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Policy Perspectives
June 17, 1998

What Price Survival?The Future of Blue Cross and Blue Shield

JAMA. 1998;279(23):1863-1869. doi:10.1001/jama.279.23.1863

ON DECEMBER 20, 1999, the Blue Cross and Blue Shield plans, or, to be specific, the health insurance notion that evolved into the plans, will be 70 years old. On that date in 1929, a coverage experiment was implemented in Dallas, Tex. The experiment was conceived by Justin Ford Kimball, vice president of Baylor University, Dallas. It was inspired in part by the efforts of employers and workers to create prepaid health care coverage, which in time led to the other major health insurance movement of this century, managed care.1 Kimball developed a prepaid program under which teachers in the Dallas area could, for a premium of $6 a year, receive 21 days of inpatient care at Baylor University Hospital, Dallas, which had been losing money and was struggling. By the time the program benefits became effective, the plan had 1356 members.

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