Page 28 - OctSam2019

CORPORATE
MEDICINE

Employer-Sponsored

Healthcare Revisited

By Roger Moczygemba, MD, MHA

“Corporate medicine has become one of those phrases that has first health plan of what would come to be known as blue Cross.
no real definition, but still makes most physicians shudder”(Cook, In this example, the employer (the school district) directly con-
1999). Nearly a decade after the Affordable Care Act (ACA) man- tracted with the provider (the hospital) to provide access to care.
dated individuals to receive healthcare and subsidized insurance, the Another example of a problem solved is when Henry Kaiser col-
structure of the U.S. healthcare system remains unchanged and laborated directly with Sidney Garfield, Md who had previously
problematic. saved his own hospital from bankruptcy at the height of the Great
As I have matured, I have come to appreciate the fact that if depression by shifting away from fee-for-service to collecting a pre-
something is too difficult to achieve a good fit, maybe it is not meant payment of a dime-per-day from aqueduct workers in exchange for
to be, and there is a better way. his comprehensive services. This shift away from fee-for-service to
let us consider some examples of a good fit and a problem prepayment and group practice gave rise to what would be known
solved from our healthcare history. In the 1920s, even wealthy as health maintenance and wellness, emphasizing prevention and
Americans were unable to pay hospital fees, and many were facing early detection or the “new economy of medicine.”
bankruptcy. doctors were not receiving payment for their fee-for- Another case of our American, employer-financed healthcare sys-
services from patients, and dr. Justin F. Kimball of baylor Univer- tem is with the coal miners. After a life-risking career in mining,
sity wanted to ensure hospitals were paid. He invented the method miners often developed occupational illnesses and diseases. In 1946,
of prepayment during a time when hospitals were mostly nonprofit President Truman, Julius Krug and United Mine Workers of Amer-
community institutions. dr. Kimball solved the university hospital's ica President lewis made a deal that miners would have extended
unpaid bill problems by discovering the delinquencies were coming health care post-retirement, funded by their last employer known
from local schoolteachers who were unable to pay. Kimball resolved as The Promise of 1946 (Krug-lewis Agreement). For decades,
the issue by offering teachers covered hospital stays of up to three contracts required this stipulation. Retirement health care was so
weeks for 50 cents per month. 1,250 dallas teachers enrolled in the critical to union miners that they were willing to strike and accept

28 San Antonio Medicine • October 2019