The Fourth Arm · Episode 2 of 11 · 20 min
Twenty Cents a Month: America's First Federal Health Law
In 1798 a cash-strapped republic docked twenty cents a month from every merchant sailor's wages to build hospitals for them, the first federal health law in American history. The episode traces it from the Marine Hospital Service to the U.S. Public Health Service, and is careful to call it prepaid for merchant seamen but not universal.
Who's who
- John Adams+3 more episodesPresident who signed the 1798 seamen's relief act
- Thomas WelshPhysician in charge of the first marine hospital facility, 1799
- John Maynard Woodworth+1 more episodeFirst Supervising Surgeon, who imposed a military model in 1871
Where it happens
- Castle Island, Boston HarborSite of the first temporary marine hospital, 1799
- Washington Point, Norfolk County, VirginiaFirst federally owned marine hospital, bought in 1801
- Charlestown, MassachusettsSite of the more permanent Boston hospital, 1804
Timeline
- July 1798Adams signs the act deducting twenty cents a month from seamen's wages
- 1799First temporary hospital opens on Castle Island
- 1871Woodworth appointed first Supervising Surgeon
- 1889Congress formally authorizes the Commissioned Corps
- 1912Service renamed the United States Public Health Service
- 1981The last of the former marine hospitals close
Still debated
Scholars dispute whether the law was a prepaid mandate on individuals or a commercial regulation of ship-master employers, and it should not be flattened into the first Obamacare. It covered one occupational class, not the public, and how well the promise of care was kept in practice remains an open question.
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