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Caldwell B. Esselstyn papers

 Collection
Call Number: MS 1171

Scope and Contents

The Caldwell B. Esselstyn Papers, part of the Contemporary Medical Care and Health Policy Collection, are made up of thirty-nine linear feet of correspondence, professional papers, organization files, writings, and print material. More than half the papers date from Esselstyn's career as director of the Rip Van Winkle Clinic (1946-1964). The later papers (1964-1975) are less complete but include extensive correspondence files.

The Esselstyn Papers provide Interesting coverage of the origins and development of prepaid group practice from the mid 1940s through the mid 1970s and of the organization and delivery of health care in rural areas. They also include valuable information on efforts to implement a national health insurance program for the elderly (Medicare) as well as on a variety of other medical care and health policy programs and issues during the period.

The papers are organized in five series: CORRESPONDENCE, PRINCIPAL PROFESSIONAL ACTIVITIES, OTHER PROFESSIONAL ACTIVITIES, WRITINGS, and REFERENCE.

Series I, GENERAL CORRESPONDENCE, is organized in three sections: Correspondence, 1945-1964, Correspondence & Subject Files, 1964-1975, and Personal Correspondence. The Correspondence, 1945-1964section is made up of Esselstyn's professional correspondence while he was director of the Rip Van Winkle Clinic (through July 1964). The section includes exchanges with directors and other officials of the Rip Van Winkle Foundation, associates in a variety of medical and health services fields, friends, local and state community leaders, professional societies and organizations, and others. The section provides information on Esselstyn's activities and interests, his developing national influence in group practice and medical care, and his opinions on a variety of health and social issues.

Most of the significant correspondence concerning the Rip Van Winkle Foundation in Correspondence, 1945-1964 is listed and cross referenced in the Rip Van Winkle Foundation section (see Series II, PRINCIPAL PROFESSIONAL ACTIVITIES). The correspondence with Allan A. Ryan, foundation chairman, and exchanges with Laurence J. Ackerman regarding prepayment (1955 Jun 2) and with Edwin F. Blair concerning clinic finances (1959 Jan 28) are of special note. The papers as a whole contain little information on Esselstyn's patients, but this section does include a few letters from patients or their relatives.

Correspondence with leaders in health and social policy develops in the early 1950s and becomes increasingly more voluminous over time. Individuals represented in the section include George Baehr, David P. Barr, Morris Brand, Lester Breslow, Agnes Brewster, James Brindle, Wilbur J. Cohen, George Crile, Jr., Nelson H. Cruikshank, Michael M. Davis, Isidore S. Falk, Leslie A. Falk, Franz Goldman, Lorin E. Kerr, Margaret C. Klem, Isidor Melamed, M. Allen Pond, C. Rufus Rorem, Cecil G. Sheps, Milton Terris, and Ray E. Trussell.

Both the first and second sections of Series I contain correspondence with Benjamin Spock, a friend and former classmate, which covers personal and professional concerns. Other correspondence of special interest in the section includes exchanges with Norton Sager Brown, a former associate and private practitioner, regarding prepaid group practice and a letter to Aims C. McGuiness (1959 Jun 19) concerning the American Medical Association.

The Correspondence & Subject Files, 1964-1975 section represents the continuation of Esselstyn's professional correspondence and dates from August 1964 through 1975. The section consists primarily of correspondence but also includes reports, printed matter and other material.

The section reflects Esselstyn's succession of professional appointments during the period, but in general the correspondents and subjects covered are the same or similar to those in the first section. There are a number of letters to friends and associates informing them of the closing of the Rip Van Winkle Clinic, and a letter to Milton C. Rose (1965 Dec 12) includes a description of the clinic's financial problems. An exchange with Rolf Scholdager (1968 Apr) explains why he resigned from the Community Health Association is of special interest.

The first two sections of the CORRESPONDENCE series contain cross references to most of the significant correspondence in Series II, PRINCIPAL PROFESSIONAL ACTIVITIES, and Series III, OTHER PROFESSIONAL ACTIVITIES. However, there are no cross references between the two sections. The names in both sections must be reviewed to find all of the correspondents in the papers.

The third section in Series I, Personal Correspondence, contains exchanges with Esselstyn's family and correspondence regarding a variety of personal activities, including alumni associations, expense accounts and honoraria. More interesting are the 1964 inquiries regarding employment (folder 488).

