Health care reformer ahead of his time

Book review: The Story of Dr. Sidney R. Garfield by Tom Debley and Jon Stewart

Sid Garfield’s plan for health care reform was so far ahead of its time that the organization he founded — Kaiser Permanente — still drives toward the vision, years after his death. (Disclosure: I am senior director of communications and brand management for Kaiser Permanente’s Colorado region).

This biography puts today’s health care discussion into historical context. As early as the 1930s, reform proposals that threatened the status quo were called “socialized medicine.” Garfield and uber-capitalist Henry Kaiser were “socialists” because they came up with a financing system that brought quality health care to working Americans. Workers and their employers “pre-paid” a few cents a day for full coverage. Garfield and his doctors and nurses were thus assured of a predictable revenue stream that enabled them to open clinics and hospitals close to work sites, such as the Grand Coulee Dam in Washington, the California Aqueduct in the Mojavi Desert and the WW II shipyards in Oakland.

The financing mechanism also encouraged Garfield’s team to reduce injuries and prevent illness. Workplace safety and the country’s earliest screening and vaccination programs blossomed under the arrangement. The smoking cessation, stress reduction and nutrition classes offered by Kaiser Permanente today have their roots in this core emphasis on what Garfield called “Total Health.”

Garfield’s approach brought doctors of all specialties together under one roof.  This “group practice” model is the environment in which doctors train, and it only made sense to continue it in day-to-day practice. Today, 60 percent of J.D. Power’s top 20 health care systems are group practice models, such as Kaiser Permanente, Mayo and Harvard Pilgrim.

I was surprised to learn that Garfield created hospital designs. His put the medical team closer to patients and segregated sterile hallways from public ones. He installed pneumatic tubes so that “medical records will get to the doctor before the patient does.”

Garfield championed computer-assisted medicine in the 1960s, recognizing that information is the currency of health care. With medical information collected and analyzed, doctors get granular about each patient’s needs and they get the big picture about diseases and effectiveness of treatments.

Garfield’s vision still unfolds today, as Kaiser Permanente recently completed an electronic medical records system that serves more than 8 million patients. But implementation of an EMR is only the first step toward Garfield’s vision of a coordinated system of health care rather than sick care. In the next steps, patients use the online access to their records to become more engaged in their health care, physicians and their teams use the information to tailor care precisely to the patient need, and researchers compare the effectiveness of treatment protocols.

Ironically, Garfield, who believed his health care model would “keep medicine out of the hands of government bureaucrats,” was called a socialist. President Obama, who has said the Kaiser Permanente model is one the nation should emulate, also is called a socialist. Perhaps we need to change the definition of socialist to: One who threatens the status quo.

Favorite Garfield quotes:

National health insurance, an attractive idea to many Americans, can only make things worse. Medicare and Medicaid — equivalents of national health insurance for segments of our population — have largely failed because the surge of demand they created only dramatized and exacerbated the inadequacies of the existing delivery system and its painful shortages of manpower and facilities.

It’s really time for us to revitalize our plan. I suggest a radical new idea — that we stop building hospitals and clinics for sick people. Let’s concentrate on a brand new type of facility — a new first in the world. Let us conceive a building for health — designed, streamlined, and geared to serve our healthy members.

This change from episodic crisis sick care to programmed total health care forces a new look at the recording and processing of medical information … Continuing total health care requires a continuing life record for each individual … The content of that life record, now made possible by computer information technology, will chart the course to be taken by each individual for optimal health.”