Master Builder

Most socialized medicine enthusiasts, and a lot of people who never heard of socialized medicine, will read Paul de Kruif's Kaiser Wakes the Doctors (Harcourt, Brace; $2), out this week. Its 158 pages are an enthusiastic popularized account of the prepaid group medical care Shipbuilder Henry Kaiser and Dr. Sidney Garfield established for Kaiser workers. Throughout the book, De Kruif is an unabashed St. Paul, exhorting readers to faith, hope & charity for the new group medical revelation. Writes De Kruif: "Henry Kaiser stirred me to drop all else. . . to tell America this story."

And Venetian Blinds. Dr. Garfield had worked out his group medicine formula through medical care plans at the Los Angeles Aqueduct, Parker Dam and Imperial Dam projects before Kaiser hired him at Grand Coulee. He had found that complete medical care for workmen in their own hospitals could be financed by a 5-c--a-day payroll tax plus a percentage of the industrial insurance premiums. The insurance companies were glad to chip in, as the good medical care cut compensation payments.

When medical needs in the San Francisco Bay and Vancouver shipbuilding areas got acute, Kaiser rehired Garfield. The doctor's first step was to establish the Permanente Foundation in the name of Mr. & Mrs. Kaiser. The Foundation borrowed $550,000 from banks to remodel and enlarge an old hospital near Richmond (Calif.), whose population had jumped from 23,000 to 127,000. Soon the money began pouring back into the banks at the rate of $50,000 a month--the Garfield plan was raking in 7-c- a day from 60,000 workers, plus a percentage from the insurance companies. Later Garfield built other hospitals, many first-aid stations in Kaiser shipyards and plants. The hospitals have air conditioning, attractive paint jobs and Venetian blinds. The most unusual feature: rooms are private or semiprivate, because Garfield believes pleasant surroundings help recovery; and "Henry Kaiser--fanatical believer in a medical golden rule--maintained that if he himself should have a private room, then so should every worker."

There is no limit to the amount of care a man gets in the Kaiser clinics. Theoretical hospitalization limit is 118 days free of charge, but the rule has never been invoked. Even illnesses acquired before patients worked for Kaiser are included (unofficially) in the service.

A.M.Animosity. From all over the U.S., at salaries of $450 a month and up, Garfield hired the best doctors he could persuade to risk American Medical Association ostracism. (A.M.A. routinely objects when a patient is denied free choice of physician.) In California, more social-minded than most states, the Medical Association was not so obdurate: after a short period of skepticism, the local California doctors cooperated fully with Garfield's 60 physicians. But the Northern Permanente Hospital at Vancouver ran afoul of the A.M.A.'s "invisible hand": through the Government's Procurement and Assignment Service, the A.M.A. threatened to push some young Kaiser doctors into the Army by declaring them nonessential workers (TIME, Nov. 23, 1942). Kaiser and Garfield got them to hold off until replacements were found.

"They Stopped Dying." With a convert's zeal, De Kruif lists the selling points for prepaid group medical practice :

> Prepaid group practice brings the best care and experts within every man's reach without resort to charity.

> Individual practice is "as if fine auto mobile mechanics would do most of the fixing of your car with a screw driver, monkey wrench and a pair of pliers in their own backyards; and only occasionally insist that your motor trouble should have all the advantages of an up-to-date garage."

> When no cash outlay is involved, patients come for treatment early in their illnesses. Result: "They stopped dying."

> In group practice, young, well-trained doctors waste no time waiting for their practices to develop. They go right to work at regular pay.

New Humanity. Preoccupied with his dramatic story, De Kruif disappointingly omits many down-to-earth details about finance and management which Dr. Garfield could probably furnish. He leaves out the figures on exact costs of each man's medical care, the death rate with & without group medicine, the drop, if any, in absenteeism in the Kaiser shipyards. But the book is convincing: the Kaiser plan is working, and on a huge scale. "In the health centers that we now can build, Kaiser, the master builder, sees the foundation for a new American humanity."

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