Health Care Reform - mandates from 1798

History is a wonderful thing. Not that it's always pretty, but there is so much to learn.

Thanks Mooncat and Paul.

Take Health Care reform, for instance. People like Alabama Attorney General Troy King are claiming the new health care reform, signed into law by President Barack Obama, runs afoul of the Constitution.

"These are the oldest victims I've ever been called on to defend. They are the founding fathers, the people who wrote the founding documents of this country, and they have been hurt," he said.

One of those founding fathers was John Adams. In July 1798 President Adams signed into law “An Act for the Relief of Sick and Disabled Seamen,” a bill which had been passed by Congress.

This bill created the marine hospital service. How was the marine hospital service funded? By mandating that privately employed sailors purchase health care insurance, from which the proceeds were turned over to the hospitals.

Marine Hospital Service Stapleton Staten Island in 1887

Each ship's owner was required to deduct 20 cents from each sailor's monthly pay, and this money was channeled to the hospitals that provided care for the sailors.

Furthermore, failure to comply was discouraged by fining the ship's owners or captains $100 for each infraction.

Here is the bill that founding father John Adams signed into law. Highlights are mine.

CHAP. LXXVII – An Act for the Relief of Sick and Disabled Seamen

Section 1. Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled -
That from and after the first day of September next, the master or owner of every ship
or vessel of the United States, arriving from a foreign port into any
port of the United States, shall, before such ship or vessel shall be
admitted to an entry, render to the collector a true account of the
number of seamen, that shall have been employed on board such vessel
since she was last entered at any port in the United States,-and shall
pay to the said collector, at the rate of twenty cents per month for every
seaman so employed; which sum he is hereby authorized to retain out
of the wages of such seamen.

SEC2. . And be it further enacted, That from and after the first day
of September next, no collector shall grant to any ship or vessel whose
enrolment or license for carrying on the coasting trade has expired, a
new enrolment or license before the master of such ship or vessel shall
first render a true account to the collector, of the number of seamen,
and the time they have severally been employed on board such ship or
vessel, during the continuance of the license which has so expired, and
pay to such collector twenty cents per month for every month such
seamen have been severally employed, as aforesaid; which sum the said
master is hereby authorized to retain out of the wages of such seamen.
And if any such master shall render a false account of the number of men, and the length of time they have severally been employed, as is herein required, he shall forfeit and pay one hundred dollars.

SEC3. . And be it further enacted, That it shall be the duty of the
several collectors to make a quarterly return of the sums collected by
them, respectively, by virtue of this act, to the Secretary of the Treasury;
and the President of the United States is hereby authorized, out of the same, to provide for the temporary relief and maintenance of sick or
disabled seamen, in the hospitals or other proper institutions now established
in the several ports of the United States, or, in ports where no
such institutions exist, then in such other manner as he shall direct:
Provided, that the monies collected in any one district, shall be expended
within the same.

SEC. 4. .And be it further enacted, That if any surplus shall remain
of the monies to be collected by virtue of this act, after defraying the
expense of such temporary relief and support, that the same, together ,
with such private donations as may be made for that purpose (which the
President is hereby authorized to receive) shall be invested in the stock
of the United States, under the direction of the President; and when,
in his opinion, a sufficient fund shall be accumulated, he is hereby
authorized to purchase or receive cessions or donations of ground or
provision for buildings, in the name of the United States, and to cause buildings,
when necessary, to be erected as hospitals for the accommodation of sick and disabled seamen.

SEC5. . And be it further enacted, That the President of the United
States be, and he is hereby authorized to nominate and appoint, in
such ports of the United States, as he may think proper, one or more
persons, to be called directors of the marine hospital of the United
States, whose duty it shall be to direct the expenditure of the fund
assigned for their respective ports, according to the third section of this
act; to provide for the accommodation of sick and disabled seamen,
under such general instructions as shall be given by, the President of
the United States, for that purpose, and also subject to the like general
instructions, to direct and govern such hospitals as the President may
direct to be built in the respective ports: and that the said directors
shall hold their offices during the pleasure of the President, who is
authorized to fill up all vacancies that may be occasioned by the death
or removal of any of the persons so to be appointed. And the said
directors shall render an account of the monies received and expended
by them, once in every quarter of a year, to the Secretary of the Treasury,
or such other person as the President shall direct; but no other
allowance or compensation shall be made to the said directors, except
the payment of such expenses as they may incur in the actual discharge
of the duties required by this act.

APPROVED July 16, 1798.

The tax rate later was increased to 40 cents per month, and was discontinued in 1884. From 1884 until 1906 the cost of running the marine hospitals was paid from a tonnage tax on vessels entering the country. From 1906 until the hospitals were closed in 1981, they were funded by direct appropriations from congress. NIH reference


Here is a modern day ship in New York harbor. These pictures were taken during our trip to New York last year.