U.S. Government Operated Hospitals and Federally Mandated Socialized Healthcare, Part I: The Present... or the Past?

More than 200 years before PPACA, the U.S. government created a socialized medical program known as the Marine Hospital Service which later evolved into the modern Public Health Service.
As Rick Ungar notes in his article from Forbes.com, the "ink was barely dry" on the Patient Protection and Affordable Care Act ("PPACA") signed into law by the Obama administration when "the first of many lawsuits to block the mandated health insurance provisions of the law" was filed.[1] One of the arguments advanced against PPACA is that a federal mandate requiring all U.S. citizens and legal residents to purchase minimum healthcare insurance coverage abrogates the United States Constitution.[2]

The 1798 Act authorized a federal system of hospitals and services to provide healthcare for sick and disabled seamen in the ports of the United States.
In 1798, President John Adams signed into law An Act for the Relief of Sick and Disabled Seamen (the "1798 Act"), which authorized the federal government to create and operate a system of hospitals and services to provide healthcare for sick and disabled seamen in the ports of the United States. The Act also required "the master or owner of every ship or vessel of the United States" to pay a tax, retained from the wages of the seamen in his employ, to the federal treasury to be used to fund these marine healthcare services.[3]

Thus, more than 200 years before PPACA, the U.S. government endorsed, created and maintained a socialized medical program which later came to be known as the Marine Hospital Service.[4]

Interestingly, the U.S. Marine Hospital Service has its roots in British and colonial traditions. Great Britain supported hospitals with taxes from the monthly wages of seamen and merchant mariners. The Virginia colony funded a hospital for Mariners in Hampton from a tax on exports in 1710, and Pennsylvania taxed seamen’s wages for a marine hospital in Philadelphia in 1729.[5]

The Marine Hospital Service grew rapidly after its creation in 1798, and annual admissions consistently exceeded 10,000 during the 1850s.
The Marine Hospital Service grew rapidly after its creation in 1798, with the government establishing federal marine hospitals in Boston, Philadelphia, Baltimore, Charleston and New Orleans by 1809. The system expanded to include twenty-six (26) hospitals and medical facilities by 1818, and ninety-five (95) by 1858. Annual admissions to Marine Hospital Service facilities "consistently exceeded ten thousand during the 1850s."[6]

Establishing these marine medical services was considered so important, in fact, that President Thomas Jefferson called on Congress in 1802 to create "a marine hospital in New Orleans even before the United States officially assumed control of the Louisiana Purchase." Congress complied and, in 1803, the New Orleans Marine Hospital treated over four hundred (400) American sailors.[7]

The Service focused more on sailors aboard river and coastal ships as the economy shifted towards domestic concerns.
The Marine Hospital Service expanded as the country expanded, evolving as the country’s economy and political environment changed. As the country moved westward, the American economy shifted away from foreign commerce to domestic agriculture and manufacturing. The Marine Hospital Service shifted, as well, focusing more on sailors aboard river steamboats and coastal transports than transatlantic trading ships. [8]

The Marine Hospital Service administration was centralized in Washington, D.C., in the 1870s, and it adopted a military model as part of a systematic reform. After the passage of the national Quarantine Act in 1878, the "task of controlling epidemic diseases through quarantine and disinfection measures, as well as immunization programs, fell to the Marine Hospital Service."[9]

The Marine Hospital Service became the U.S. Public Health Service in the early 1900s.
Eventually, the Marine Hospital Service evolved into the United States Public Health Service in the early 1900s. Today, the Public Health Service continues "to protect, promote, and advance the health and safety" of the nation under the supervision of the Surgeon General.[10]


1Congress Passes Socialized Medicine and Mandates Health Insurance – In 1798; Rick Ungar, Forbes.com.
2Florida et al v. United States Department of Health and Human Services, Case 3:10-cv-00091-RV-EMT, United States District Court, Northern District of Florida, Pensacola Division.
3An Act for the Relief of Sick and Disabled Seamen, U.S. Congress, 1798.
4Id, Ungar.
5Sailors' Health and National Wealth, Gautham Rao, Common-place.org, Vol. 9, No. 1, October 2008.
6Id, Rao.
7Id, Rao.
8Id, Rao.
9U.S. Public Health Service Commissioned Corps; About the Commissioned Corps; History.
10U.S. Public Health Service Commissioned Corps.

1 comment:

  1. Good info, I hadn't seen that before, thanks

    ReplyDelete