In 1933, Dr. Sidney Garfield was finding it difficult to make a living in fee-for-service medical practice. He hit upon the idea of prepaid medical care, which he offered to the 5,000 workers building the Los Angeles Aqueduct for a nickel a day. In 1938, at the invitation of Henry Kaiser, Garfield offered prepaid care to workers on the Grand Coulee Dam.
The rest is history.
If Kaiser Permanente and the idea of prepaid care interests you - and it should - check out this story about Dr. David Ores in today's New York Times.
Dr. Ores is 51, lives in a cheap (by NYC standards) apartment on the lower East Side, owns two Harleys, has a tattoo of a naked woman wearing a pink cowboy hat on his arm, and is shown blowing a cloud of cigar smoke in a photo accompanying the article. Like Dr. Garfield (who is in a suit and tie in all the photos I've seen) Dr. Ores has contracted to provide prepaid care - to restaurant workers whose employers pay a dollar a month per worker for outpatient care. (The article doesn't say how hospital care is paid for.)
The article emphasizes Dr. Ores' counter-cultural persona, but prepayment is not a counter-cultural idea. If the national policy debate goes in a sensible direction we'll be seeing lots more prepaid care in the future.
In the meanwhile, enjoy reading about Dr. Ores and the restaurant workers!