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For the Record

Baltimore, Md.

In his otherwise interesting article in the Viewpoints column in the February 2 issue, Dr. Jan Leard-Hansson says that the Kaiser Health Plan "was launched" during World War II. While perhaps he is technically correct because World War II was the period when the Kaiser system of care supported its huge defense industry activities during the war, the beginnings of this "first clinic-based system of managed care" actually occurred in the 1930s, when Kaiser Industries had difficulty finding its employees health care in far-flung parts of the United States—the Grand Coulee Dam being a good example.

The source of my information is the Kaiser Web site at www.kaiserpermanente.org/locations/georgia/newsroom/history.html. It states, "In the 1930s, Sidney A. Garfield, M.D., had built a hospital in the Mojave Desert for construction workers who couldn’t afford insurance. He’d set up a system that let them pay him 5 cents a day for whatever health care they needed, and that prepayment system encouraged him to promote prevention. Henry Kaiser, who owned several industrial businesses, needed health care for 6,500 workers and their families at the Grand Coulee Dam. Dr. Garfield and Henry Kaiser turned a rundown hospital there into a state-of-the-art treatment facility and recruited a team of doctors to work in a ‘prepaid group practice.’ The plan was a big hit with the workers and their families. A few years later, in Richmond, Calif., America’s entry into World War II brought tens of thousands of workers pouring into the Kaiser Shipyards to build Liberty Ships, aircraft carriers, and the like. To provide health care for this teeming mass of 30,000, Kaiser brought Dr. Garfield and his innovative health care delivery system to San Francisco. When the war came to an end, Dr. Garfield and Henry Kaiser wanted to keep practicing this new form of health care delivery. So, on October 1, 1945, the Permanente Health Plan officially opened to the public. That first year, membership was 26,000."

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