Series II, PRINCIPAL PROFESSIONAL ACTIVITIES, contains Esselstyn's files from his professional appointments for the years 1946 to 1974. The series is organized in five sections: Rip Van Winkle Foundation, Community Health Association, New York Metropolitan Regional Medical Program, New York State Department of Health, Bureau of Emergency Services, and United States Department of Health, Education, and Welfare, Health Maintenance Organization Service.

The Rip Van Winkle Foundation section makes up more than half of the series and is organized in five subsections: General Papers, Business Records, Programs and Projects, Publications and Photographs, and Reference Material. The papers, which primarily cover the period 1946 to 1964 but include a few items through 1968, are not complete, but they provide information on the organization of the foundation, the functioning of the clinic, fund raising and a number of medical programs and projects. The General Papers subsection contains a few administrative papers (e.g., board and committee minutes, annual reports) and correspondence and subject files. The latter include correspondence with clinic staff, the Columbia County Medical Society, the Health Insurance Plan of Greater New York, Inc., and other individuals and organizations; the files also contain cross references to relevant correspondence in Series I. The Business Records sub-section contains financial records (including fund raising correspondence) and material regarding personnel recruitment. The Programs and Projects subsection covers seven topics and includes extensive subject correspondence. The Publications and Photographs subsection includes an almost complete run of the clinic Proceedings from 1949 to 1962, and Reference Material contains clippings from local newspapers which cover foundation activities from 1946 to 1964.

In addition to the material in the Rip Van Winkle Foundation section, Series V, REFERENCE, contains Esselstyn's desk calendars for the period and dictaphone recordings of a conference held to commemorate the tenth anniversary of the foundation. Tape recordings of the conference have been transferred to Historical Sound Recordings, Sterling Memorial Library.

The Community Health Association section is made up of a small number of personal office files which Esselstyn retained after his resignation from C.H.A.; nearly all of the papers date from 1964 to 1967. Although the section is small in volume, the Correspondence and the Administrative and Program Papers subsections provide a good deal of information on C.H.A.'s program and on Esselstyn's involvement with local and national health care issues. The correspondence with Melvin Glasser, Emil Mazey, and other United Auto Worker's officials, which also includes transcripts of telephone conversations, contains frank discussions of policy differences between Esselstyn and the union.

The last three sections in the series New York Metropolitan Regional Medical Program, New York State Health Department, Bureau of Emergency Services, and the Department of Health, Education, and Welfare, Health Maintenance Organization Service provide limited information on both the organizations' functions and on Esselstyn's activities. They typically include routine correspondence, occasional minutes and administrative files, and a variety of photocopied, mimeographed and printed materials. However, the files of the Committee on Health Careers for the Disadvantaged in the N.Y.M.R.M.P. section are an exception. Esselstyn chaired the committee, and the files document its activities.

Series III, OTHER PROFESSIONAL ACTIVITIES, is made up of Esselstyn's files from his participation in professional societies and other volunteer activities. The papers date from 1952 to 1973 and are organized in seven sections: American Public Health Association, Group Health Association of America, Health Insurance Plan of Greater New York, Inc., New York State Public Health Council, Physicians Committee for Health Care for the Aged through Social Security, and Public Affairs Committee, Inc.

The American Public Health Association section is made up primarily of papers of the A.P.H.A. Medical Care Section, of which Esselstyn was elected chairman in 1960. The Medical Care files include correspondence with Isidor Melamed, George Baehr, E. Richard Weinerman, Frederick Mott, Leslie Falk and other leaders in the field as well as minutes, memoranda and related material. The section also includes a few general papers and files of the Subcommittee on Medical Care of the Committee on Administrative Practice.

The Group Health Association of America section is the largest in the series and is organized in five subsections: Background Papers, Correspondence and Subject Files, Subdivisions, Programs and Institutes, and Reference. The papers date from 1953 to 1974 and provide extensive information on Esselstyn's role in the association and on the association's organization and activities.

Esselstyn was elected president of the G.H.A.A. in 1960, and the Correspondence and Subject Files subsection contains nine folders of his correspondence as president (arranged chronologically) as well as individual folders (arranged alphabetically) for Appalachian Regional Hospitals, James Brindle, W. Palmer Dearing, fund raising, Horace R. Hansen, Lorin E. Kerr, legislation, Frederick D. Mott, Saskatchewan group practice development, and other subjects and individuals for the years 1950 to 1974. The Background Papers subsection contains material on the founding of the G.H.A.A in 1958 and on its predecessor organizations. The Subdivisions subsection includes correspondence, minutes, and related material on the association's board of directors, committes, and divisions.

