Congress Passes Socialized Medicine and Mandates Health Insurance – In 1798

The ink was barely dry on the PPACA when the first of many lawsuits to block the mandated health insurance provisions of the law was filed in a Florida District Court.

The pleadings, in part, read:

The Constitution nowhere authorizes the United States to mandate, either directly or under threat of penalty, that all citizens and legal residents have qualifying health care coverage.

State of Florida, et al. vs. HHS

It turns out, the Founding Fathers would beg to disagree.

In July of 1798, Congress passed – and President John Adams signed – “An Act for the Relief of Sick and Disabled Seamen.” The law authorized the creation of a government operated marine hospital service and mandated that privately employed sailors be required to purchase health care insurance.

Keep in mind that the 5th Congress did not really need to struggle over the intentions of the drafters of the Constitutions in creating this Act as many of its members were the drafters of the Constitution.

And when the Bill came to the desk of President John Adams for signature, I think it’s safe to assume that the man in that chair had a pretty good grasp on what the framers had in mind.

Here’s how it happened.

During the early years of our union, the nation’s leaders realized that foreign trade would be essential to the young country’s ability to create a viable economy. To make it work, they relied on the nation’s private merchant ships – and the sailors that made them go – to be the instruments of this trade.

The problem was that a merchant mariner’s job was a difficult and dangerous undertaking in those days. Sailors were constantly hurting themselves, picking up weird tropical diseases, etc.

The troublesome reductions in manpower caused by back strains, twisted ankles and strange diseases often left a ship’s captain without enough sailors to get underway – a problem both bad for business and a strain on the nation’s economy.

But those were the days when members of Congress still used their collective heads to solve problems – not create them.

Realizing that a healthy maritime workforce was essential to the ability of our private merchant ships to engage in foreign trade, Congress and the President resolved to do something about it.

Enter “An Act for The Relief of Sick and Disabled Seamen”.

I encourage you to read the law as, in those days, legislation was short, to the point and fairly easy to understand.

The law did a number of fascinating things.

First, it created the Marine Hospital Service, a series of hospitals built and operated by the federal government to treat injured and ailing privately employed sailors. This government provided healthcare service was to be paid for by a mandatory tax on the maritime sailors (a little more than 1% of a sailor’s wages), the same to be withheld from a sailor’s pay and turned over to the government by the ship’s owner. The payment of this tax for health care was not optional. If a sailor wanted to work, he had to pay up.

This is pretty much how it works today in the European nations that conduct socialized medical programs for its citizens – although 1% of wages doesn’t quite cut it any longer.

The law was not only the first time the United States created a socialized medical program (The Marine Hospital Service) but was also the first to mandate that privately employed citizens be legally required to make payments to pay for health care services. Upon passage of the law, ships were no longer permitted to sail in and out of our ports if the health care tax had not been collected by the ship owners and paid over to the government – thus the creation of the first payroll tax in our nation’s history.

When a sick or injured sailor needed medical assistance, the government would confirm that his payments had been collected and turned over by his employer and would then give the sailor a voucher entitling him to admission to the hospital where he would be treated for whatever ailed him.

While a few of the healthcare facilities accepting the government voucher were privately operated, the majority of the treatment was given out at the federal maritime hospitals that were built and operated by the government in the nation’s largest ports.

As the nation grew and expanded, the system was also expanded to cover sailors working the private vessels sailing the Mississippi and Ohio rivers.

The program eventually became the Public Health Service, a government operated health service that exists to this day under the supervision of the Surgeon General.

So much for the claim that “The Constitution nowhere authorizes the United States to mandate, either directly or under threat of penalty….”

As for Congress’ understanding of the limits of the Constitution at the time the Act was passed, it is worth noting that Thomas Jefferson was the President of the Senate during the 5th Congress while Jonathan Dayton, the youngest man to sign the United States Constitution, was the Speaker of the House.

While I’m sure a number of readers are scratching their heads in the effort to find the distinction between the circumstances of 1798 and today, I think you’ll find it difficult.

Yes, the law at that time required only merchant sailors to purchase health care coverage. Thus, one could argue that nobody was forcing anyone to become a merchant sailor and, therefore, they were not required to purchase health care coverage unless they chose to pursue a career at sea.

However, this is no different than what we are looking at today.

Each of us has the option to turn down employment that would require us to purchase private health insurance under the health care reform law.

Would that be practical? Of course not – just as it would have been impractical for a man seeking employment as a merchant sailor in 1798 to turn down a job on a ship because he would be required by law to purchase health care coverage.

What’s more, a constitutional challenge to the legality of mandated health care cannot exist based on the number of people who are required to purchase the coverage – it must necessarily be based on whether any American can be so required.

Clearly,  the nation’s founders serving in the 5th Congress, and there were many of them, believed that mandated health insurance coverage was permitted within the limits established by our Constitution.

