on the staff until 1946, although his license had been revoked in 1943. The charge of not registering interns arose when Garfield explained that the five doctors were undergoing training.

Dr. Garfield wins fight with medical board, 11/11/1948.

Dr. Garfield defended his actions, saying “The procedure which we followed over a period of years in our training program was the same as that followed in other teaching institutions in this state, such as Stanford University and the University of California.” Of the approved hospitals in the state, only Permanente has been singled out and charged with technical violations, Dr. Garfield added.

Dr. Garfield appealed the decision. At the same time, one of the targeted physicians, Clifford Keene, MD, was issued his license after a two-day grilling by the Board of Medical Examiners and departed to run the employee medical program at Kaiser’s Willow Run, Mich., automobile plant.

Dr. Garfield’s case was eventually dropped, and his right to practice restored in 1948, but the blows had landed.


Part 2
, where we learn more about the response by the Permanente Health Plan and the similar experiences of Group Health Cooperative.

Short link to this article: http://k-p.li/2vd5Oi5

 

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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.

Short link to this page: http://k-p.li/2wb8axr

 

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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.

 

Short link to this article: http://k-p.li/2i1GmGm

 

‘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.”

 

Short link to this article: http://k-p.li/2wMhZ1U

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Skateboarding – That Dangerous “Fad”

posted on July 27, 2017

“Doctors Concerned Over Skateboard Fad,” Planning for Health, 1965

Throwback Thursday

“Doctors Concerned Over Skateboard Fad”
Planning for Health
[Kaiser Permanente member newsletter], Fall 1965.

Skateboarding, a growing menace among many Bay Area residents, is beginning to concern orthopedic doctors, who are now treating many difficult fractures and head injuries as a result of the fad.

Skateboard patients normally range from age nine to twelve years old. Usually they sustain fractures of the extremities which can sometimes be serious. When a skateboarder loses his balance, the board tends to shoot off in one direction, the rider in another. Unlike the surfer who falls into water, the skateboarder hits hard pavement.

Even adults apparently succumb to the challenge of a skateboard. Among a group of patients recently treated at the San Francisco hospital Orthopedic department for skateboard fractures, were nine adults, including three fathers and two housewives.

Photo caption:

“Health Plan member, Elaine McLeish, demonstrates how to use a skateboard. The recent fad has caused concern on the part of some doctors who are now treating many injuries as a result of it.”

Editor’s note:

California Vehicle Code section 21212, passed in 2003, requires that a person under 18 who rides on a skateboard is required to wear a helmet. Even adults like Elaine would be wise to observe common sense in wearing protective gear. Please ride safely.
-Lincoln Cushing, Kaiser Permanente Heritage Resources

Short link to this item: http://k-p.li/2v1Qiou

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Tunnels, Trains, and Tubes: Kaiser’s Role in Building an Accessible Transit System

posted on July 14, 2017

Lincoln Cushing
Heritage writer

 

BART trans-bay tube built by Kaiser Steel being barged down Napa river, 1968.

Kaiser Steel was the backbone of San Francisco’s mighty Transamerica Pyramid in 1972. And, Kaiser Steel, and Kaiser Permanente, were both also involved in another major Bay Area construction project that opened the same year – the Bay Area Rapid Transit, or BART.

Henry J. Kaiser built the first West Coast integrated steel mill in Fontana in 1942 to supply plate for his seven shipyards, and by the 1960s he had fabrication facilities all over the world. The closest to San Francisco was located south of the town of Napa on the Napa River. Today it’s the Napa Pipe Corporation.

Kaiser Steel won the contract to build the transbay tubes, the tunnel through which the trains scoot back and forth between Oakland and San Francisco. The tubes were prefabricated sections 330 feet long, 48 feet wide, and 24 feet high. They were much more complex than a simple drain culvert, having to endure deep water pressure and earthquakes. Special Teflon-coated seismic joints allowed up to a foot of motion without damage.

BART also required tunnel liner rings – 27,000 of them. These were 36-foot-diameter behemoths weighing 6,500 pounds. Each one was composed of six giant fitted parts, and they reinforced 13 miles of tunnel.

