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.