The moral to the story is that the political right-wing has to stop pretending they have the blessings of the Founding Fathers as their excuse to oppose whatever this president has to offer.

History makes it abundantly clear that they do not.

UPDATE: January 21- Given the conversation and controversy this piece has engendered, Greg Sargent over at The Washington Post put the piece to the test. You might be interested in what Greg discovered in his article, “Newsflash: Founders favored government run health care.

Rick Ungar writes on politics with a specialty in health care policy. He consults a number of government officials and health care advocacy groups and can be seen on “Forbes on Fox” on the Fox News Network. This post originally appeared on Forbes.

17 replies »

  1. same go for car insurance? You are not really an MD, no MD I know is against universal health coverage, at whatever cost necessary. All MDs I know put patient health and welfare above theories of protecting the sovereignty of money. cf. Pauls.

  2. Be it the governments responsibility to help bolster the economy by creating and stimulating new industries and services that don’t yet exist in the private sector. Then the politician would then turn the newly created service over for the private sector to grow. At the time of the creation of the Maritime Insurance program, medical insurance was just a theory as the practice of medicine was just in it’s infacy itself. The program was set up primarily for prevention and early detection of quarentinable spread prevention techniques as no real treatments for really anything existed at that time. To call this medical insurance is a false claim. If anything it is just another perfect example of how once a government program starts you can’t get rid of it.

  3. The problem is that someone who makes the bad choice of not paying for health insurance who then becomes seriously ill causes the rest of us to bear the burden of their bad choice. We end up paying higher hospital fees to cover the emergency care and other hospital bills that they cannot afford. And we bear the tax burden for the bankruptcy court and other debt related expenses that the “bad chooser” may face as a result of their bad choice.

    And one other danger of allowing such bad choices is the increased opportunity it could lead to the start of an epidemic. People without health insurance are less likely to see a doctor until they are too seriously ill to do otherwise. In the meantime, if they are suffering from a deadly communicable disease, how many others did they infect while avoiding the doctor?

    While I am strongly against forcing people to buy private insurance, I am similarly strongly against for-profit private insurance period. The least costly way to assure that all citizens are cared for is to create the largest risk pool possible, one that includes ALL US residents. The only way to do that is via universal single-payer health care, something that every other industrialized nation on earth has already chosen for their own citizens (and like we have already done here for our military veterans and our elderly and disabled).

    The personal freedom and responsibility argument falls apart completely when it meets with reality.

  4. The Merchant seamen covered by the law were neither employees of a federal contractor nor were they government employees. They were private citizens employed by private concerns.

    I have a couple history books on my shelf dealing with the founding of the Public Health Service, which is what ultimately developed out of the Marine Hospital Fund. This was the first payroll tax in the USA and it was used to provide health care for private citizens.

    Using these facts I’ve made the same arguments that Rick Ungar and Greg Sargent have made. Not being a Republican I could certainly construct a rational argument that would take the opposing view, but why should I do work for them that they appear incapable of doing themselves?

  5. A brilliant piece of legal reasoning.
    1. Congress passed a law.
    2. In said Congress were some people who had worked on the Constitution.
    3. Ergo, the law is constitutional.

    (Alien and Sedition Act, anyone?)

    Go ahead, the satire just writes itself from here.

  6. While the Democrats just snicker silently in the shadows, mission accomplished!

  7. No one is required to buy anything under the ACA just for being in the country. Why keep repeating a falsehood?

  8. Perhaps we need to give the hospitals a break then and do away with EMTALA. Also do away with DSH payments. Equalize the playing field so the uninsured spill out into the streets with no care.

    Just creating an example that IMHO be described for all.

  9. Who in their right mind would accept being told to pay for something they don’t want, or feel they should have to burden that is not a necessity. Yes, health care insurance coverage is NOT a necessity, even though without it and having to pay out of pocket for care will have incredible consequences. It is about choice, and although to not get health insurance is a bad choice, aren’t people entitled to make bad choices?

    Not if you are a Democrat. Or, not if you are excluded from the rules.

  10. One of the mandates of the Constitution is to provide defense for citizens. Obviously being a sailor (federal employee) a that time was a voluntary position and as such one had the choice of not joining the navy. This is not the same as a mandate that every citizen must pay for insurance.

  11. The Act quoted above mandated the collection of taxes from seamen and in return provided them with medical care in federal and/or private facilities. The government was the “insurer”.

    Is this what the contested “individual mandate” does?

    If you want Constitutionally sound legislation, then tax away. Legislating that people must purchase certain goods and services on the private market is not the same thing, and this is not a minor semantic difference considering that our legal system is precedent based.

  12. Of course it is not difficult to see the distinction between mandating to an employee of a federal contractor the ability to pay for service n a federal hospital by buying insurance. Even today you as an employee are mandated to buy social security, at far greater cost than 1%.

    In 1798 no one was required to buy anything just for being in the country.

    Therein lies the obvious 800 pound gorilla in the courtroom.