Medicine: Backyard or Garage?

The notion of prepaid medical care by physicians practicing in groups has no stronger advocate than Shipbuilder Henry Kaiser. He has built the Kaiser Foundation Health Plan into a 475,000-member concern with 507 doctors and twelve hospitals (TIME, June 29, 1953). And for a long time the Kaiser plan had no more high-pressure booster than Author Paul (Microbe Hunters) de Kruif, the nation's best-known writer on medical subjects. Twelve years ago, no superlative was too sweeping for De Kruif's praise of scientific and efficient group practice as against individual care by the old-fashioned family doctor. The old way, said De Kruif (a Ph.D. in bacteriology, but no M.D.), was like tinkering with an automobile with a pair of pliers in the backyard instead of taking it to a well-equipped garage.

Last week Writer de Kruif recanted. In GP, published by the American Academy of General Practice, he violently attacked group practice in general, and the Kaiser plan in particular. Wrote De Kruif: "[I was] sold a bill of goods, that the ancient, close, personal relation between doctors and their patients—that's the pride and the unique distinction of family physicians—was no longer necessary . . . The good old family doctor? He'd soon be a relic, replaced by integrated groups of specialists, all streamlined under an ultramodern hospital roof . . . It dazzled me to watch the plan's huge profits build and actually pay off beautiful hospitals. I fell for the plan's economics offering what seemed complete surgical and medical care for a few dollars a month.

"But now . . . I know that . . . its physicians are not servants of their patients—but, primarily, of the bookkeeping of the plan. It isn't the condition of his patient that dictates the time and care the doctor devotes to the sufferer; it's the red and black of the plan's economics . . . .[That] isn't the kind of medicine I'd pick for my family."

At least one member of De Kruif's family disagrees. His son David, 35, has been a Kaiser doctor since his residency six years ago in Oakland's Permanente Foundation Hospital. A heart specialist, he is now one of a doctor group which runs a clinic under Kaiser contract in San Leandro.