Esselstyn, Caldwell B., 1902-1975.

Caldwell B. Esselstyn: physician, health care administrator; A.B., Yale, 1925; M.D., Columbia University College of Physicians and Surgeons, 1929; established the Rip Van Winkle Foundation in 1946 [renamed the C. B. Esselstyn Foundation in 1975] in the Hudson River Valley to provide medical care for the impoverished; appointed to Public Health Council of New York, 1955-1963; organized support for federally sponsored health insurance for the aged [the Medicare Act of 1965]; director of the Community Health Association of Detroit, 1964-1967; member of the Health Insurance Benefits Advisory Council, 1967-1971; director of the New York Bureau of Emergency Services, 1968-1972.

From the description of Caldwell B. Esselstyn papers, 1945-1964 (inclusive). (Unknown). WorldCat record id: 702204583

Caldwell B. Esselstyn: physician, health care administrator; A.B., Yale, 1925; M.D., Columbia University College of Physicians and Surgeons, 1929; established the Rip Van Winkle Foundation in 1946 [renamed the C. B. Esselstyn Foundation in 1975] in the Hudson River Valley to provide medical care for the impoverished; appointed to Public Health Council of New York, 1955-1963; organized support for federally sponsored health insurance for the aged [the Medicare Act of 1965]; director of the Community Health Association of Detroit, 1964-1967; member of the Health Insurance Benefits Advisory Council, 1967-1971; director of the New York Bureau of Emergency Services, 1968-1972.

Caldwell B. Esselstyn, physician and health care administrator, was a pioneer in the field of prepaid group practice. Born in New York City, he was educated at Yale University (A.B., 1925) and Columbia University College of Physicians and Surgeons (M.D., 1929). Following a residency in surgery at Columbia Presbyterian Hospital, Esselstyn established a successful surgical practice in New York City. His patients included Lou Gehrig, Ed Wynn, and other celebrities.

In 1941 Esselstyn returned to Columbia County, New York, where his family had lived since the seventeenth century, and established his surgical practice. The existing health care services in the county evinced problems similar to those in other economically depressed rural areas: many residents were unable to afford adequate medical care: there were few qualified medical specialists and the area was not attractive to young specialists; there were no preventive health care programs; and the population was scattered geographically.

In June 1946 Esselstyn established the Rip Van Winkle Foundation in an effort to meet the health care needs of the area (the foundation name, suggested by Ed Wynn, was intended to be distinctive and to evoke the atmosphere of the Hudson River Valley). Esselstyn was convinced that good medical care required group practice, and the foundation's major activities were organized, in the Rip Van Winkle Clinic, staffed by Rip Van Winkle Medical Associates. In addition to the problem of attracting medical specialists, Esselstyn intended that the foundation would address the other problems of rural medicine and would create a national model for health care delivery in rural areas.

At the same time Esselstyn was forced to contend with the problems common to group medical practice during the period: (1) opposition from organized medicine and (2) lack of public or private grant funds to meet the high costs of acquiring facilities and beginning operation. Columbia County had a relatively high physician population despite the lack of specialists, and members of the local medical society both feared encroachment and reflected the American Medical Association's hostility toward group practice. The local society attempted to obstruct the foundation by forcing it to accept responsibility for treating the medically indigent in the county and by influencing local banks against making loans to the foundation. The society also harassed clinic physicians, and twice censured Esselstlyn.

The Rip Van Winkle Clinic quickly achieved notable success in spite of inadequate funding and hostility from the county medical society. Esselstyn attracted young, board qualified specialists by setting high standards and creating academic and cultural programs. The clinic established a variety of preventive health programs, including the first Cancer Detection Center in upstate New York (1947), an annual review exam which attracted patients from throughout the state, and an innovative health education service. In order to meet the needs of the outlying population, the Rip Van Winkle Clinic became perhaps the first group practice plan in the country to establish satellite branches.

The foundation approached the problem of providing affordable health care by establishing a schedule of fixed fees which initially were equivalent to the rates then charged by "free" out-patient departments in New York City hospitals and clinics. In 1955 the clinic achieved a prepayment option by becoming one of only two medical facilities outside of the metropolitan area to be accepted for affiliation by the Health Insurance Plan of Greater New York, Inc. (H.I.P.). By joining H.I.P. Columbia County residents could cover all of their medical expenses by paying one regular fee.