A 2002 article in the Napa Valley Register burst with local pride in this accomplishment. Harold Halterman, Vice President of Kaiser Steel’s Fabricating Operations in Napa and Fontana, was quoted as saying “We kept a couple hundred people busy for five years. It was a fascinating time. People came from (all over the world) to see what we had done.”

And when Kaiser Steel was finished, a Kaiser Permanente employee took on a leading role in making BART accessible to all people

Harold Willson on new BART car with Easter Seal poster boy Eric Staley, 1972.

Harold Willson was coal miner with a crushed spine who arrived at the Oakland Permanente Foundation Hospital from West Virginia in 1948. At the Kabat-Kaiser Institute of Neuromuscular Rehabilitation in Vallejo, Calif., he regained mobility and went on to work for the Kaiser Foundation Health Plan. In the mid-1960s Willson, as a volunteer with the Easter Seal Society, became a staunch advocate for making the then-new BART more accessible. This included services we now take for granted, such as station elevators, ramps, chair-high water fountains and telephones, accessible bathrooms, lowered hand railings, and “kneeling” buses.

While BART was under construction, in 1968 California Governor Ronald Reagan signed Assembly Bill 7, into law, requiring public utilities constructed with state funds to be usable by the physically disabled. This added to BART’s projected costs – just adding elevators (originally, only escalators had been planned) at 28 to 33 stations was projected at $7 million. The city of Berkeley stepped up and offered to pay for the elevator in its Ashby station as a trial.

And it was worth it.

By 1972, an article in the San Francisco Chronicle boasted that “BART Leads Way in Transit System Aid to Handicapped.”

Whatever the strengths and weaknesses of the Bay Area Rapid Transit system, it can claim one admirable distinction- BART is the first rapid transit system in the world to offer 100 per cent usability, at almost every station, for the handicapped. This claim was made proudly today by Harold L. Willson of Alamo, himself handicapped, partly responsible for the installation of special facilities for the handicapped and elderly along BART’s 75-mile system.

According to Willson, “Accessible transportation is often the deciding factor between being dependent on society, friends or family and being independent within society. I’ll never forget that sense of freedom I experienced boarding a BART test train for the first time.”

Henry J. Kaiser was a doer, and once told his long-time attorney Paul Marrin “Don’t tell me what I can’t do.  Figure out a way to do it.” Although Kaiser had already passed away in 1967, surely he would have been proud of Halterman’s and Willson’s accomplishments.

 

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Mending Bodies and Minds – Kabat-Kaiser Vallejo

posted on July 7, 2017

Lincoln Cushing
Heritage writer

 

Physical therapy at Kabat-Kaiser Vallejo

Mark Wellman fell from a cliff and broke his spine in 1982 at the age of 22. A well-known mountain climber, Wellman went on to scale Yosemite’s El Capitan seven years later despite his injuries, and was the first person to climb the 3,000-foot cliff using only his arms. Two years later, he summited Half Dome, and later became the first person with paraplegia to sit-ski across the Sierra Nevada.

Wellman received physical therapy and rehabilitation treatment at the Kaiser-Kabat Institute in Vallejo, Calif. (also called the Kabat-Kaiser Institute of Neuromuscular Rehabilitation), now the Kaiser Foundation Rehabilitation Center and Hospital which is still in operation. The work in Vallejo built upon the distinctive and important physical rehabilitation work done under the direction of Herman Kabat, MD, at the Kabat-Kaiser Institute in Santa Monica, which operated from 1947 to 1962.

Henry J. Kaiser had purchased the Vallejo Community Hospital in March 1947 from the

Permanente Hospital, Vallejo, circa 1948

Federal Works Agency to serve the growing Permanente health plan membership in that corner of the San Francisco Bay Area. The innovative facility had been designed by noted architect Douglas Dacre Stone (1897-1969), who’d also designed Children’s Hospital Oakland and Peralta Hospital. The facility was larger than needed, and in June part of the campus was allocated to the new Kabat-Kaiser rehabilitation program. There was also a Kabat-Kaiser clinic at the Permanente Foundation Hospital in Oakland, but after living quarters were built in Vallejo in late 1947 the Oakland clinic only served outpatients.

