Courage to Heal: The origins of the first HMO | Q&A with author Dr. Paul Bernstein

During the COVID-19 pandemic, Kaiser-Permanente is one of the great HMOs that is providing health care. In fact, Kaiser was the FIRST ever HMO that grew out of a small medical facility in the Mojave Desert. The historical fiction Courage to Heal tells of how it had to fight the existing medical system to create a new system that could provide affordable care. This fast and exciting read was written by a Kaiser-Permanente doctor who wanted to capture the early history of this great institution.

Courage to Heal is currently available at a discounted price of $9.00 through June 30th to give easier access to this important and relevant information. Enjoy the following Q&A with author Dr. Paul Bernstein.

Q: The NY Times and NBC News have stated that KP may be the answer to our nation’s health care crisis.  Too good to be true?

A: KP through its focus on preventive care, originated by Dr. Sidney Garfield, has created a unique, affordable way to provide patient centric care. Prepayment, that Henry Kaiser and Dr. Garfield started, changed our nation’s system of “sick care” – where doctors are paid fee for service when a patient is sick – to “health care” where you and your physician “thrive” by keeping you healthy.  

Q: How did managed care begin?

A: The largest managed care system, KP, began in 1933 in Desert Center when Henry Kaiser and Dr. Garfield came up with the idea of prepayment – a nickel a day to take care of the workers building the aqueduct.  

Q: What were and still are the reasons that made Sidney Garfield and Henry Kaiser look for a new way of providing health care to the general public.

A: The reasons are the same today as they were 75 plus years ago. Patients couldn’t (and still can’t) afford health care or preventive care which was the impetus behind prepayment and complete coverage as a new way to provide care.

Q: What are the basic differences between a non-profit HMO, eg Kaiser Permanente and a for-profit HMO, e.g. PacifiCare or Aetna?

A: The main difference is that all patient dues in a non-profit HMO go for patient care and that programs to make health care more affordable are passed on to the patient by keeping monthly rates low. In a for-profit HMO – care is managed so at the end of the year a profit can be generated for their investors and shareholders.  

Q: Why have we not heard more of Sidney Garfield, the doctor who started the managed care movement in America, wrote the first article on the computerized health record, and received national recognition by Lady Bird Johnson?

A: Great question! Tell all your friends about Courage to Heal so people learn more! The same applies to Henry Kaiser, America’s greatest industrialist, who built much of America’s largest dams, roads, and created an Industrial empire that built America after World War II and helped to create America’s middle class.

Q: Did the American Medical Association have the patients’ interests at heart when they accused HMO doctors of being socialists and threatened to “blacklist” them in a manner reminiscent of McCarthyism?  

A: The AMA was concerned at the time about protecting the fee-for-service way of practicing American medicine and looked at prepayment as an economic threat. They considered the most important bond between the doctor and patient to be the “fee” and not quality, caring, etc. 

Q: In your novel, Dr. Garfield falls in love with his nurse, Judy, in a romance reminiscent of a Hollywood movie.  Is this based on fact or fiction?

A: The romance was based on fact and the “real nurse” who was interviewed on her 84th birthday, said that Sidney Garfield was “the love of her life.” 

Q: Did the AMA really suspend Dr. Garfield’s medical license for no other reason than he was trying to provide care to what at that time were the “uninsurable”?

A: The main reason they revoked his license was again, political. To try and stop prepaid medicine by harming Dr. Garfield’s reputation. Not only did they oppose prepayment, they were opposed to the residency programs that Dr. Garfield was running to train new physicians and specialists. 

Q: Dr. Garfield was a rich man after selling his hospitals in Desert Center, why didn’t he just follow the mainstream and become a fee for service surgeon?

A: Dr. Garfield did make a profit at the end of Desert Center, but he had seen first-hand how patients suffered when they could not afford health care. He devoted his life to providing affordable, preventive prepaid care. 

Q: How did Dr. Garfield and Henry Kaiser manage to create a new system of health care and take care of thousands of 4F patients during WWII? Were they able to provide quality care at the same time?

A: Dr. Garfield and Henry Kaiser had learned from taking care of workers at Boulder Dam and the Grand Coulee Dam how to care for patients in a way that was both affordable (prepaid) and high quality. The Kaiser Shipyards in WWII had the best safety record of any shipyard and most of their records still hold today. Kaiser and Garfield also provided in WW2 equal care for all – with the first integrated hospital – the first time health care disparities, which are still seen in America today, were addressed in a fair and equal fashion.

Author Dr. Paul Bernstein at a signing

About Dr. Paul Bernstein
A nationally recognized leader, Dr. Bernstein was the Medical Director of one of California’s largest medical groups.  Under his leadership of this multi-billion-dollar group, he was awarded the National Malcolm Baldrige Best Practice Award for leadership and innovation.  He is well known as a futurist, author, and speaker dedicated to transform the patient experience through telehealth and virtual medicine.  Committed to improving the health of his community, he served as a Board of Director for the American Cancer Society and ran its Head and Neck division for over two decades.  A prolific novelist, his book, Courage to Heal, has garnered numerous accolades including awards in the San Diego, New York, and London Book competitions.

Blood of the Band: An Ipai Family Story

The Ipai and the Jews

Blood of the Band: An Ipai Family Story by David L. Toler, Jr.; Sunbelt Publications, © 2015; ISBN 978-1-941384-12-1; 285 pages, including index; $19.95.

