By Steve Gilford
Senior KP History Consultant
A recent phone call brought me the sad news that Jeanne Wallin, wife of the late Ira “Buck” Wallin, MD, a Southern California Permanente Medical Group pioneer, had passed away this month at the age of 89.
I first met Jeanne a bit more than ten years ago when my interest in recording first hand accounts of the origins of Kaiser Permanente led me to her and Buck Wallin, one of the first Permanente doctors on the ground in Southern California.
In 1950, after just a few weeks at the Permanente hospital at the Kaiser Steel plant in Fontana, Calif., Permanente founder and executive director Sidney Garfield enlisted Wallin to open medical offices to care for longshoremen at Los Angeles harbor in San Pedro. This was the first expansion of the program into Southern California outside of the steel plant and the beginning of the Southern California Region.
After Buck’s death in 2002, I remained in occasional contact with Jeanne. A cheerful, articulate woman with an easy manner, she enjoyed reminiscing about “the old days.” Unlike others I had talked to about Dr. Garfield, Jeanne Wallin knew him neither as family nor as physician. He’d been a friend with whom she, her then-husband, Joe Lydon, and a group of other couples, would often share weekend afternoons and evening parties.
Permanente founder had movie star quality
Jeanne, a native of Oakland, Calif., had married Wallin in 1987 after the death of Lydon, a marketing consultant. It had been Lydon who, in 1972, had introduced her to Dr. Garfield. Before Jeanne met Sidney Garfield, Lydon told her, “You’ll like this man, he’s such a gentleman; everyone likes him.” Soon Jeanne and Joe had become close friends with Sidney, his wife Helen, Health Plan Regional Manager Karl Steil and Karl’s wife, May.
“Almost every weekend, Sid and Helen came down (to Alameda) so we spent a lot of time together.” What they all had in common was a fondness for boats and so much of their social time together was aboard either the Steil’s boat or their own, berthed near each other at Alameda’s Ballena Bay Yacht Club.
According to Jeanne, Dr. Garfield had a movie star quality. “He reminded a lot of people of Spencer Tracy . . . The women adored him.” Even so, she recalled, “He was very, very quiet around me.” However, after they’d become better acquainted, he began to open up a little.
“One day, we were cruising somewhere. He and I were sitting out in the cockpit and he told me all about designing the Oakland hospital. . . . and how originally he wanted to be an architect. He had a very quiet way about him. He was utterly charming. I could see why women liked him so much.”
Garfield pushed good health, not health plan
Dr. Garfield didn’t mind that she and her husband were not members of the Permanente Health Plan. In the 1970s when Jeanne mentioned to him that she and Joe were planning a trip to Europe, he insisted that they have a medical checkup before they leave. “You cannot go until you have a ‘multiphasic,’” he said.
The multiphasic program was basically a battery of screening tests that was offered to Kaiser Permanente members. The advantage was that in a short period of time, with minimal inconvenience, a patient could get a complete health examination. Sidney told them that if they went through the multiphasic examination before they left, they could leave the country knowing that they were in good health.
Garfield arranged simultaneous appointments for the couple at the Oakland Kaiser Permanente hospital. “Of course, my husband went one way and I went the other . . . Sid personally took me through the whole multiphasic. We’d have little stops: open a door and go in and there’d be cake and cookies and a cup of coffee. It was the most wonderful way to get all these physicals done and over with.”
Garfield as architect and planner collaborated with Wallin
She remembered another one of the Garfield innovations she’d seen that afternoon: colored lines painted on the medical center floors to help patients find their way easily from one test station to the next. “Well, I thought it was fantastic, following the lines. He told me how he’d invented all this stuff.
“Then he showed me through the whole hospital and how he designed the rooms to be between the central corridors and the outside ones off of the center corridors. It was so charming of him to share this with me, and you could tell the great pride he had in it. Great pride. I felt very honored,” she related.
In the mid-1950s, Dr. Garfield collaborated with Medical Director Wallin on the design of the 56-bed Harbor Hospital in Harbor City. When membership grew, Wallin and Garfield worked together to plan that hospital’s expansions. In the early 1960s, the two men again collaborated to plan and launch the new Bellflower service area, including the layout of the hospital, the budgeting and selection of the 60-physician staff.
In 1966, when the health plan took over the financially troubled San Diego Community Health Association, Wallin became the founding medical director there. Dr. Wallin served on the board of the Southern Permanente Medical Group until 1973. He stayed on in San Diego as a member of the staff there for several more years until he moved to the Bay Area.
When Jeanne met and married Dr. Wallin, she took great pride that Buck had played an important part in what had become the largest private medical care program in the world. Following her death, her family paid her a high tribute, “Jeanne embraced life in both difficult and joyous times.”
By Ginny McPartland
Affordable health care was an elusive commodity in 1930s America. Medical practice was becoming more sophisticated, and qualified doctors were in great demand. Consequently, private professional care was out of reach for many Americans. Employer-sponsored health plans started to spring up in the late 1930s and early 1940s, but even those progressive prepaid plans were slow to add workers’ families to the coverage.
