Balls and Walnuts
more than you ever wanted to know
I drank the Kool-Aid.
At our hospital in Antioch, a great big picture of Sidney Garfield decorates the lobby’s wall, side by side with photos of one of his first hospitals and quotations regarding his philosophy of medicine. The man was a visionary, recognizing in the latter days of the Great Depression the fundamental illogic of fee-for-service medicine and recognizing that a system providing incentive to keep patients well would ultimately benefit everyone.
At the retreat (my retreat, not Jake’s), they handed out a book to every one of us: Courage to Heal by Paul Bernstein, a fictionalized account of Garfield’s early days in medicine, his nearly disastrous attempt to found a hospital in the middle of the Mojave Desert to take care of aqueduct laborers, his introduction to Henry Kaiser, and the work they did together to change medicine. These guys came up with the idea of a health maintenance organization when those words still retained their meaning: a network of health care providers, facilities, and insurers whose business is most successful when they keep their patients healthy.
Nowadays, HMOs are often considered sharks that want to take premiums and administer as little care as possible. Speaking as someone inside the system, though, that’s not how Kaiser Permanente functions. They really do want their patients to stay healthy, and there’s an ass-ton of emphasis placed on preventive medicine.
Yes, I drank the Kool-Aid. I’m a believer.
When I learned that the Kaiser-Permanente model was conceived by a landsman, the son of a Russian Jew, who if not a socialist was at the very least considered a socialist by the medical establishment of his day, I got that warm and fuzzy all over feeling. I’m part of an organization that shares my attitudes about caring for people. I’m part of a pro-labor outfit, one that has been pro-labor from the start. I’m doing good. I’m part of the solution. And it doesn’t hurt the warm-and-fuzzies that they pay me well and give me great benefits for doing good and being part of the solution.
The book is mesmerizing — not because it’s well written (it’s not), but because the story itself is compelling. But the author is unapologetic about being inventive; this is a novel, and he comes right out and tells you in the acknowledgments, “I have tried to respect history wherever doing so served my purposes as a novelist, but wherever it did not I have, cheerfully, and without regret, ignored it.” So there’s no telling how much of this is BS. I figure the love story is probably all hooey, but the bones of the story are probably true.
Not to worry, though, because Tom Debley and Jon Stewart (not THE Jon Stewart. The OTHER Jon Stewart) have written a more factual account: The Story of Dr. Sidney R. Garfield: The Visionary Who Turned Sick Care into Health Care. Yes, I’m going to buy this puppy, even if it means I have to buy it from Amazon since Barnes and Noble doesn’t have a copy available. I figure it will be fun to learn the boundaries of Paul Bernstein’s creative license.
And besides, after a while, Kool-Aid’s addictive.
D.
Ever since we had Preston Maring http://www.permanente.net/homepage/kaiser/doctor/prestonmaring/ to speak at a conference I helped to organize, I have been a fan of KP policy. Good health begins with a good diet and I applaud KP for being a leader in promoting a healthy diet for it’s employees and the people who live near KP hospitals by sponsoring farmers markets on hospital grounds. When my husband spent 10 days at Vanderbilt Hospital recently it was shocking to note how many hospital employees were frankly obese. Having a McDonald’s on the premises did not help, but the cafeteria selections were not any better.
My parents are big fans of Kaiser. I hadn’t known the roots of Kaiser, which were clearly radical at the time.
It does feel good to belong to an organization with a bit more of a purpose than increasing shareholder value and making money.
Lucie, at Children’s Hospital Los Angeles we had a McDonalds in the lobby, AND residents got coupons so we could get free food there. Coronarilicious!
Kira, one thing I learned is exactly how much the medical establishment still brainwashes us regarding fee for service versus capitation. In private practice I wouldn’t have touched a capitated contract with a ten foot pole. Of course, capitation only makes good financial sense in a huge organization like Kaiser, where we have the resources to fund lots of preventive medicine programs. For an individual practitioner, capitation is a recipe for disaster, an absolute crapshoot.