By Donald H. Harrison

SAN DIEGO – This is a story of the San Pasqual band of Ipai Indians. The Ipai are the western branch of the Kumeyaay Nation, as opposed to the Tipai who occupy farther eastern San Diego County, Imperial County and parts of Baja California. The history is told through the eyes of the Trask family, and the various branches of that family, which have occupied the San Pasqual area of the county since the early 20th century. The author, David L. Toler, Jr., is a descendant of Frank Trask, whose father, Roswell Task, was a white settler, and whose mother was reportedly a San Pasqual Ipai, name now unknown, believed to have died in 1867 during childbirth. Frank married Leonora La Chappa in 1902, and in 1910 was appointed by the federal government as a judge of the San Pasqual Indian Reservation, a position reserved for tribal members.

Readers learn of Kumeyaay creation legends, about what anthropologists say about the lives of the Ipai prior to European contact, and then are taken on a journey through more modern history: The Mission period when many Indians converted to Catholicism under the influence of Franciscan missionaries; the Mexican period when the missions were secularized and Indians scattered; the early American period when treaties were made and broken in favor of land-hungry white settlers; the later American period when reservations were established; the 1920s when Indians were granted full American citizenship; and subsequent periods of flux when Congress at one point desired to terminate reservations, and later decided to reinforce them. San Pasqual, in the political cross currents, was moved from one location to another, off the Ipai’s ancestral lands and onto the lands of neighboring Indians.

Some Ipai declined to live on the reservations, retreating to inaccessible inland areas. Others initially lived on the reservations, and then left to live in the cities of San Diego County. However, they later returned when being counted as a member of the tribe brought with it not poverty but the new possibility of financial rewards, either through compensation if the land were condemned by the federal government, or through profit from gaming and other business enterprises on the reservations.

As a Jewish reader, I found three interesting points of intersection between the history of the San Pasqual band and the history of the Jews.

We all know the Jewish biblical creation story involving Adam and Eve, and a talking snake who persuaded Eve to take a bite from the forbidden fruit from the Tree of Knowledge.

A snake figures in the Ipai creation story as well. As recited by Jose Bastiano LaChappa, and published within Toler’s book:

The people planned a ceremony, and built a large enclosure of brush. Then they sent a messenger to bring the great serpent Umaihuhlya-wit (“sky moon”) from the ocean. He came and coiled himself in the enclosure but he could not get his entire length inside. On the third morning, when he had coiled as much of his body as the enclosure would contain, the people set fire to it and burned him. His body exploded and scattered. Inside his body was all knowledge, comprising songs, magic secrets, ceremonies, languages, and customs. Thus these were scattered over the land and different people acquired different languages and customs.

In our Jewish culture, the snake put one over us humans, though it paid the consequences later. In the Ipai tradition, humans got the better of the snake. But in both instances, mankind was exposed to knowledge.

I winced at the next reference, which drew an analogy between the Israelites conquering the Land of Canaan on the instructions of God, and white Christians appropriating Indian land by what they considered divine right. Toler’s account quoted Native American historian Steve Newcomb of Shawnee/ Lenape background, as opining:

An explanation … is that for the Christian colonizers of the Americas, the Chosen People-Promised Land cognitive model was the basis for drawing an analogy between the lands of North America and the lands of Canaan in the Old Testament. This entails the lands of North America being conceived of as “land free to be taken.”

Finally, I found in the testimony of Julie Holder, a Native American, an analogy to another experience in Jewish history: the Holocaust.

Toler quoted her as saying:

Now the issue has become, “Who is really Indian”? The reservation Indians resent the Urban Indians returning only to take advantage of the current opportunity of abundance. So now you must prove you are an Indian. Genocide is the deconstruction of cultures. The American government has forged this deconstruction onto the American Indian people since 1846. Not only were Indians not citizens until 1924, but our history, births, deaths and responsibility was in the Department of War until the termination act. This left Indian people without historic documented and validated identity; we were the original enemy combatants and have been historically treated as such. Outside of the Jewish people in Nazi Germany, the Indian people are the only race required to prove their degree of Indian blood. How much pure blood one carries can be equated to the genocide of the Jews with Hitler’s need to prove, “how much Jewish blood was carried by each individual Jew.” The product of this demand was Hitler’s excuse and his foundation for genocide.

Personally I found Toler’s analogy distressing. It seems to me the two situations are easily distinguishable. In Hitler’s Germany, anyone with one-quarter Jewish blood, that is a single grandparent, was liable to be categorized as a Jew and sent to a concentration camp. In the case of Indians, as little as one-sixteenth Indian blood enables one to establish oneself as a member of an Indian nation. In the Jewish case, a slight percentage meant imprisonment and death; in the native American case, a slight percentage could lead, depending on the rules of the tribe, to economic benefits.

Harrison is editor of San Diego Jewish World. He may be contacted via

Blood of the Band

Ricardo Breceda

Ricardo Breceda, Anza-Borrego’s most famous sculptor has moved his studio and found new homes for his whimsical metal sculptures. His work is iconic work is featured throughout Anza-Borrego State Park and surrounding areas, and now can be found in local cities from San Diego to Joshua Tree, California. Click here to read about his new locations! Breceda’s Art Finds New Home