Kabat-Kaiser Vallejo, from Collier’s article, 1950

A key impetus behind Kaiser’s involvement in physical rehabilitation was in response to his youngest son Henry Junior (1917-1961) contracting multiple sclerosis in 1944 and being successfully cared for by program director Dr. Kabat. The first Kabat-Kaiser Vallejo administrator was Felix Day, and the medical director of the physical therapy school was physiatrist Ora Leonard Huddleston, MD.

The center in Santa Monica primarily treated patients with polio and multiple sclerosis, but Vallejo handled a much wider population of patients with disabling conditions including stroke and spinal cord injury. A 1954 brochure for the Kaiser Foundation Health Plan specifically noted “Members are entitled to rehabilitation and treatment for polio after the acute and contagious state, provided they have had continuous membership since the condition arose, and it originated after April 1, 1954.”

UMWA patients arriving by Pullman train for Kaiser physical therapy, 1948

Interestingly, this last group included coal miners from rural mining communities in the Midwest and East. In 1947 legendary United Mine Workers of America leader John L. Lewis and the UMWA Welfare and Retirement Fund partnered with Henry J. Kaiser and the Kabat-Kaiser Institute to provide top-quality medical care and rehabilitation for injured miners. They came across the country on the Southern Pacific’s elegant “Gold Coast Limited,” and when they arrived some had to be handed out through windows because they could not be lifted from their berths onto gurneys.

One of the mine workers to benefit from rehabilitation at Vallejo was Harold Willson, who arrived in 1948 with a crushed spine. There he met his nurse and future wife, regained mobility, and went on to work for the Kaiser Foundation Health Plan. Willson became a staunch advocate for making the then-new Bay Area Rapid Transit more accessible with elevators, ramps, chair-high water fountains, accessible bathrooms, lowered hand railings, and “kneeling” buses.

Maggie Knott and Dr. Kabat, Kabat-Kaiser Vallejo, from Collier’s article

It was in these early years that great strides were being made in the use of physical therapies to treat neuromuscular disabilities. Dr. Kabat received national publicity in the early 1950s for his work at the Vallejo facility, including a major spread in the popular magazine Collier’s Weekly. The institutes, under the direction of Dr. Kabat and physical therapist Margaret “Maggie” Knott, pioneered the therapy called “proprioceptive neuromuscular facilitation.” Maggie Knott and another physical therapist, Dorothy Voss, published the first textbook on PNF in 1956. PNF has become internationally recognized as one of the most widely used and effective treatments for certain injuries and illnesses.

Wheelchair square dance, from Kabat-Kaiser article in Collier’s

It was also during these years that some in the medical establishment attacked the Permanente Health Plan as “socialized medicine.” Left-sympathetic Dr. Kabat became a casualty, and he resigned from KKI in 1954 to pursue private practice and engage in research. (Also targeted but never harmed was Rene Cailliet, MD, certified in physical medicine and rehabilitation and chief of Kabat-Kaiser Santa Monica). Sedgwick Mead, MD, from Harvard University, was appointed medical director of the Vallejo KKI facility and it was renamed the California Rehabilitation Center.

KKI programs included a range of occupational training such as shoe and watch repair. One of their more popular recreational programs was wheelchair square dancing. And a local sports page on March 16, 1950, noted that the Fifth Annual Hayward Area Open Basketball Tournament would host the “First civilian wheelchair basketball team in the world” the “Wheeling Warriors” from KKI, where they would tangle with the National Guard 49ers.

Outdoor physical therapy at Kabat-Kaiser, Vallejo, circa 1960

Because the PNF method works so well, the program at the Kaiser Foundation Rehabilitation Center in Vallejo continues to draw graduate students from all over Europe, South America, and Asia. Just as in the early years, all productive approaches are welcome in physical and emotional therapy. A recent article highlighted several patients whose recovery was greatly enhanced by the healing power of visual art.

Kabat-Kaiser Vallejo – mending bodies and minds since 1947.

 

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