Permanente medicine, developed by industrialist Henry J. Kaiser and enterprising physician Sidney Garfield, was launched to take care of workers in Kaiser’s West Coast shipyards. The two had done this before: Garfield had set up a prepaid plan for workers on the Los Angeles Aqueduct project in 1933, and he and Kaiser had teamed up to care for workers at the Grand Coulee Dam in Washington state in the late 1930s.
The Kaiser-Garfield prepaid, group practice plan for shipard workers was progressive and exemplary by all accounts. Unlimited medical care for the individual workers was provided for 50 cents per week. But Garfield and his doctors had their hands full, so initially only the worker – not the family members – was covered by the health plan.
Stuart Lester of “Medical Economics,” writes in the February 1944 issue: “The principal threat to the permanence of the Permanente Foundation – which provides virtually unlimited medical care for 130,000 Kaiser shipyard workers in two states* is the workers’ complaint that it makes no provision for their families.”
The article continues: “The family problem is especially acute in the shipyard town of Richmond, Calif., where the ratio of physicians to population is something like 1 to 4,000 and where the only hospital facilities of any consequence are those provided by Kaiser’s Richmond Field Hospital.”
In Richmond, Portland (Oregon) and Vancouver (Wash.), nonsubscriber family members were treated for a fee. Office visits were $2.25. For maternity, $200 covered prenatal care, delivery, hospitalization, C-section if required, postnatal care, and care for the newborn. Employees at the Kaiser Fontana steel plant in Southern California were the exception. In 1944, Fontana workers could purchase complete coverage for a family of four for $1.80 a week.
Physicians debate how to cover families
“Medical Economics” writer Lester refers to three possible solutions proposed at the time: an expansion of the Permanente plan to include family members; an expansion into the Richmond area by the California Physicians’ Services (CPS) prepaid plan as operating in other war industry communities; or the development of a prepaid arrangement for families through a private physician network.
The California Medical Association (CMA) launched the CPS in 1939 to offer prepaid care to low-income families in California. Initially, the physicians association’s plan offered a “full coverage contract” that included all outpatient physician services. In 1942, CPS excluded the first two doctor visits from coverage to make the plan financially viable, according to the April 1943 issue of the CMA’s “California and Western Medicine.” In 1943, CPS, the precursor to Blue Shield, had 39,000 commercial members, 5,100 government rural health program subscribers and a total of 32,000 war housing resident members in Vallejo, Marin, Los Angeles and San Diego.
“Dr. Sidney R. Garfield, Kaiser’s medical director, sees two obstacles to an extension of his program to include families: One is opposition by the local medical societies. The other is lack of facilities – particularly in the hospital at Richmond,” Lester wrote in “Medical Economics.” The article noted that expansions of the Richmond Field Hospital and the Permanente Foundation Hospital in Oakland were under way.
The second proposal – having CPS provide family coverage for Richmond area workers – had been tried previously and failed. In 1942, CPS had offered a family plan in nearby El Cerrito and was not able to attract enough members. The coverage for non-Kaiser workers was enticing: a $5 flat fee no matter how many family members. It wasn’t practical for Kaiser employees, however. To take advantage of the CPS plan, a worker would have to buy his or her own coverage for $2.16 a month and then pay $5 for the rest of the family.
According to the “Medical Economics” article, solving of the family care issue by fee-for-service doctors was doomed from the beginning. A shortage of private doctors and inadequacy of medical facilities made any such plan unfeasible. Also, California private practice physicians were admittedly just tolerating the Permanente model of prepaid, group practice with salaried physicians. One private doctor told the magazine: “The Kaiser-Garfield groups are doing a job right now that is aiding the war effort, and are doing it well. But we don’t like their system.”
Kaiser extends coverage to shipyard families
In the spring of 1945, the Permanente medical plan, now with expanded facilities to accommodate more members, was extended to the families of all Kaiser shipyard workers. “Medical Economics” reported the details of the Permanente family care plan: for $117 a year ($2.25 per week) for a family of four, coverage was extensive. It included 111 days of hospitalization, complete diagnostic services, necessary drugs, physician services at home or medical office, major and minor surgery, and ambulance service within a 30-mile radius. Members paid an extra charge of $60 for comprehensive maternity care, $15 for a tonsillectomy and $2 for a house call.
“Medical Economics” concluded the article with this statement: “Insurance men pointed out that the total annual cost for a family of four, $117 a year, is an amount which has generally proved to be too high for any wide participation on a voluntary basis.”
Workers who left the shipyards could maintain coverage for a “slightly higher” premium as long as they continued to live in the service area. This retention provision foreshadowed Kaiser and Garfield’s plans to keep the Permanente medical care plan alive after the war industries shut down.
*Kaiser shipyards health plan actually took care of workers in three states, California, Washington and Oregon, and enrolled up to 190,000 members at the peak of the war.