Posts Tagged ‘Harry S. Truman’

Celebrating 50 Years of Medicare

posted on July 29, 2015

Jennifer Downey

Healthgram 1965-Winter

Kaiser Permanente member newsletter, 1965

On July 30, 1965, President Lyndon B. Johnson signed the Medicare Bill into law, immediately granting 35 million older and disadvantaged Americans access to the medical care they needed. He praised the country’s aging World War II veterans as the nation’s “prideful responsibility [who] are entitled … to the best medical protection available,” and thanked former President Harry S. Truman, one of the program’s original architects, for “plant[ing] the seeds of compassion and duty which have today flowered into care for the sick, and serenity for the fearful.”

Although “medical care as a right” was a boon to those who would receive coverage, the question of exactly how a national health insurance system would function in terms of administration, organization and approach of care delivery quickly enmeshed government and private sector, industry and commerce, in a heated debate that continues today. And Kaiser Permanente, as one of a number of private health plans established prior to Medicare’s inception, was swept up into a national health care tornado.

An aging population

Following 16 years of depression and war, 1946 was a turning point as America’s peacetime economy boomed. The workforce filled jobs and factories, and most workers received health coverage through their employers or unions. The aging and disadvantaged segment of the population, however, was falling behind. Accessibility and affordability of health care had quickly become out of their reach, yet their numbers continued to grow: A health care crisis was looming.

No one argued that there wasn’t an urgent need for large-scale care; however, the debate over how to structure and administer it was just ramping up, and would intensify over the next decade.

The Medicare proposal

The Medicare program was characterized by 1) government administration of the program and funding through payroll taxes, and 2) a continuation of the prevailing fee-for-service model of health care. This second characteristic directly conflicted with Kaiser Permanente’s model of prepaid health care. The organization saw the fee-for-service system not only as a challenge for its own structure to integrate, but maybe more importantly, as a faulty approach to delivering health care.

“Under the prevailing fee-for-service system, income of doctors and hospitals is directly related to the volume and price of the services they provide. Illness produces income,” read Kaiser Permanente’s 1965 annual report.

Scott Fleming, Kaiser Permanente attorney and executive, echoed that sentiment: “[T]he industry’s purpose is wrongly conceived; the industry should develop the capability of delivering comprehensive health care for people rather than merely providing episodic treatment for patients.”

Kaiser Permanente’s approach of total health — health care versus sick care — influenced the national debate early on. Other private and voluntary health plans also joined the fray, as they braced for the impact Medicare would bring.


Visitors at Kaiser Permanente Sacramento Hospital open house, 1965

Medicare enacted July 30, 1965

While key Kaiser Permanente personnel remained active in policy dialogue around Medicare’s structuring, the organization had been intensely preparing for the program’s integration into its own (very different) system. Its priority was to maintain its standard of excellent care for all members through the coming transition — a shift that would bring an influx of new Medicare beneficiaries and see the conversion of a portion of its existing members to Medicare covered. Kaiser Permanente’s health plan reached out to members, encouraging those who were eligible to enroll in Medicare, and adapted benefits and coverage to maintain best care for beneficiaries.

It also undertook a massive training effort in its facilities to ensure that staff was prepared and the integration was smooth. The effort paid off — implementation was a huge success. Life magazine’s Sept. 3, 1965, issue reported how catastrophic Medicare implementation was for most medical facilities, but spotlighted Kaiser Permanente as a success story.

An evolving program

Medicare has evolved greatly in the five decades since its enactment. It has seen major reforms, amendments, new legislative acts and bills, and has been the subject of ongoing scrutiny around budgetary, administrative and quality issues. The heated debate continues — how best to administer it, fund it, and ensure that it’s efficient yet effective.

That the argument continues isn’t surprising, given the mammoth, complex system that it is.

Today’s seniors benefit from early visionaries

In 1958, Kaiser Permanente consultant and health care economist Avram Yedidia voiced the imperative to “face the responsibility of providing health care or protection for [those] which we presumably show the most concern — the sick, the unemployed, the retired, and the aged.”

Despite Medicare’s growing pains over the last 50 years, older and disadvantaged Americans continue to benefit from accessible, affordable health care through the program. They receive resources and coverage, guaranteed, just as the program’s early architects envisioned.

