Strengthening Constitutional Self-Government

No Left Turns

Health Care

Founders Favor Mandated Health Insurance?

Rick Ungar (writing in Forbes) claims: "In July of 1798, Congress passed - and President John Adams signed - "An Act for the Relief of Sick and Disabled Seaman". 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 concludes:

"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."

Well, what do you think?

Categories > Health Care

Discussions - 13 Comments

Would this have been the same Congress that passed the Alien and Sedition Acts?

It's quite a surprise to see that posted here - that's something that "silly" me would post in the comments (and then get berated by Redwald, Art Deco, Owl, and Cow for linking to it; what's going to be posted next, that Inc. magazine article that I posted the other day, the one about how Norway is just abuzz with entrepreneurial business activity, has a rock-bottom unemployment rate, high happiness index, high tax rates, and thoughtful, successful, Porsche-driving people who don't mind paying them?)

But seriously, why were the Founders Communist fascists who sympathized with Mozlim terrists and hated America? err....wait a minute...

Has any entrepreneur tried to produce and sell rubber bracelets with a Founding Fathers take on the WWJD (What Would Jesus Do?) phenomenon of a few years back? WWFFD (or just WWFD)! Could come in handy as a reminder when doing stuff like buying snow tires or telling a kid to get off your lawn. Because any Real American should never think or do anything without asking themselves that very question (along with the WWJD one too - used in conjunction with an approved Conservative Bible - I think NewsMax is selling them now).


The Federal government has delegated power over maritime law. The Congress was merely using that delegated power. Since time immemorial the maritime courts (now federal) have noted that seamen are no more to be trusted with their own care than children or mental defectives. They are practically wards of the Court. Congress was, in making this law, using its powers to advance remedies and benefits available to the seamen under maritime law which Congress had the power to change.

It also has the sole power over international commerce which was borne soley by ship in those days. When you combine the power to control such commerce with the long maritime precedent regarding seamen this is perfectly unobjectionable from a delegation of powers persepective, even then.

As noted here- Congress’s power to regulate in the area of maritime law is nearly plenary with no need to invoke the commerce clause.

I think I would check Rick Ungar's citations. I believe the practice of underwriting by merchant banks did originate in the late medieval or early modern period but that insurance as we would understand it today was a novelty in the 18th century. We could look it up, but the descriptive terms he uses seem anachronistic. It is my understanding that medical insurance in this country was an innovation offered by trade unions in the 1930s and hardly existed before that. In the 1920s, fraternal lodges did put doctors on retainer and they visited lodge members in return for something very like a co-pay, so there were substitutes for it.

Some seamen were public employees so the erection of such hospitals couls be seen as a form of deferred compensation or fringe benefit, much like veterans hospitals in a later period.

Thanks to Dr. Schramm for raising this issue. Thanks to John and Art Deco for helping to straighten it out. Thanks to Craig for his typical content-free stream of insult and abuse.

That's a lot of thanking - are you expecting to receive an award of some kind?

But okay, you're quite welcome. If you really like "content-free stream[s] of insult and abuse" be sure to check out this blog post:

Wasn't one of the arguments between Federalist and Democratic Republicans over whether Congress could mandate something like this for the general welfare, or not? We have been arguing over whether Congress could do things not enumerated in the Constitution ever since there was Constitution.

However, John Vecchione has a good point which is partly about federal control of the coasts.

Here is a history of the Public Health Service That Act produced "a loose network of locally controlled marine hospitals" perhaps without Federal control until 1870. Weren't the lighthouses on our coasts similarly considered federal property, but largely locally controlled? The PHS calls it self part of our "health defense", saying it has been "our Nation's frontline against the spread of disease from sailors returning from foreign ports" among other things.

Yes, a bit more solid information would be nice.

AD, insurance has been around for a long time. I think it is positively medieval.

In this case, it looks like the purchasing of goods and services was a condition of employment, not a condition of citizenship and therefore this is not a precedent.

Underwriting has been around a long time. Corporations making a speciality of providing risk-pooling services through the collection an investment of premiums are more recent.

