Health Care Reform--A History of Prevention

You asked for it. Here it is.

These are my thoughts on health care reform in the current state of media attention the issue.

I like Michael Moore. I enjoyed his movie about the war. I took the kids to see him when he came to speak at the Del Mar Fairgrounds. I am glad that health care reform is being discussed. I am glad that the movie is opening up the country to dialogue on this important issue. I'm glad that the movie noted how much money Hillary is taking from Pharma. I do disagree however with the attacks Moore makes on Kaiser Permanente. Some of them are factually inaccurate, which causes questions about whether he is indeed an accurate factual historian on many of the health care issues he treats in the movie.

I have seen the underbelly of Kaiser Permanente. Even so, I believe in the mission of Kaiser Permanente. That mission is to provide our members affordable, quality health care that is delivered by caring and committed professionals. I take my children to Kaiser Permanente for care. There is no greater vote of confidence.

I know and see that the physicians of Kaiser Permanente get their incentives based on patient satisfaction surveys (MAPS/TOPPS) not based on saving money or denial of care. I fill out the survey whenever it comes in the mail and tell the truth. Twice this week I have been looked in the eye by caring KP providers. Both appointments were given to me within 24 hours of the request.

In my job, I can select any health plan I choose. I choose Kaiser Permanente because I believe in it.

Over the past 13 years, I have gathered and read a bit of history on Kaiser Permanente and at its founder Sidney Garfield. He was the innovator and founder of KP's current integrated care delivery system.

HISTORY

It all started back in 1933 during the Depression with a single surgeon and a 12-bed hospital in the middle of the Mojave desert. When Sidney R. Garfield, MD, saw the thousands of men building the Los Angeles Aqueduct, he also saw something else—an opportunity to provide health care for those workers. He borrowed money to build Contractors General Hospital, six miles from a tiny town called Desert Center, and began treating sick and injured workers.

But financing was difficult, and Dr. Garfield had trouble getting the insurance companies to pay his bills. And though not all of the men had insurance, Garfield refused to turn away any sick or injured worker. As a result, often he was not paid for his services. And it wasn't long before the hospital's expenses were far greater than its income.

So, Harold Hatch, an engineer-turned-insurance-agent approached Garfield with the idea that insurance companies pay a fixed amount per day, per covered worker, up front. This would solve the hospital's immediate money troubles, and also let Dr. Garfield put one of his pioneering medical ideas into practice: emphasizing prevention. By keeping people healthy and treating them early to prevent more serious problems later—rather than providing reactive care during and after illness and injury—Dr. Garfield introduced a new kind of care.

And so, along with preventive care, prepayment was born. For only 5 cents per day, workers received health coverage. For an additional 5 cents per day, workers could also receive coverage for non-job-related medical problems. Thousands of workers enrolled, and Dr. Garfield's hospital became a financial success.

In March 1938, Consolidated Industries (a consortium led by the Kaiser Company) initiated work on a contract for the upper half of The Grand Coulee Dam in Washington state, and took over responsibility for the thousands of workers who worked on the first half of the dam. Edgar Kaiser, Henry's son, was in charge of the project. To smooth over relations with the workers (who had been badly treated by their earlier employer), Hatch and Ordway persuaded Edgar to meet with Garfield, and in turn Edgar persuaded Garfield to tour Grand Coulee. Garfield then agreed to reproduce at Grand Coulee Dam what he had done on the Colorado River Aqueduct project. He spent $100,000 on renovating the decrepit Mason City Hospital and hired seven physicians.

The workers at Grand Coulee Dam brought dependents with them. You can still see the rows of little houses in the town of Grand Coulee that the workers and leaders lived in when they were building the Dam. The unions soon forced Kaiser to expand its plan to cover dependents, which resulted in a shift from industrial medicine into family practice and enabled Garfield to formulate some of the basic preventative care principles of Kaiser Permanente. It was also during this time that Henry Kaiser forged a friendship with Garfield which lasted until Kaiser's death.

