Congress Passes Socialized Medicine and Mandates Health Insurance -In 1798
Jan. 17 2011 - 9:08 pm | 180,054 views | 5 recommendations | 396 comments
John Adams: "the man who at certain point...

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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.”

Contact Rick at thepolicypage@gmail.com

http://blogs.forbes.com/rickungar/2011/01/17/congress-passes-socialized-medicine-and-mandates-health-insurance-in-1798/

Does that blow out the idea of unconstitutionality of CongressCare?

It appears our framers saw it as constitutional.

No comments here?

I have not researched what you posted but from what I can see the biggest difference is that the sailor version was still optional. They have the choice to pay, if they pay then they get the medical treatment...if they did not pay then they would not be covered. I did not see anything in what you posted as fines or any thing bad if the sailor did not pay...

You misread.

The sailor couldn't have the job if he didn't pay,

And the captains of the ships were penalized if they didn't pay the tax at port.

OK, I missed that part but I see it now. But another thought is this is only for sailors, not the whole country... Think about the ratio of sailors to hospitals then vs the whole US population to hospitals now. I do not know about the rest of the hospitals but here the Emergency Rooms are under staffed and crowded as it is and there are usually limited beds available for inpatients. Now think about if everyone was there.

The other thing about the government take over of hospitals is all the hospitals will have to follow the government rules. Currently there are a bunch of religious hospitals, most of them have been in the news saying that if the government makes then do things they do not want to like abortions and stuff then they will just close their doors. Now imagine the already crowded hospitals getting even more crowded from the lack of the religious hospitals that do actually close their doors...

So you think that with Congresscare there will be more people in the emergency room than now? Why is that? If a health emergency happens people go to the emergency room no matter if they can pay for it or not, which lots of Americans cannot pay for it.

In emergencies, insurance or not you are going to the hospital there will be no change in emergency room visits.

And that kinda covers the religious hospitals too. No change just insurance instead of none.

Religious hospitals would not be forced to do any kind of care they don't wish to do. Why would you think that would happen anyway?

the founding fathers also declared blacks to be 3/5 human and women should not vote. it's taken no less than twenty seven amendments to correct some of their screw ups and we still have work to do.

John Adams was a big government guy, which was his major disagreement with Thomas Jefferson.

I really find the conversation on the constitutionality of what the government offers as services to be a silly conversation.

The constitution is vague on many many points, lets not sit here and play that game, its a politicians/lawyers game anyway. I am neither.


What is important, is how does it get done, how can it be fair, how can it fail if it fails and succeed if its successful?

The problem with government sponsored programs, is that the free market cannot punish sloppy inefficiency with the people running the program loosing all the money they put into it.

THAT is the driving force of innovation, efficiency, and smart work over hard work that only a free market can create.

If the government offered a competitive option, which could fail, and had a way for people to opt out and NOT have there tax dollars spent to support the failure then that would allow the program to evolve with the market.

It is my opinion that our current government (both parties) is good for nothing but propagating its own election cycle ad infintum.

What is it vague about? I'm not a lawyer or a politician and I'll bet I can answer 99% of your questions.

Agreed,lots of work.

Point here is that government sanctioned and requested healthcare is not unconstitutional at all by the framers themselves.

We can't help but improve a document that is so old.

Things change and needs change so the constitution needs to change.

No, that's not true. Slaves were counted as 3/5's a person for calculating seats for Congress. That was done by abolitionists to rein in the slave owning states. The slave owning states wanted to count slaves as a full person for appointing seats in Congress, but the abolitionists refused. They eventually compromised on 3/5's, which allowed the North (with their greater numbers) to push through laws that reduced or prevented slavery.

I think comparing something from 1798 that probably had a few thousand people involved is hardly the standard by which Obamacare should be measured.

You are talking about millions of people and hundreds of billions of dollars.

If it works out.. great..

If it fails.. It will be sent to the trashcan of history.


I read a report earlier that says only 1 state has an obesity rate under 20%.

In 1995 that would have been the highest in the country.

We have much bigger health issues than whether or not socialized medicine will work right now, in this country.

Of course.

Well, if people want to eat themselves to death, it is a free country after all.

Do your part and try not to become obese if that is your concern. Since you only control what you eat after all.

I watch what I eat for the quality of my life, I don't do it for anybody else. If that was the case, I would probably be big as a house. People have to do what is good for themselves because they want to, not because other people force them to.

Maybe if more folks could get to a doc more often with CongressCare they would hear from someone they trust and want to do it more often.

congress care? WHF is that? It's Oberrycare...