The success which Esselstyn and the Rip Van Winkle Foundation achieved in dealing with the problems of rural health care soon began to attract national attention. The clinic became an important port of call for academicians, health care professionals, community organizers, and legislators, and Esselstyn achieved recognition as an innovative health care administrator.

In 1955 Esselstyn was appointed to the Public Health Council of the New York State Department of Health (1955-1963), and he began to play an active role in the American Public Health Association, Medical Care Section and the Group Health Association of America. Personal warmth, eastern establishment credentials, and a reputation as a successful surgeon made him an especially effective spokesman for group practice, national health insurance and other proposals which were branded by the American Medical Association and other opponents as socially radical or medically naive. In 1960 he was elected chairman of the A.P.H.A. Medical Care Section and president of the Group Health Association of America, and early in the following year he began organizing support for the most controversial health care legislation of the time--federally sponsored health insurance for the aged.

On March 27, 1962 Esselstyn and other physicians met with President Kennedy to express their support for the legislation, and the meeting received national media attention. The Physicians Committee for Health Care for the Aged through Social Security, formally established on March 28, 1962, with Esselstyn as chairman, was made up of distinguished, politically moderate physicians. The committee's support helped to counterbalance the opposition of the A.M.A. and other conservative groups to what became the Medicare Act (1965).

In his role as a national spokesman for health care, Esselstyn maintained that adequate, modern health services required group practice and that group practice, to be viable, required government support for health services. The Rip Van Winkle Foundation illustrated his message. Despite its success both in meeting the health care needs of Columbia County and in providing a national model for the organization and delivery of health services in rural areas, the foundation's financial problems continued to mount during the 1950s and early 1960s. Esselstyn's ongoing fund raising efforts were only partially successful, and prepayment was unable to get a foothold in the economically depressed area. The clinic also experienced continuing opposition from the Columbia County Medical Society and, in the early 1960s, dissension among the medical staff on a number of issues, especially salaries. In July 1964 the clinic, unable to meet its expenses, closed. The Rip Van Winkle Foundation, however, continued to operate and in 1975 was renamed the Caldwell B. Esselstyn Foundation.

In August 1964 Esselstyn accepted the directorship of the Community Health Association (C.H.A.) of Detroit. The C.H.A. had been founded in 1957 by the United Auto Workers and began operations in 1960. Although officially a community group practice prepayment plan which operated independently of the union, the C.H.A. had remained dependent on the U.A.W. for funding and membership. Esselstyn accepted the directorship on the understanding that the plan would become progressively more community oriented and independent of U.A.W. control.

Although Esselstyn achieved some success in expanding the C.H.A. program, his three year term as director (1964-1967) was characterized by growing conflict with Melvin A. Glasser, director of the U.A.W. Social Security Division, and other union officials. The major issue in the conflict was Esselstyn's desire to see the C.H.A. expand into a community health plan, versus the U.A.W.'s attempts to increase benefits for union members.

While in Detroit Esselstyn continued to play an influential national role in health polity. He was appointed as one of the original members of the Health Insurance Benefits Advisory Council, created by the 1965 Medicare legislation, and he was reappointed to a regular four year term in 1967. The council advised the Secretary of Health, Education, and Welfare on policy to implement the Medicare programs, and it later incorporated the duties of the National Medical Review Committee. Also in 1967 Esselstyn was elected vice-chairman of the board of directors of the Health Insurance Plan of Greater New York, Inc., one of the oldest and best known group practice prepayment plans.

Following his resignation from the Community Health Association in 1967 Esselstyn returned to New York where he served as associate director of the New York Metropolitan Regional Medical Program from 1967 to 1968. Citing the "severe limitations of the program" (See Series III, Box 48, folder 385, federal job application 1 Nov 1971) Esselstyn left to join the New York Bureau of Emergency Services. From 1968 until 1972, when he reached the mandatory retirement age of 70, he served as its director.

Despite chronic illness (he developed cancer in 1970) Esselstyn continued working, and following his retirement he served, until 1974, as a part-time consultant with the Department of Health, Education, and Welfare, Health Maintenance Organization Service.

Esselstyn died in Claverack, Columbia County, New York on March 11, 1975.

From the guide to the Caldwell B. Esselstyn papers, 1945-1964, (Manuscripts and Archives)