Government and Public Health in America

Government and Public Health in America

Ronald Hamowy

How involved should the government be in American healthcare? Ronald Hamowy argues that to answer this pressing question, we must understand the genesis of the five main federal agencies charged with responsibility for our health: the Public Health Service, the Food and Drug Administration, the Veterans Administration, the National Institutes of Health, and Medicare. In examining these, he traces the growth of federal influence from its tentative beginnings in 1798 through the ambitious infrastructures of today – and offers startling insights on the current debate.

Chapter 1: The Public Health Service

Ronald Hamowy

Subjects: economics and finance, health policy and economics, politics and public policy, public policy, social policy and sociology, economics of social policy, health policy and economics


The Public Health Service is the successor agency of the United States Marine Hospital Service, which was established in 17981 by act of Congress for the purpose of caring for sick and injured merchant seamen.2 Seamen were required to contribute 20 cents per month to cover the costs of this medical care.3 In 1800 the first marine hospital was opened at Washington Point, near Norfolk, Virginia, and by 1802 hospitals were also established at Boston, Newport, and Charleston. As the nation expanded, the number of marine hospitals multiplied as more seamen, including those manning boats and rafts on the Mississippi and the Ohio and on the Great Lakes, were brought under the law’s provisions. Indeed, by 1861 Salmon P. Chase, at the time Secretary of the Treasury in President Lincoln’s cabinet, was compelled to observe that the number of marine hospitals, over which the Department of the Treasury had jurisdiction, ‘has been increased far beyond necessity or utility’.4 While the tax on seamen was collected without interruption between the genesis of the program and 1870,5 Congress was compelled to augment these proceeds out of the general revenue during 49 of those years. In addition, appropriations were made for land and construction costs. Twenty-seven marine hospitals were operating at American ports at the start of the Civil War. By 1870, however, this number had been greatly reduced and the Service operated only seven hospitals, while it leased two others to private parties. Of the 31 hospital projects undertaken by the...

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