August 10, 2017

‘Good medicine brought within reach of all'

Paul de Kruif, microbiologist and writer, provides early accounts of Kaiser Permanente's health plan during World War II.

Paul de Kruif, from cover of The Sweeping Wind: A Memoir, 1962; photo circa 1926.

“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.”

Clipping from Reader's Digest article titled 'Tomorrow’s Health Plan — Today!'

"Tomorrow’s Health Plan — Today!” by Paul de Kruif, The Reader’s Digest May 1943.

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.”

De Kruif (1890 to 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-rays, 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.

Table of contents from May 1943 issue of The Readers Digest

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.”