The Story of Dr. Sidney R. Garfield: The Visionary Who Turned Sick Care into Health Care by Tom Debley, Jon Stewart

Abstract

THE STORY OF DR. SIDNEYR.GARFIELD: THEVISIONARY WHO TURNEDSICK CARE INTOHEALTH CARE byTomDebley in collaboration with Jon Stewart The Permanente Press, Oakland, California, and Portland, Oregon, 2009. Photographs, bibliography, index. 168pages. $19.95 paper. Everyone knows the Kaiser name, and spe cificallyHenry J. Kaiser. But how many know that Sidney R. Garfield was Kaiser's partner in the development of Kaiser Permanente, responsible forestablishing and expanding the principle ofprepayment health care combined with multispecialty group practice dedicated to prevention and maintenance of health? This short book, written by theDirector of theKaiser Permanente archives, tells Garfield's story,a narrative that isentwinedwith the rise of Kaiser Permanente. After completing his surgical residency in 1933at theLos Angeles County General Hospi tal, with thehelp of a loan fromhis father, Gar field constructed a twelve-bed hospital east of Los Angeles on the edge of the Mojave Desert. He named his small building theContractors General Hospital, aiming to provide medical care to the thousands ofworkers building the aqueduct to deliver Colorado River water to Los Angeles. Alonzo B. Ordway and Harold Hatch, both from the largest insurance company involved with theaqueduct project,became friendswith Garfield and viewed thehospital as essential in providing medical care to theworkers. Itwas Hatch who firstproposed a prepayment pro gram, amounting to a nickel a day per worker. Garfield immediately saw thathewould make more money by improving the health of the workers and preventing accidents; this insight was his unique contribution of combining pre payment with preventive health care. Finally, Garfield broadened theconcept ofprepayment by providing totalhealth care for theworkers and their families for another nickel per day paid by theworkers themselves. The concept worked, and Garfield prospered. Henry J. Kaiser's son Edgar was in charge of the consortium of contractors building theGrand Coulee Dam. When fatherand son wanted to provide medical care for thework ers on theGrand Coulee dam, they turned to Garfield. Edgar Kaiser supported the prepay ment and preventive care philosophy, and beginning in 1938, Garfield organized a group practice in the Mason CityHospital at thedam site.Garfield provided total familyhealth care for50 cents permonth foradults and 25 cents per child. When World War II made shipbuilding magnates of theKaiser family,Garfield, now thirty-five years old, was recruited to care for thousands ofworkers infour shipyards inCali fornia and Oregon, using his now-established program.With the end of thewar, many of the shipyardworkers remained in the West and, already familiarwith prepaid health care, eagerly signed up with the new non-profit Permanente Health Plan.When labor unions joined the program, the size and resources exploded. From near extinction in 1945, by 1950, there were about 250,000 members, and the Permanente Medical Group had 125 physicians. Eventually, Henry J.Kaiser and Garfield came to an impasse, culminating in a pivotal organization meeting in 1955. Kaiser aggres sively increased his involvement in the pro gram, and theKaiser physicians began to chafe under Garfield's direction. An agreement was reached in 1955, removing Garfield from his leadership position, and theorganization was named Kaiser Permanente. The name "Perma nente"was the suggestionofBess Kaiser,Henry J.'s first wife. On theKaiser private grounds on the San Francisco peninsula, awaterway that flowed year around bore the Spanish name Permanente Creek. Garfield turned his attention to designing and building new hospitals with innovations that earned critical praise. With enormous Reviews 643 foresight in the 1960s, he began to propose a reorganization ofmedicine with computers playing a central role ? thisat a timewhen the computer was amassive IBM machine using punch cards.He fine-tuned theKaiser model into something he called theTotal Health Care Project,described inScientific American in 1970, that laterbecame theKaiser blueprint, caring for about 9million members and employing more than 13,000 physicians. Garfield died inhis sleep at age seventy-six, on December 29,1984. He lefta history that contains lessons for the present. As America struggles to provide effective and efficient health care in thetwenty-first century, many of theconcepts and plans being articulated can be found inGarfield's story.It would be useful for present-day legislators to read theKaiser his tory, as recordedbyRickeyHendricks in 1993 in his book entitledAModel forNational Health Care: TheHistory of Kaiser Permanente (Health...