The Health Insurance Benefits Advisory Council section covers the years 1965 to 1970, the period of Esselstyn's membership, and consists primarily of agenda books, reports, procedural manuals, circulars, and technical correspondence which document the implementation and early operation of the Medicare section of the Social Security Amendments of 1965.

The bulk of the Health Insurance Plan of Greater New York, Inc. section is made up of minutes, memoranda and reports extending from 1962, when Esselstyn was appointed to the board of directors, through 1974. Esselstyn's involvement with H.I.P. began much earlier, however, and other series in the papers contain additional material on the plan (see especially Series I, folder 273, and Series II, folders 36-46).

The New York State Public Health Council section is divided into two subsections, General Papers and Meeting Files, and documents the last five years of Esselstyn's term (1955-1963) on the council. The correspondence supporting and opposing Esselstyn's reappointment to the council (March-August 1961) is of special interest. The correspondence with Health Commissioner Herman E. Hilleboe and others covers a variety of health topics.

The Physicians Committee for Health Care for the Aged through Social Security section provides broad coverage of both the committee's origins and operation, and of the issue of federal health insurance for the aged. The Background Material subsection traces the development of the issue from the introduction of the Forand bill in 1957 through 1960. The correspondence and other material in General Papers documents the organization of the committee, plans for and reaction to the meeting with President Kennedy in March 1962, and promotional and other activities through 1965. The transcript of a 1966 oral history interview (folder 364) contains Esselstyn's account of the committee's development and operation. (NB: The transcript is copyrighted and may not be photocopied.)

Series IV, WRITINGS, is arranged chronologically. The series extends from 1949 to 1974, although the bulk of the material dates from 1960 forward. About one third of the series is made up of correspondence concerning speaking engagements, publications, and requests for reprints. The remainder consists of speech texts and notes, reprints, and drafts of articles and other writings. Some of the writings prior to 1960 deal with medical and surgical topics; after 1960 the series concerns the organization and delivery of health services.

Series V, REFERENCE, includes print material on medical care for the aged, the Saskatchewan doctors' dispute, and labor and health care. The series also contains Esselstyn's desk diaries and calendars and dictaphone belt recordings of a panel discussion presented by the Rip Van Winkle Foundation in 1956.

The Esselstyn Papers were donated to Yale University Library by Mrs. Caldwell B. Esselstyn in 1980.

Dates

  • 1945-1964

Creator

Conditions Governing Use

Copyright has been transferred to Yale University for unpublished materials authored or otherwise produced by the creator(s) of this collection. Copyright status for other collection materials is unknown. Transmission or reproduction of materials protected by U.S. Copyright Law (Title 17, U.S.C.) beyond that allowed by fair use requires the written permission of the copyright owners. Works not in the public domain cannot be commercially exploited without permission of the copyright owners. Responsibility for any use rests exclusively with the user.

Immediate Source of Acquisition

Gift of Mrs. Caldwell B. Esselstyn in 1980.

Arrangement

Arranged in five series: I. General Correspondence. II. Principal Professional Activities. III. Other Professional Activities. IV. Writings. V. Reference.

Related Material

Contemporary Medical Care and Health Policy Collection, Manuscripts and Archives, Yale University Library.

Extent

40 Linear Feet (96 boxes)

Language of Materials

English

Catalog Record

A record for this collection is available in Orbis, the Yale University Library catalog

Persistent URL

http://hdl.handle.net/10079/fa/mssa.ms.1171

Overview

Correspondence, professional files, subject files, writings, personal and family papers, and printed material. The papers document Esselstyn's pioneering work as founder and director of the Rip Van Winkle Clinic in New York state (1946-1964). The papers also chart Esselstyn's career as director of the Community Health Association of Detroit (1964-1967), as associate director of the New York Metropolitan Regional Medical Program (1967-1968), as a member of the Health Insurance Benefits Advisory Council (1967-1971), and his post as vice chairman of the board of directors of the Health Insurance Plan of Greater New York. There is only a small amount of personal, family, and financial papers. These papers form part of the Contemporary Medical Care and Health Policy Collection.

Biographical / Historical

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.
Title
Guide to the Caldwell B. Esselstyn Papers
Status
Under Revision
Author
compiled by R. Joseph Anderson, Jo-Anne Woolner, and Sharon Laist
Date
September 1981
Description rules
Finding Aid Created In Accordance With Manuscripts And Archives Processing Manual
Language of description note
Finding aid written in English.

Part of the Manuscripts and Archives Repository

Contact:
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