There have not been corporations for very long. There have been companies that provided property insurance since the 1300s. Life and accident insurance came later. Yes, underwriting predates what we now call insurance, but was a kind of insurance. Something like underwriting has been available to defer risk almost as long as there has been international trade. The economics book I had with a history of insurance is packed away while we are doing renovations, so I was relying on memory and now on Wikipedia and other websites. Insurance is nothing new, although it has evolved.

So have ideas of what government needs to do.

I have been wondering if those coastal hospitals paid for out of seamans' wages were some of the first American hospitals. I just don't remember reading about many/any hospitals in America in the early republic. Does anyone know?

Kevin H is right. Merchant sailors who sailed under the American flag were considered to be under jurisdiction of American Maritime law,and under the protection the of the US Navy. Just as all merchant shipping companies had certain requirements if they wished to sail under the American flag, and (to this day) Merchant Marine Officers needed to acquire a Mate's or Captain's license to be able to navigate an American-Flagged ship, there could be requirements on sailors as a condition of employment. If the sailors stopped going to sea and started farming, they didn't have to keep purchasing insurance.
I don't know if this is a good analogy, but suppose the government said that any coal miner who worked in an underground mine that was on government land (though it was operated by a private company) had to buy life insurance if he/she had minor dependents. It is, as Kevin H said, a condition of employment, not existence.
By the way, as a postal worker, I am given a life insurance policy as a benefit; if I refuse it, I don't get to keep the premium money.

Congralutions pumpkin!!! A whole response without the dump truck load of links. You're learning!!

I think we are probably looking at this the wrong way round. Without information, I am merely speculating, but considering the period, the insistence was that the sailors pay for their own medical care. In other words, they take personal responsibility for their need for hospitalization.

Try this story: port communities had increased exposure to disease because of ships in port. Sailors brought a variety of diseases home with them. Scurvy merely required the proper treatment, but smallpox, yellow fever, syphilis and all sorts of other diseases were contagious. There were not always ship's doctors who would keep sick sailors on board until they were well. Heck, there were not always ship's doctors. Sailors disembarked, melted into the general population and spread the diseases they had brought home from distant ports.

The populace was rightly outraged. Someone had to do something. Communities did not have the money to build hospitals to treat sailors, who, in any case, were probably not always, or even mostly, local taxpayers. The states did not want to handle the problem; they had no money for such things at the time. Maybe some did. I'll bet Massachusetts would do something, but maybe Rhode Island and New York would not or could not. Why should the general population bear the burden of sick seamen, anyway? Citizens outside or the port towns had less interest in the matter.

People complained to their congressmen who brought the matter to the House. Someone must do something about sick and disabled sailors who were becoming a burden on communities in so many ways. Who had the power to compel those seamen to do the right thing and seek out and pay for their own health care? Who had authority in the ports? I think the federal government did.

Through argument and compromise, Congress, pressured by New England Federalists, agreed on "An Act for the Relief of Sick and Disabled Seaman". It was a good thing, proposed for the general welfare, to limit disease to have hospitals in ports for sailors. The federal government did not have the money to pay for hospitals, no matter how good a thing they were. Therefore this act lay the financial burden for the care of sick and disabled sailors right where it belonged, on the sailors themselves.

I wonder this, though: for how many years did seamen pay for the hospitals? At what point was the expense picked up by the local or state governments? Ever? In the 1870s the federal government took control, at about the same time it began picking up control of all sorts of things as federally managed public works or improvements.

That's my guess, my story. More actual facts would help it, but this is my surmise.

Leave a Comment

* denotes a required field

No TrackBacks
TrackBack URL:

Warning: include(/srv/users/prod-php-nltashbrook/apps/prod-php-nltashbrook/public/sd/nlt-blog/_includes/promo-main.php): failed to open stream: No such file or directory in /srv/users/prod-php-nltashbrook/apps/prod-php-nltashbrook/public/2011/01/founders-favor-mandated-health-insurance.php on line 778

Warning: include(): Failed opening '/srv/users/prod-php-nltashbrook/apps/prod-php-nltashbrook/public/sd/nlt-blog/_includes/promo-main.php' for inclusion (include_path='.:/opt/sp/php7.2/lib/php') in /srv/users/prod-php-nltashbrook/apps/prod-php-nltashbrook/public/2011/01/founders-favor-mandated-health-insurance.php on line 778