As a participant in Medicare since the program’s inception, Kaiser Permanente has been influential in improving the program’s service model to deliver better coverage and care to seniors. For example, it pushed for a capitation model — resulting in Medicare Advantage — which serves as a substitute for fee-for-service, and it helped develop the Medicare Star Quality Ratings, which rewards health plans for excellent service and care.

Over the past five decades, Kaiser Permanente has delivered high-quality health care to millions of Medicare members throughout their lifetimes. As a recognized frontrunner of leadership and innovation in Medicare, Kaiser Permanente has and continues to build initiatives, programs and institutes for the improvement of health care and coverage for seniors. Its Medicare plans in California consistently receive top national ratings for excellence in care and service from the U.S. Centers for Medicare & Medicaid Services, and its health screening rates are among the best in the nation, according to the 2014 National Committee for Quality Assurance’s Quality Compass® data set.

The bold call for compassion by Medicare’s early visionaries fundamentally changed the shape of health care for older Americans today and beyond — and at 50, Medicare continues to serve those who need it most.


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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.


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Henry J. Kaiser: America’s No. 1 Civilian Hero

posted on April 13, 2010

By Tom Debley, Director, Heritage Resources

Henry J. Kaiser was featured as "Shipbuilder No. 1" in a 1943 Real Heroes comic book.

Sixty-five years ago this year Henry J. Kaiser emerged on the American scene as the single most popular civilian hero of World War II, which came to an end in 1945.

It was a Roper Poll that spring that reported that—in the words of Stephen B. Adams, author of “Mr. Kaiser goes to Washington”—the American public “believed Kaiser had done more to help the president win the war than any other civilian.”

A Gallup Poll a few months later found Kaiser at the top of the list of people Americans thought should be president—with Kaiser trailing only Generals Douglas MacArthur and Dwight Eisenhower. It is no surprise, then, that Kaiser was on President Roosevelt’s short list for vice president when he chose Harry Truman in the election of 1944.

Why not Kaiser? One answer comes from Michael Dobrin, guest curator of a special exhibit on Kaiser’s life at the Oakland Museum of California in 2004, who concluded Kaiser was too progressive for Democratic Party leaders.

“…Conservative party insiders—probably sensing coming postwar struggles over civil rights—balked at his overt advocacy of voter education, voters’ rights and support for unions,” Dobrin wrote in The Museum of California Magazine. “His name was dropped from the list.”

The public’s admiration for Henry Kaiser—whose most enduring legacy is co-founding with surgeon Sidney R. Garfield the medical care program that bears his name—lasted up to and beyond the end of his life in 1967. Indeed, he was so beloved that when he died in 1967 mourners flooded his memorial service with more than 20,000 white and red roses – said to be the entire supply of all florists in the San Francisco Bay Area. This was in addition to thousands of orchids and other flora from people in the Hawaiian Islands.

As President Lyndon B. Johnson said in condolences sent to Kaiser’s family, “Henry J. Kaiser embodied in his own career all that has been best in our country’s tradition. His own energy, imagination and determination gave him greatness—and he used that greatness to give unflaggingly for the betterment of his country and his fellow man.”

Today, of course, his efforts—and the legendary labor of almost a quarter million men and women of all races who worked for him in his West Coast ship building operations—are honored by the Rosie the Riveter / World War II Home Front National Historical Park in Richmond, Calif., which celebrates its 10th anniversary this year.

In addition, the newly renovated Oakland Museum of California will reopen May 1 with its first major redo in nearly 40 years. Its completely new Gallery of California History will include Henry J. Kaiser. According to the museum, the theme of the gallery will be Coming to California—“an idea that evokes not only the arrivals and departures of people throughout human history and their interactions with the inhabitants already here, but also the notion of coming to terms with the influence of California on our individual and collective identities.”

Late last year, Kaiser also was inducted into the California Hall of Fame and is featured in an exhibit at The California Museum  in Sacramento.

Interested in learning more about Henry J. Kaiser? Here are three good books, any one of which you might find in a local library (or for sale online):

“Henry J. Kaiser: Builder in the Modern American West,” Mark S. Foster, University of Texas Press, Austin, Texas, 1991.

“Henry J. Kaiser: Western Colossus,” Albert P. Heiner, Halo Books, San Francisco, Calif., 1991.

“Mr. Kaiser Goes to Washington, The Rise of a Government Entrepreneur,” Stephen B. Adams, The University of North Carolina Press, Chapel Hill, North Carolina, 1997.

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