Dr. Kildare Goes Home: The Past as Prologue (repost)

Originally posted January 4, 2012

Over the holidays, one of the cable stations showed a marathon of Dr. Kildare movies and, as a fan of old movies and of Dr. Kildare, I watched a fair number. I hope that some readers will remember Dr. Kildare. No, not the 1960’s TV series with Richard Chamberlain as the young Dr. James Kildare, but the 1940’s series of nine movies with the late Lew Ayres in the lead role. Now for a little background.

The fictional Kildare was an intern receiving his post-graduate education at Blair General Hospital, under the mentorship of the irascible and cranky-yet-underneath-there-beats-a-heart-of-gold Dr. Leonard Gillespie, played by the wonderful actor Lionel Barrymore. The wheelchair-bound Gillespie is the master clinician, an incredibly astute diagnostician, and educator. In “Dr. Kildare Goes Home,” Kildare has just finished his internship and, as was commonly the practice 70 years ago, prepared to enter clinical practice. Gillespie offers young Kildare a position as his partner – a fabulous offer indeed. Yet Kildare chooses to go home to Parkersville to help his overworked and incredibly stressed out physician father. The young doctor conceives the idea of he and two of his internship colleagues opening a practice there – a clinic that provides health care services to the community, funded by a 10 cent per week contribution by all local residents. Under this plan, everyone will have access to care that is funded by the community, regardless of the individual’s ability to pay. Is this beginning to sound familiar?

Now recall that Medicaid funding of health care for those unable to pay was still some 25 years away when this movie was made. Based on historic inflation rates, 10 cents in 1940 is worth $15.66 per week in 2011, or a little over $800 per year.

The citizens of Parkersville are skeptical of this unheard of concept and are quite resistant to converting to such a system. This also sounds somewhat familiar, right? Well, as luck would have it, the newly trained Kildare becomes concerned that George Winslow, a community leader and major opponent of the proposal, is ill and offers to “run some tests.” The skeptical Winslow adamantly resists but the clever new physician obtains a blood sample (by somewhat less than ethical means) and learns that Winslow has a elevated white blood cell count suspicious of an infection.

Somehow, Kildare is able to diagnose pneumococcal meningitis (I admit I am mystified how he did this based on an almost total lack of signs and symptoms of the disease, but I digress). Kildare successfully treats the community icon. Winslow recovers and convinces the city to support Kildare’s health care delivery plan. For now at least, the city of Parkersville is happy and healthy!

Like all of the Dr. Kildare movies, there are lessons to be learned and “Dr. Kildare Goes Home” is no exception. Many of Kildare’s ideas about public financing of health care have come true. Yet, resistance to new ideas about access to care and the funding thereof remain ever present.

The day after I watched this movie, I came upon a piece from “The Atlantic” entitled “The Year in Preview: The Top 10 Politics Stories to Watch in 2012” (read it here). Included on the list is health care reform, specifically The Affordable Care Act, and the upcoming court challenges to the legality of the nearly two-year old Act. While 28 states to date have filed challenges, the Supreme Court will hear the challenge from Florida to the law, which specifically argues that the requirement for individuals to buy health insurance is unconstitutional. With arguments scheduled to be heard in March, and a decision anticipated in June, there will be ample time for the Court’s decision to impact the Presidential campaign – and the ultimate election outcome – in a big way.

While the new and unique 1940 ideas of Dr. Kildare about insurance and funding were ahead of their time, the Parkersville-like controversy remains.

Buckle up – the year ahead should be very interesting!!

Paul Katz, MD
Founding Dean
Cooper Medical School of Rowan University