Kaiser Permanente began at the height of the Great Depression with an inventive young surgeon and a 12-bed hospital in the middle of the Mojave Desert. When Sidney R. Garfield, MD, saw thousands of men building the Los Angeles Aqueduct, he saw an opportunity to provide health care for the workers. He borrowed money to build the hospital, and began treating sick and injured workers. But Dr. Garfield had trouble getting the insurance companies to pay his bills on time. Not all of the men had insurance, but he refused to turn away any sick or injured worker. As a result, often he was not paid. Harold Hatch, an insurance agent, approached Dr. Garfield with the idea that insurance companies pay a fixed amount per day, per covered worker, up front. This would solve the hospital's immediate money troubles, and also let Dr. Garfield put one of his pioneering medical ideas into practice: emphasizing prevention. Today, Kaiser Permanente is the nation's largest nonprofit health plan, serving 8.7