The AHA and The American College of Surgeons approved of the prepaid plans but the editor of the Journal of American Medical Association, Morris Fishbein called it "Socialism and communism".
The health plan caught on through local enterprise and was gathering more and more people to its list. Other plans were being added to give more choices to employees. In 1947 changes needed to be added because of competition among the hospitals. Solicitation of patients to certain hospitals was unethical and patients wanted the hospital of their choice. Many hospitals were reluctant to accept the new plan because they needed the competitive edge to stay in business, but with hospitals falling down in occupancy they wanted to survive so eventually they gave in and accepted it.
The Blue Cross system came into effect by Frank Van Dyk who wrote the first multihospital plan. He saw that both doctors and patients were dissatisfied with the requirements. Two such requirements were: doctors were not working at the hospital where their patient had to go, and patients felt the same about their doctors not being at the hospital where their plan was in effect. .
Other multihospital plans were becoming popular and radio was helping that out. .
In 1934, the first dependent care coverage was established in Durham, North Caroline by the Hospital Care Association, this even included the first maternity care, which would cause a baby boom like some had said.
Support in the community leaders was what the Cleveland Plan was about. It had all major hospitals involved and medical society was endorsing it. .
John Mannix was the first to categorize rates, which is now called DRG"s. He was also concerned about the increase in the hospital's need of services. He said the more incentives you offer the more patients you get but he was not worried about that, he quoted "It will be easy enough to build more hospitals".
President Roosevelt, scared by roomers, left health insurance out in when making the social security package.