With all the controversy swirling around health care reform these days, it’s hard to find clarity. For so many, especially those of us living with chronic disease, the high cost of insurance deductibles and prescription drugs all too often forces impossible choices between paying basic living expenses and getting appropriate care. Narrow networks limit provider access. For all the advances of medical science, quality care is not guaranteed.
Our system in the U.S. has to change. But there is so much misinformation and disinformation about proposals for health care reform that it’s hard to know what’s the best, most viable solution. Any suggestion of government-supported universal health care is labeled anti-democratic by the right; those who prefer a choice between public and private options are tarred as sell-outs by the left. None of the bullying is helpful, to say the least.
So, I was wondering, as I write on President’s Day, whether the Founders had anything to say about government’s role in health care. Believe it or not, they did.
According to Harvard Law Professor Einer Elhauge, the very first U.S. Congress, in 1790, passed a law mandating that shipowners provide medical insurance for their seamen. Twenty of the Constitution’s framers were part of that body. And the law was signed by our first president, George Washington.
Eight years later, Congress passed another health insurance mandate regarding seamen. Since the 1790 law only covered them for medications and physicians’ services, Congress decided that when ship owners or masters came into port, they had to pay 20 cents per seaman for each month he had been in their employ. Those funds could be withheld from the mariner’s wages and were used “to provide for the temporary relief and maintenance of sick or disabled seamen, in the hospitals or other proper institutions now established.” Any funds left over were used to build hospitals for the sailors. President John Adams, whose legal writings had strongly influenced the drafters of the Constitution and Bill of Rights, signed that bill into law.
So it turns out that our federal government has, since its inception, played an active role in how health care is paid for and who should be covered. None of the Founders who were involved in those discussions considered it a violation of the Constitution to mandate health insurance. We can debate health care reform proposals on their merits—who is covered, who pays for what—but let’s keep the fear-mongering and flag-waving distractions out of the conversation. There’s too much at stake, and we have to get this right.
Image: “George Washington,” attributed to Rembrandt Peale, oil on canvas, ca. 1795. Worcester Art Museum collection.