July 22, 2015
Kaiser Permanente as a national model for care
Kaiser Permanente proposed a revolutionary national health care model after President Harry S. Truman took office at the end of World War II.
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 nationwide 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” 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 the 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.
