As the Democratic primary campaign unfolds, health care remains the subject of heated discussion. While the conversation about universal access and government responsibility has followed partisan lines in the 21st century, the idea that government has, could and should shoulder responsibilities to ensure the health and well-being of its citizens is at the heart of our country’s founding.
George and Martha Washington, John and Abigail Adams, Benjamin Franklin, Thomas Jefferson and James and Dolly Madison lived in an age where modern medicine was just beginning to develop. Even though they were part of the colonial elite, none were immune to sickness, disease and rampant epidemics, and concerns about both public and personal health frequently shaped the trajectory of their daily lives.
Despite their political differences, they all recognized early on that the economic, social and political health of the American nation clearly was connected to the physical health of its citizens, lessons leaders of both parties should remember today.
Before the advent of modern antibiotics, one’s life could be abruptly shattered by contagion and death. Debility from infectious diseases was commonplace in every ethnic group and class. Surgery was especially risky in an era when there were essentially no reliable antiseptics or anesthetics. As one of the first historians of medicine Richard Shryock put it so succinctly over a half-century ago, “In reviewing the circumstances of health in early America one almost wonders that so many people survived and that the country grew and prospered.”
The Founders’ personal encounters with illness and tragic loss of family members, including many of their children, made them acutely sensitive to issues surrounding medical treatment and disease. Smallpox and yellow fever epidemics provided the impetus for several early American health-care initiatives. As early as 1777, during the height of the Revolutionary War, John Adams recorded that the Continental Congress had passed legislation that expanded the Army’s Hospital Department. He lamented the fact that more soldiers died of smallpox than British bullets. The frugal New Englander wrote his wife, Abigail, with approval that, “The expense will be great, but humanity overcame avarice.”
Later, after Adams became the second president of the United States, he signed a bill in 1798 “to provide for the relief and maintenance of disabled seamen,” creating the U.S. Marine Hospital Service. It gave rise to a network of hospitals located at sea and river ports across the country, and over the next century it evolved into the national U.S. Public Health Service. The 1798 bill passed following a severe outbreak of yellow fever, as Adams and other politicians recognized that sailors often brought a variety of diseases with them to ports, including smallpox, yellow fever and malaria, and quarantine was sometimes necessary.
In the beginning, the means to provide seamen with hospital care, including doctors, medicine and room and board, came from a combination of private and public funds. Sailors paid a 20-cent tax per month out of their wages as a share toward an early form of insurance for medical care. The government then directed the use of those funds and underwrote most of the real remaining costs.
Through the Seaman’s Act, arguably for the first time in U.S. history, the federal government took an active role in providing temporary medical treatment of individuals who could not afford their own private care. Creating a safety net for thousands of mariners, it protected both individual citizens and commerce. The Founders understood that epidemics not only brought personal devastation to individuals, families and communities, but also brought economic havoc by disrupting trade when, for example, ships had to be quarantined at ports and were unable to unload cargo.
While the Founders had just fought a long and bloody war against government tyranny, they also understood the important role government played in promoting the physical well-being of its citizens. Improving general health care and the state of medicine could have far-reaching positive economic and social consequences and was therefore beneficial for even poor and vulnerable Americans. They believed that in the American republic, government and individuals could work together productively to promote good health, and they took concrete steps to advance that goal.
This belief united the founding generation that was otherwise frequently divided over questions about the role of government in American life. For example, Franklin helped found the country’s first voluntary public hospital (financed through a combination of individual private contributions and government funds) and the first American medical school. Washington insisted on smallpox inoculation for all his Revolutionary War troops, as many of the young soldiers had never been exposed to the disease. Despite concerns about ineffectiveness and even the dangerous potential for contracting a severe case of smallpox, which could be fatal, Washington believed such a mandate could protect his troops and help ensure the success of the war effort.
As president, Jefferson played a pivotal role in bringing smallpox in America under control though his vocal advocacy of the newer, safer Jenner method of vaccination. He wrote that, “I think it is important … to bring the practice of the [smallpox] inoculation to the level of common capacities, for to give to this discovery the whole of value, we should enable the great mass of the people to practice it on their own families & without an expense, which they cannot meet.” In 1813, Jefferson’s successor, Madison, signed into law a statue to encourage wider smallpox vaccination, one of America’s first public health bills. The aim of the Vaccine Act of 1813 was to ensure drug purity for the consumer by regulating the Jenner vaccine to protect Americans from unscrupulous suppliers who offered adulterated versions.
From the beginning, America’s Founders recognized that government had compelling reasons to shoulder some new responsibilities with respect to ensuring the health and well-being of its citizenry while still protecting individual liberty, an outlook which contemporary Americans from across the political spectrum should appreciate as they search for common ground over a contentious issue that personally affects us all.