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Bulletin of the History of Medicine 74.2 (2000) 401-402

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Book Review

From Company Doctors to Managed Care: The United Mine Workers' Noble Experiment

Ivana Krajcinovic. From Company Doctors to Managed Care: The United Mine Workers' Noble Experiment. Cornell Studies in Industrial and Labor Relations, no. 31. Ithaca: Cornell University Press, 1997. xiv + 212 pp. Ill. $37.50.

The subject of this book, the United Mine Workers of America Welfare and Retirement Fund, an alternative health-care system, was an innovative health plan designed to provide affordable care to a high-risk population. The Welfare and Retirement Fund was established in the 1940s through collective bargaining that gave financing responsibility to the coal operators and control of the plan to the United Mine Workers (UMW). The Fund utilized group practices, managed care, treatment review, and retainer payment to provide a level of care that surpassed what had previously been available to coal miners and their families. The quality of care available before the Fund matched the miners' substandard housing, poor sanitation, and inadequate social protections. One of the stated purposes of the author of this book was to indicate how an examination of the United Mine Workers' experience with the Welfare and Retirement Fund could lead to a better understanding of the centrality of health benefits as a collective-bargaining issue.

Ivana Krajcinovic describes the establishment, rise, operation, and demise of the Fund. She addresses issues of interest to both labor and health historians, but gives the subject of occupational health, closely associated with coal mining, little coverage. The trivialization of occupational health detracts from the analysis presented. Nevertheless, Krajcinovic's economic and political analysis of the forces (both political and economic) and the compromises that shaped the Fund's innovations in health care are excellent. In an explanation of the rise and fall of the UMW Welfare and Retirement Fund she writes: "visionary in its inception, the Fund ultimately fell victim to the shortsightedness of the union's leaders" (p. 4).

Chapter 1, "The Early History of Health Plans for Workers," presents some insights into the health system that existed in the coalfields prior to the Fund. Before 1947, coal miners received continuous but substandard health care through the mechanism of the company doctor system. Krajcinovic notes that by establishing the Fund in the 1940s, the UMW received virtually all the credit for bringing [End Page 401] modern health care to the coalfields. Although coal operators did finance the plan, we now know the hidden cost that eventually hurt miners--namely, mechanization and sweetheart contracts in exchange for a union-controlled welfare plan financed by royalties on coal production.

Chapter 2, "Bargaining for Benefits: The Fund and the Transformation of Industrial Relations in the Coal Industry," develops this theme more fully in the most interesting section of the book. In a short period of time the absence of social protections for a neglected group of workers was changed through the mechanism of the Welfare and Retirement Fund to provide unparalleled medical care. In a decade the union replaced the company doctor system; miners, both retired and working, and their families could now visit a range of physicians in new clinics and hospitals. The fact that the union controlled the Fund and the operators financed it was a reversal of a historical pattern. In this chapter the author relates events at the negotiating table, in the mines, and in the industry that led to creation of the Fund. She discusses the compromises made by John L. Lewis that started a new era in the coalfields, placing the union on the side of the operators in the operators' campaign to modernize the industry.

The next five chapters describe in detail the design of the Fund, the delivery of care, the Miners' Memorial Hospital Association, changes in how the Fund operated based on external changes, and finally, its transformation and dismantling. Ironically, the Fund was not jeopardized by actions of the rank and file, but by the mismanagement and shortsightedness of the union...


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