Health insurance reform has been on my mind lately, as I have been denied coverage due to pre-existing conditions.

Arkansas has an interesting medical history, not all of it typified by quack doctors and hookworms. In 1924 a group of Little Rock doctors built a hospital and in 1931 began offering prepaid medical insurance similar to a modern Health Maintenance Organization or HMO. And, as one might suspect, this innovation caused no small amount of discord in the medical establishment.

The hospital was named Trinity because it arose from a group practice begun in 1916 by three Little Rock physicians-Drs. Mahlon D. Ogden Sr., O. K. Judd, and Augustine M. Zell. Located at 20th and Main streets, the hospital building was designed by Max Meyer, a prominent Little Rock architect, at a cost of $240,000, including equipment and furnishings.

The two-story red brick building contained 23 patient rooms on the second floor along with an operating room, nurses’ office, chart room, scrub rooms, an obstetric room with a 12-bassinet nursery and utility rooms. Doctors’ offices were on the ground floor, in addition to a laboratory, an X-ray facility, more nurses’ quarters, a dining room and a kitchen.

At first Trinity operated as a fee for-service hospital, like all the other hospitals in the state. Dr. Ogden stated that the motivation for going to a prepayment plan was to eliminate the excessive costs for surgical and hospital care “which often results in financial disaster to the man with a moderate or small income.” In 1937 the Trinity insurance contract cost $2 per month for families enrolling as part of a group and $5 monthly for non-group families. At that time more than 100 Little Rock businesses had group enrollments of at least 8 employees. About 5,000 people were covered by prepaid contracts in 1937.

In keeping with the prevailing Jim Crow segregation of that time, black residents were denied access to the insurance coverage and the hospital.

The Trinity experiment caught the attention of the public and the larger medical community within and outside the state. In 1935 American Magazine in New York published a feature on the Trinity experience, which was later reprinted in Reader’s Digest.

The author interviewed a number of Little Rock residents and found a generally positive assessment of the prepaid system. When a grocer named Barrow was asked his opinion of the Trinity operation, he exclaimed, “Why, it’s wonderful.” He went on to explain that for a yearly cost of $44 he obtained coverage for himself, his wife, and their four children.

The visiting journalist acknowledged that prepaid medical insurance such as offered by Trinity had generated considerable opposition from the larger medical community, including being called “socialized medicine.”

“The attacks on community medicine in this Southern city are fundamentally the same as are being directed against similar medical plans elsewhere,” he concluded.

The first example of opposition came in 1924 when the Pulaski County Medical Society established a committee to investigate Trinity, but no specific actions were taken against the doctors. The situation grew more intense in 1931 when the local medical society charged the Trinity doctors with being in “violation of the ethics in attempting to do that which they knew was not accepted custom locally . . .” The Trinity doctors immediately resigned from the medical society.

The actions of the local medical society were endorsed by both the Arkansas Medical Society and Dr. Morris Fishbein, the editor of the Journal of the American Medical Association. (Fishbein is known to Arkansas historians for his role in debunking America’s most famous 20th Century medical quack, “goat gland doctor” Dr. John R. Brinkley, whose practice was located in Little Rock in the 1930s.) Despite efforts at compromise by the Trinity group, both the state and national associations held fast to their opposition.

Ironically, as historian Edwina Walls Mann has noted, “All the while that the Pulaski County Medical Society was censoring the Trinity group, it was searching for a way to meet the competition of such groups by seeking to develop a corporation of its own whose membership would include all society members and would have as its purpose the selling of medical and surgical services.”

In 1947 the Arkansas Medical Society and the Arkansas Hospital Association created the Arkansas Health Plan, a prepayment arrangement that was similar to the Trinity plan. Trinity Hospital closed Nov. 1, 1953. The building became a nursing home, and today it is an apartment building.

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Tom Dillard is a historian and founding editor-in-chief of the Encyclopedia of Arkansas History & Culture. Email him at Arktopia.td@ gmail.com.

Editorial, Pages 80 on 09/01/2013