Excerpts from Sailors’ Health and National Wealth, Marine hospitals in the early republic
Written by PhD student (at the time) Gautham Rao

The United States’ approach to health care for maritime laborers built upon British and colonial antecedents. Since Elizabethan times, Great Britain supported hospitals—the “Chatham Chest” and Greenwich Hospital—by taxing naval and merchant mariners’ monthly wages. In 1710, Virginia imposed a small tax on tobacco exports to England to fund a hospital for mariners at Hampton, Virginia. Nineteen years later Parliament ordered Pennsylvania to tax seamen’s wages for a marine hospital in Philadelphia. In 1749 Charleston, South Carolina, ordered churchwardens to create a hospital for sick and disabled sailors. Finally, voluntary “marine associations” in Boston (1742) and New York (1769) also cared for ailing sailors.

….This concern for the health of merchant mariners loomed large in postcolonial America. During the American Revolution, some dreamed of a self-sufficient economy that would not rely upon distant and often politically problematic European markets. But during the 1790s such utopianism gave way to a hard, and ultimately lucrative, reality: the United States economy remained tethered to European markets and long-distance maritime trade. Great profits awaited American merchants who did business in England, France, and the colonial ports of the West Indies. Now again society realized the great significance of the merchant marine.

Commentators of every political stripe—editors such as John Fenno, political economists such as Pelatiah Webster, and physicians such as Benjamin Rush and Samuel Latham Mitchill—found common ground in their advocacy of a system of marine hospitals. Importantly, the United States Constitution mandated a uniform, national system. Dr. Mitchill, soon to be elected to Congress, made this clear in a 1799 petition to Congress. Since “the regulation of commerce belong[s] exclusively to the National Legislature,” only Congress and the federal government could handle the problem of maritime labor that had once fallen to the individual colonies.

In 1798, Congress thus enacted a law “for the relief of sick and disabled seamen.” The bill taxed mariners’ wages—at the rate of twenty cents per month—to finance health care for ailing sailors in ports throughout the country. The gentlemen attorneys and merchants who wrote this legislation did not trust mariners to personally pay hospital taxes. Rather ship captains garnished the wages and paid them directly to federal customs officials. In this sense the marine hospital tax was a progenitor of the payroll tax.

…The marine hospitals grew rapidly in the early republic. A system that included twenty-six facilities in 1818 expanded to include ninety-five by 1858.

…By 1860, new marine hospitals were to be found in western ports, such as Napoleon, Ark., Evansville, Ind., and San Francisco; on the hubs of the Great Lakes, such as Cleveland, Chicago, and Galena, Ill.; and even in some aging eastern ports, such as Burlington, Vt., Portland, Me., and Ocracoke, N.C. Annual hospital admissions, which ranged in the low hundreds throughout the first decade of the nineteenth century, consistently exceeded ten thousand during the 1850s.

…The marine hospitals’ rapid westward expansion illustrates the durability and significance of this federal institution in a changing economy and polity. By the Jacksonian era, the center of the American economy had shifted away from foreign commerce, into domestic agriculture and manufacturing. Merchant sailors aboard river steamboats, rather than Atlantic schooners, were crucial links in this new American economy. But these laborers remained mariners nonetheless. Thus cities such as Paducah, Kentucky, demanded only a “NATIONAL HOSPITAL, with national funds, and administered by national functionaries.”

Where in the Constitution does it mention health care? This question has been asked by those who oppose the Affordable Care Act of 2010, which requires everyone to buy health insurance (with subsidies from the government) starting in 2014.  While the constitution might not specifically mention “the right to health insurance”, it appears that the Founding Fathers of our nation did believe in government-run, mandated health care coverage.

In 1798, Congress passed “An Act for the Relief of Sick and Disabled Seaman,” which was signed by President John Adams. The law authorized the creation of a government operated system of marine hospitals and mandated a 1% tax on the pay of merchant marine sailors to support it.

I found out about this law in a column by Rick Ungar, who writes for Forbes.com. Here is some of what he wrote:

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.

Adam Rothman, an associate professor of history at Georgetown University, commented on the 1798 law for an article in the Washington Post.

“[The 1798 law] is a good example that the post-revolutionary generation clearly thought that the national government had a role in subsidizing health care,” Rothman said.

“You could argue that it’s precedent for government run health care,” Rothman continues. “This defies a lot of stereotypes about limited government in the early republic.”

Rick Ungar at Forbes.com wrote:

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.

If you are interested in American history, you might want to read here about the importance of Sailors’ Health and National Wealth to the economic growth of the United States. The writer, Gautham Rao,  was a post-doctoral fellow in the Program for Early American Economy and Society at the Library Company of Philadelphia when he wrote the piece in 2008.

A recent New York Time’s editorial highlighted the stark differences between the Republicans’ plans for Medicare and those of the Obama Administration. The editorial said:

“The Democratic approach is mostly imbedded in the broader health care reforms enacted last year. The Republicans’ approach — including a call to repeal reform and ultimately privatize Medicare.”

The New York Times editorial pointed out a detail that was news to me:

The reform law provides subsidies to help close a gap in prescription drug coverage, known as the doughnut hole, that poses a hardship for millions of patients who need lots of medicine and often cannot afford to pay for it. The Republicans would repeal that subsidy.

I have previously written about the Congressional Budget office analysis of the Republicans’ plans, and the Times editorial said:

The Congressional Budget Office estimates that by 2022 new enrollees would have to pay at least $6,400 more out of pocket to buy coverage comparable to traditional Medicare.

The editorial points our the different approaches to controlling rising cost of medical care, which is ultimately the biggest problem for Medicare and the country:

President Obama is clearly dedicated to reforming the health care system. Mr. Ryan relies mainly on the idea that costs will come down because of competition among private plans and more judicious use of health care by patients who are forced to pay more.

In its conclusion, the New York Times editorial points out how Medicare was used in the 2010 elections to punish Democrats for their votes on health care reform, which included cost cutting for Medicare and Medicare Advantage:

During last year’s Congressional campaign, Republican leaders claimed to be Medicare’s stalwart defenders — conveniently ignoring their historical animosity toward the program. Older voters overlooked that history and flocked to the party in large numbers. Now the Republicans have embraced many of reform’s changes for Medicare — without, of course, advertising their flip-flop.