For the better part of his 91 years, Michael Davis rattled the medical community with his relentless calls for change.
"Can you imagine a world without health insurance?" asks Robert Sigmond, a 2001 Hall of Fame inductee. "When (Davis) got involved in this field at the turn of the century, nobody thought about the healthcare system, the financing of healthcare."
What Davis understood before anyone else, say Sigmond and others, was that the future of healthcare would depend just as strongly on the organization of healthcare services as it would on medical science. Davis, whose background was steeped in the social sciences, helped promote the development of ideas such as health insurance and community medical clinics.
Davis set the course of healthcare for the next five decades with his role as part of the Committee on the Costs of Medical Care, an independent group funded by the major foundations of the time that produced 27 volumes recommending changes in the financing and organizing of healthcare services.
When Davis entered healthcare, he saw the administering of medical care as fragmented and ineffective. Practices of the time ignored medical treatment for the average person, who either was ineligible for charity care or couldn't afford private care. And often their illnesses could have been eliminated by preventive care.
With his insistence on seeing healthcare as a business, Davis sought to eliminate waste and redundancy. He helped forge the modern healthcare landscape by injecting it with themes such as "efficiency," which he borrowed from other industries. Davis relished facts and was among the first to insist on measuring efficiency in healthcare services.
As a pioneer in the business of healthcare, Davis tirelessly developed and promoted his ideas on insurance, group practice and preventive medicine. He published more than 400 articles, including a column in Modern Hospital, a predecessor of Modern Healthcare."He was a little guy, thin and wiry," Sigmond says of his mentor, who "often had you by the lapels of your coat. He was thoughtful and respectful; he just had to get his point across."
Davis grew up in a comfortable, bustling home in New York, where he was born in 1879, the youngest of seven children-five of whom were girls. Early on, he was exposed to lessons in social justice, according to his biographer Ralph Pumphrey in Michael M. Davis and the Development of the Health Care Movement, 1900-1928.
Davis graduated from Columbia University in 1900 with a bachelor's degree, then got his Ph.D. there in 1906. In school he balanced his interest in science with his passion for social justice. He changed his focus from chemistry to sociology, and wrote his dissertation on Gabriel Tarde, a 19th-century French sociologist who urged the use of empirical evidence to support academic theories.
Teachers who influenced him at Columbia included Franklin Giddings, sometimes called the intellectual architect of the progressive movement, and Edwin Seligman, who taught economics as a science rather than history.
After a stint at the People's Institute in New York, a gathering place on Manhattan's Lower East Side for the discussion of social issues, Davis landed his first job in healthcare in 1910 as director of the Boston Dispensary, where he worked on the day-to-day problems of managing the charity-based clinics while keeping an eye on the larger question of organizing healthcare.
When Davis began work at the dispensary, the clinics were disjointed and inefficient. Davis estimated that much of the clinics' efforts were being wasted because the patients weren't getting the care they needed. He devised tests to measure efficiency.
Dispensaries traditionally provided medical treatment to the indigent who were seen largely as victims. Davis envisioned expanding healthcare services, including preventive care, to the masses before they became victims. His vision would later be called "community medicine."
Davis preached the idea of efficiency in hospitals to the American Medical Association and other groups for the next 20 years.
In 1913, he began operating pay clinics-self-sustaining centers where people would pay a small fee in exchange for healthcare services-and his writings were a seedbed of ideas on the future of the clinics and physician groups.
In 1920, Davis was called to New York by the Rockefeller Foundation to duplicate his work in Boston, at the Committee on Dispensary Development. The next year, he launched the Cornell pay clinic in New York. Based on his work in New York, Davis wrote: "Our spending habits for sickness are less than our spending ability. . . . It is the unevenness of the burden of sickness, not its total amount, which creates most of the present financial burdens."
After his Rockefeller-funded commission ended, Davis joined the Julius Rosenwald Foundation in Chicago in 1928 as director of medical services. A year later, he hired 1988 Hall of Fame inductee C. Rufus Rorem, who had been assistant dean of the business school at the University of Chicago, and together they worked on the Committee on the Costs of Medical Care, where they laid out plans for group practices, health insurance and community medicine.
When the group put out its findings in 1932, the AMA called the study "an incitement to revolution." Many years later, David Willis, who had worked for Rorem at the Pittsburgh-based Hospital Planning Association of Allegheny County, would remember meeting Davis and hearing him talk about the controversy. Along with Davis, the board of directors of the hospital planning association had asked Brian Abel-Smith, professor of healthcare and social sciences at the London School of Economics, to give a talk to the board.
The two compared notes, sharing their strong views in support of government intervention in healthcare. Abel-Smith, who was known to have ties with the Labor Party in Great Britain, said he was aware of the criticism by physicians and hospitals that the committee's report was causing declining standards in healthcare.
Davis said the only thing that was declining about healthcare was "purse-onal." He then spelled out the letters "p-u-r-s-e."
On the national healthcare policy front, Davis advised presidents Franklin Roosevelt and Harry Truman and worked on legislation that led to Medicare and Medicaid.
He remained engaged in healthcare issues, writing until shortly before his death in 1971.