"The hospital plan of the Central Pacific was the impetus for other railroads to build hospitals and employ physicians and surgeons to treat railroad employees. These comprehensive low cost plans caught the eye of Henry Kaiser, one of the constructors of Boulder Dam who then made a prepaid plan available to all of his employees. This plan was then extended to all of the Kaiser industries which included steel, cement, aluminum and ship building. His health plan became firmly established and continues to grow even though some of the Kaiser industries no longer exist. Kaiser remains the primary nonprofit HMO in the nation.

I worked for Kaiser hospitals for 17 years and retired as an asst. hospital administrator. Henry started the Health plan as an enlightened way to keep a healthy work force for his projects. After WWII ended the Kaiser employees, all union members of various persuasions, asked him to continue the program and he did, keeping in mind that the people were union and so all of the Kaiser Hospital and Health plan non-management employees are union. The nurses at Kaiser Fontana belonged to the steelworkers union. We had 7 bargaining units at my medical center in San Jose---the lab people belonged to something called CAMULT which were marine engineers from the shipyard era--------------
[b][/b]
"Short gives us insight into railroad medicine, their intern and resident programs, developing ICUs, and their evolution into corporate nonprofit hospitals. When Medicare came along, Short, as manager for the Railroad hospital plans, was invited to Baltimore to implement the Medicare legislation which was to be effective on July 1, 1966. The railroad contingent was amazed at the regulations that had been adopted for the payment of benefits. Social Security apparently did not want advice from anyone actually engaged in operating hospitals or providing care for the aged. The regulations made a federal case out of every patient. They understood that they would either do it Medicare's way or there would be no reimbursement. They were unable to convince a federal bureaucrat that providing hospital and medical care could be simple and efficient. In order to comply with Medicare regulations, Short employed thousands of clerks, supervisors, auditors, etc, with computers generating tons of paper, very little of which would ever be scrutinized. Had Medicare built on the experience of prepaid plans, Short feels they would have saved billions of dollars.

Standing behind all of the Obama care program plans is the Kaiser model-------in the screaming and hollering leading up to the final passage there was mention of Intermountain Health Care, Mayo Clinic and Group Health-------Kaiser purposely kept their name out of it but they are the model for much of it all----------The current Medicare system of reimbursement leaves far too much room for fraud-----the lag time between audits is a good part of that as is the method of "prospective" payment------very complex, really very complex (which allows for the fraud to take place)---------

C.