U.S. Government Operated Hospitals and Federally Mandated Socialized Healthcare, Part II: Back to the Future

In 1798, the U.S. Congress established a system of maritime medical facilities for merchant marines funded by a mandatory payroll tax; the federally operated Marine Hospital System appears to set a precedent for modern initiatives like PPACA.
More than 200 years before the Patient Protection and Affordable Care Act ("PPACA"), the U.S. government endorsed, created and maintained a socialized medical program for seamen which later came to be known as the Marine Hospital Service. The first part of this article discusses the European antecedents of the Marine Hospital Service and traces its history through the modern U.S. Public Health Service.

Some suggest that there is no distinction between the 1798 Act and the modern PPACA.
Rick Ungar's article from Forbes.com, also discussed in the first part of this article, suggests that there is ultimately no constitutional distinction between the federal socialized healthcare program created in 1798 by the An Act for the Relief of Sick and Disabled Seamen (the "1798 Act"), and the modern PPACA passed in 2010.

In a follow-up to Ungar's article, Greg Sargent quotes Adam Rothman, an associated professor of history at Georgetown University, as stating that the 1798 Act is "a good example that the post-revolutionary generation clearly thought that the national government had a role in subsidizing health care."[1]

Many of the nation's founders were serving in Congress in 1798 when the 1798 Act creating the Marine Hospital Service was passed
Ungar goes even further, suggesting that the 1798 Act and the Marine Hospital Service are proof that a federal mandate requiring all citizens and legal residents to maintain qualifying health care coverage is clearly constitutional. He dismisses a constitutional challenge to the legality of mandated healthcare based on the number of people who are required to purchase the coverage, and states that the nation’s founders, many of whom were serving in Congress when the 1798 Act was passed, believed that mandated health insurance coverage was permitted under the Constitution.

During its early years, Ungar notes, the nation’s leaders realized that foreign trade was vital to the country’s economy, and that "a healthy maritime workforce was essential to the ability of our private merchant ships to engage in foreign trade."[2]

The postcolonial American mariner played a crucial part in the survival of the fledgling country.
However, the vital role that the early American seaman played in the survival of the fledgling country is difficult to understate. The postcolonial merchant mariner was "a crucial laborer in an early American economy that was deeply dependent on foreign commerce."[3]

Consider the following:
Why did Anglo-American society lavish such attention on health care for the merchant marine? First, mercantilist economic theory emphasized the importance of a healthy maritime labor force. In mercantilism, economic dominion was the extension of war by commercial means. Countries vied with one another for control of the most markets, over the broadest expanse of land. Mariners were the foot soldiers in this race for global power.[4]
Over time, the safety net provided by the Marine Hospital Service actually became an incentive for early Americans to join the merchant marine trade despite its harsh, demanding and dangerous lifestyle. This ensured that "a stable supply of healthy maritime workers" was available to keep the fundamental engine of the young country’s economy at full steam.[5]

Thus, the concern for the health of merchant mariners loomed large in postcolonial America because "the United States economy remained tethered to European markets and long-distance maritime trade" and American "society realized the great significance of the merchant marine" in maintaining that vital tether.[6]

The essential role of the American seamen in the country’s economy may be a significant distinction between the 1798 Act and PPACA that justified federal intervention
An argument could be made that the essential role of the American seamen in the country’s economy is a significant distinction between the 1798 Act and PPACA that justified federal intervention for the general welfare of the nation. Further, the argument could be made that the 1798 Act was closer to federal initiatives like the regulation of workplace health and safety through the Occupational Safety and Health Administration ("OSHA").

Additionally, the long and well-established tradition of federal legal and regulatory supremacy in the maritime and admiralty arenas cannot be ignored when analyzing the legal distinctions between the 1798 Act and PPACA.

Nevertheless, the establishment and operation of Marine Hospital Service suggests that the United States has a long history of taxing individuals to fund federal institutions to provide public healthcare services.[7]

1Newsflash: Founders Favored "Government Run Health Care", Greg Sargent, Washington Post, January 20, 2011.
2Congress Passes Socialized Medicine and Mandates Health Insurance – In 1798; Rick Ungar, Forbes.com.
3Sailors' Health and National Wealth, Gautham Rao, Common-place.org, Vol. 9, No. 1, October 2008.
4Id, Rao.
5Id, Rao.
6Id, Rao.
7Id, Rao.


  1. Rick Ungar's theory is that because so many of the nation's founders were serving in the 5th Congress that passed the Marine Hospital Service, then it is clearly constitutional.

    I'm no expert on Constitutional law, but I don't believe that's quite how it works.

  2. And I would disagree strongly that there is no distinction between the 1798 Relief of Sick and Disabled Seamen Act and Obamacare.

  3. Hugh, I think his point is that if the 1798 Act was signed into law by John Adams who was one of the signers of the Constitution, then it is a pretty good bet that signers of the Constitution were on board with this kind of legislation. I just don't see that its really relevant to Obamacare.

  4. One may possibly equate this Act to current Workers Compensation and Maritime Law whereby workers and "sailors" are provided medical benefits and compensation for work related sicknees/injury, but I view it as an extreme stretch to apply this to the general public. I am no expert in Constitutional Law or the forementioned Act, but seems to me the Act was established to protect our young nation's ability to maintain a major part of our commerce at the time, that being maritime trade.
    Not sure how one jumps from that to forcing us all to "purchase" health insurance under Obamacare.

  5. Good point, Marc. I'm no expert in Constitutional law, either, but it would seem to me that the limited scope as well as the well-defined need would strengthen the "general welfare" argument for the 1798 Act's constitutionality. Admiralty and maritime has long been a significantly regulated industry that has traditionally been dominated by the federal authority, I believe.

  6. I am so glad I live in Australia. Health care here is built on a solid foundation, so we don't have to worry much about anything. Both government and private sectors offer great health insurance.