The farmers owned the hospital

In 1929 a doctor from Marjayoun asked the farmers around Elk City, Oklahoma, to buy a hospital at fifty dollars a share. They did. The local medical society spent the next two decades trying to undo it, and the idea travelled further than any of them.

In August 1931 about three thousand people came to the opening of a small hospital in Elk City, an Oklahoma town of some six thousand people on the edge of the Dust Bowl. The building was not owned by a doctor, a church or a city. It was owned by the farmers who used it.

The Encyclopedia of Oklahoma History and Culture calls Community Hospital the first cooperatively owned and operated hospital in the United States. The man who organised it was born in a village in southern Lebanon. His name was Michael Abraham Shadid.

He died sixty years ago this summer, on 13 August 1966. He is little known outside Oklahoma and a few cooperative circles. The record knows him well.

The Oklahoma encyclopedia gives his birthplace as Judaidet Marjayoun and the year as 1882. HistoryLink, the online encyclopedia of Washington State history, says he was the last of twelve children, and that only three of them lived past infancy. Steve Boisson, writing in American History magazine in 2008, adds that he never knew his actual birthday.

Both accounts say what turned him towards medicine. HistoryLink names the deep poverty of his neighbours and a missionary doctor at the American University in Beirut. Boisson names the doctor: George Post, of the Syrian Protestant College, who treated the poor of the area.

In 1898, at about sixteen, he left for the United States.

He arrived in New York with nothing to pay for a medical degree, so he earned it on foot. Boisson says he worked his way west as a door to door peddler, selling trinkets. HistoryLink says jewellery. The Oklahoma encyclopedia calls it pack peddling, and records that he entered John Tarleton College in Stephenville, Texas, in 1902.

He took his degree in medicine at Washington University in St. Louis. He worked as an assistant to a country doctor in rural Missouri, making his rounds on horseback, and then moved to Oklahoma. He married Adeeba, the girl he had been promised to as a child, and they had six children.

For about twenty years he was a country doctor. Boisson puts the number of babies he delivered in patients’ homes at about three thousand. In 1912 he published a book called The Self-Physician, which already set out his view that medicine needed reform. His practice in Carter, Oklahoma, did well. Then he gave it up and moved to Elk City, where he ran a general surgery practice and a hospital of eight beds.

HistoryLink says that in 1929 he went back to Lebanon and was shocked by the poverty there. To him it looked like the poverty of the farmers he treated in Missouri and Oklahoma. The same year, according to the Oklahoma encyclopedia, in October, he organised Community Hospital.

The plan was simple. Boisson describes it from the records. The farmers would buy shares at fifty dollars each, sold through the Oklahoma Farmers’ Union. Shadid pointed out that farmers already paid a hundred dollars to join the cooperatives that ran their cotton gins. A thousand shares would build the hospital. A member got half off his doctor’s bills. A farmer short of cash could pay ten dollars down and the other forty within a year.

By the summer of 1930, seven hundred shares were sold and building began. By December the sales had slowed and the work stopped. Boisson says the shortfall was covered with a personal advance and a loan secured on a life insurance policy.

In 1932 the hospital changed to a yearly fee. Boisson gives the figures: twelve dollars a year for one person, twenty five for a family of four, one dollar a day in hospital, and twenty dollars for a major operation. The members paid in advance for care they had not yet needed. HistoryLink sums up his cause as affordable care paid for ahead of time, given by doctors working as a group, with the stress on prevention.

Two of his sons, Alexander and Fred, became doctors and worked at the hospital, and so did his four daughters. By 1950, Boisson says, it served 2,400 families.

The Oklahoma encyclopedia names the opposition: the Beckham County Medical Society, the state medical association and the American Medical Association. Wikipedia records that the AMA called the cooperative unethical.

Boisson sets out how it was fought. In 1931 the county society, of which Shadid had been a member for twenty years, met privately to consider expelling him. It also considered reporting him to the state Board of Medical Examiners for steerage, the charge of soliciting patients unethically, because his agents sold memberships. Local doctors announced in the Elk City Press that they had nothing to do with the hospital. Doctors from other states who wanted to join him often failed the state licensing exam.

The hospital needed money from outside. In January 1932 an insurance company sent an inspector before approving a loan of fifteen thousand dollars. Shadid had his own children and their friends lie in the beds as patients, so the place would look busy. He admitted it later in his own writing, saying he did it because he was sure the hospital would succeed.

The fight over his licence reached a courtroom on 10 February 1940. Boisson counts five hundred people inside a room built for two hundred and another fifteen hundred outside. The judge found the charges unsubstantiated. His licence was not threatened again. In 1950 the hospital sued the county society for conspiracy in restraint of trade. The case was settled out of court in 1952, and the hospital’s doctors were allowed to join the society.

In 1939 he told the story himself. The Wellcome Collection in London holds a copy: A Doctor for the People, the autobiography of the founder of America’s first co-operative hospital, published in New York by the Vanguard Press, 277 pages.

HistoryLink records that a Seattle activist named Lily Taylor came across that book the year it appeared. In the summer of 1945 Shadid toured Washington, Idaho and Oregon and spoke to more than two thousand people. On 14 August 1945 he addressed about fifty people at the Roosevelt Hotel in Seattle, among them several of the people who went on to found Group Health Cooperative of Puget Sound. HistoryLink says he warned them that doctors would end up running any hospital they built, and urged them to organise a health plan instead.

Group Health was incorporated on 22 December 1945 and began giving care in 1946. HistoryLink calls Shadid an important catalyst and says its 1946 bylaws reflect his ideals of prepaid care and preventive medicine. On 1 February 2017 Kaiser Permanente took it over. Its own page puts the number of members who moved across at more than 651,000.

Shadid helped found the Cooperative Health Federation of America in 1947 and was its president until 1949. He retired from Community Hospital in 1946. Boisson notes that it stopped running as a cooperative in 1955.

He did not forget the village. The Oklahoma encyclopedia records that in 1960 he built a hospital there, which it names Hospital Haramoon, and that Lebanon gave him its Order of Merit. He died in Kansas on 13 August 1966 and is buried in Fairlawn Cemetery in Oklahoma City.

His degree. The Oklahoma encyclopedia and Wikipedia say 1907. HistoryLink says he graduated in 1906.

The move to Elk City. The Oklahoma encyclopedia says he left Carter around 1923. Boisson says he moved the family to Elk City in 1928.

The founding year. The Oklahoma encyclopedia says he organised the hospital in October 1929. HistoryLink and Wikipedia date the founding to 1931, and Boisson dates the opening to August 1931. Both can be true: one is when the scheme began, the other is when the doors opened. We give both.

His birth. Every source we opened says 1882, and Boisson says he never knew the day.

The earlier Lubnan pieces keep finding the diaspora where nobody thinks to look: a Nobel autobiography in Massachusetts, a mechanic’s shop in Brazil, a consulate ledger. This one is in a farming town in Oklahoma, on the edge of the Dust Bowl.

A boy from Marjayoun, one of three children out of twelve to survive, peddled his way through medical school. In 1929 he went home, saw poverty that looked like Oklahoma’s, and that same year organised a hospital the farmers would own. The doctors around him fought it in private meetings, in the newspaper and in court. The farmers kept paying their twelve dollars.

That is what excellence looks like when it refuses to wait for permission. The hospital was small. The idea was not, and it reached Seattle in a book.

So it goes on the record. With the dates, the disagreements and the name of the village where he was born.