In 1942 Garfield opened offices in Oakland to provide care to 20,000 ship yard workers, followed by the opening of the Permanente Health Plan. From the beginning, Kaiser Permanente strongly supported prevention as the best medical care and attempted to educate members on maintaining good health. In July of 1942 the Permanente Foundation was formed to operate Northern California hospitals linked to the outpatient health plans, followed by the creation of Northern Permanente Foundation for Oregon and Washington and Southern Permanente Foundation for Southern California.

The name Permanente apparently came from Permanente Creek, which ran by Henry Kaiser's first cement plant. Kaiser's first wife, Bess liked this name. The first Permanente Hospital opened in Oakland on August 1, 1942. Two more hospitals opened within the next few months. These hospitals were taking care of employees and their families who were working at the shipyards during the war. In 1944 Kaiser decided to continue the program after the war and open it up to the public. Meanwhile, during the war years, the American Medical Association(AMA) tried to stop demand for Kaiser Style prepaid managed care by promoting the rapid expansion of Preferred Provider insurance networks like the blues. At its inception Kaiser's system was challenged by the AMA. Physicians who participated in it were accused of being communist. Garfield fought off many attacks from state medical boards, the AMA and state and local medical societies. This integrated care delivery program with less physician billing and profit scared them because it looked like socialized medicine.

The end of World War II brought big drop in Kaiser Permanente membership; for example, 50,000 workers had left the Northern California ship yards by July 1945. Membership bottomed out at 17,000 for the entire system but then surged back to 26,000 within six months as Garfield aggressively marketed his plan to the public. In 1948, Garfield's medical practice was reorganized into a partnership, Permanente Medical Group. Then, most of the program's growth came from union members. Unions saw Kaiser Permanente care as more affordable and comprehensive than what was available from private physicians under the fee-for-service system. For example, Fortune magazine reported in 1944 that 90% of the U.S. population could not afford fee-for-service health care. Kaiser Permanente membership gradually started increasing from 154,000 in 1950, 283,000 in 1952, 470,000 in 1954, 556,000 in 1956, and 618,000 in 1958.

Sources: http://www.kp.org/, http://www.wikipedia.com/

TODAY
Today over 167,000 employees and physicians serve 8.7 Kaiser Permanente members in 9 states and the District of Columbia. These members have a choice when they enroll in employer sponsored health plans or are provided with government funded health care. Is Kaiser Permanente perfect? No....Is it better than dealing with hundreds of bills when you have an emergency incident or need care?
Yes. Sometimes you have to manage your care, but that is true everywhere, probably even more so in government managed systems.

For an article pointing out how well Kaiser Permanente does managing patients with chronic diseases please see: http://www.msnbc.msn.com/id/6738329

For Kaiser's position on the segments in Moore's movie which refer to Kaiser please see: http://xnet.kp.org/newscenter/leadership/hcreform.html

OTHER HEALTH CARE SYSTEMS

I've had health care in Canada. I remember when I was on vacation there in high school. We were there for spring break and my recent dental surgery (wisdom teeth removal) got infected and my face began to swell grossly. I was seen and cared for in a large gymnasium type ER, next to a homeless man I heard passes out or rests in the middle of streets to get a free ride across town courtesy of the government. Nearby, a woman was hemorrhaging and appeared to be waiting for someone to come clean up the blood and take care of her. At that stage of my life it was the most blood I had ever seen live. After about 5 hours of waiting I got the antibiotics I needed and a tampon shaped thing was put in my mouth to absorb the blood and the infection. I got to leave. It was a very strange experience for me. My mother was happy because the whole experience only cost about $70.00

My brother is a health care provider who now works within a few miles of the US Canada border. He performs radiation therapy on cancer patients. Many of his patients are Canadians who don't want to risk waiting their turn in Canada. Many health care providers along the US Canada boarder market directly to Canadian patients who will pay cash to come use our system.

This was true even 10 years ago. See: http://www.cmaj.ca/cgi/reprint/157/6/767.pdf

So, my question is: IF we do as Mr. Moore proposes and create a single payer system like Canada, where will WE go to get care when we can't afford to take the time to wait to get the care we need?