Thursday, July 2, 2015

Individual mandate traced to our founding fathers

Who first came up with the idea of forcing Americans to have health insurance? It certainly wasn't Obama.

Individual mandate traced to our founding fathers

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Who first came up with the idea of forcing Americans to have health insurance? That’s the key part of Obama’s health reform plan under challenge before the Supreme Court.

It certainly wasn’t Obama. In 2006, three years before he devised his plan, Romney supported the idea in Massachusetts. Before him, key Republicans in Congress endorsed it in 1993. In 1990, the Heritage Foundation promoted it. And in 1973, Richard Nixon considered it.

So, how far back does the notion go?

The answer, according to Harvard Law professor Einer Elhauge writing in The New Republic, is all the way back to our founding fathers.

Elhauge notes that in 1790, the first Congress, which included 20 of the Constitution’s framers, passed a bill requiring ship owners to buy medical insurance for their seamen. The bill was signed into law by President George Washington. 

That was America’s first mandate on employers to purchase health insurance. 

The first mandate on individuals was enacted six years later, in 1798. The 1790 law only required coverage for physician services and drugs, so Congress added a directive that seamen purchase hospital insurance themselves. That bill was signed into law by President John Adams.

As it turns out, our founding fathers were quite fond of individual mandates. In 1792, Congress enacted a requirement that all able-bodied men buy firearms.
With a rule like that, it’s hard to imagine the framers would have thought twice about mandating the purchase of broccoli, had they felt it was needed.

And, writing in a follow-up this week, Elhauge argues that Congress derived its power to enact these early mandates from the Constitution’s Commerce Clause. That’s the same provision the architects of health reform used to justify the mandate in the current law.

Of course, there are important differences between the health insurance mandate that is part of Obamacare and those enacted by our founding fathers. Most importantly, the Obama mandate applies to everyone, not just to those engaged in a specific occupation.

And the legal status of the mandate says nothing about whether it is wise public policy.

But it is clear that a government mandate to buy health insurance is hardly a novel idea. With a 222-year pedigree dating back to our founding fathers, it is, quite to the contrary, part of a longstanding American tradition.

And our founding fathers didn’t let broccoli stand in their way.


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Check Up covers regional health news and a wide array of healthcare topics from pharmaceutical happenings to patient safety. Read about some of our bloggers here.

Portions of this blog may also be found in the Inquirer's Sunday Health Section.

Robert I. Field, Ph.D., J.D., M.P.H. Professor, School of Law & Drexel School of Public Health
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