What Does Benjamin Franklin Have to Do With Obamacare?

In founding the Pennsylvania Hospital, America’s wiliest Founding Father promoted public health by leveraging politics with religion. 

The White House Historical Association

“What would the Founding Fathers say about Obamacare?” is a question that, for better or worse, seems to provide endless fodder for debate.

Back in 2010, as part of a much longer essay for GQ about the political ramifications of Obamacare, John Jeremiah Sullivan unearthed a possible clue to at least one of the founders’ positions on the matter.

In 1751, Pennsylvania statesman Benjamin Franklin (“the uber-Founding Father”) conspired with Philadelphia surgeon Thomas Bond to found the nation’s first public hospital, envisioning that it would provide free health care to the city’s “sick-poor” and even “diseased foreigners.” The colony’s taxpayers would foot the bill, but it would be to their benefit in the long run because making city-dwellers healthier could reduce poverty and prevent epidemics, and doctors could put experience gained in an urban hospital setting to use treating rural patients. Bond had seen the concept in action in Europe, where he had completed his medical training, and he convinced Franklin that it could work as well in Pennsylvania.  Here’s how Sullivan described the negotiations that followed:

Franklin said to the Assembly, You have to build it.

The Assembly said, No, you must do it with private donations. You can't tax people in the country to pay for a city hospital.

Franklin said, That won't work, it will never be enough, good health care costs a lot of money, remembering "the distant parts of this province" in which "assistance cannot be procured, but at an expense that neither [the sick-poor] nor their townships can afford." …

The Assembly said, The people will never support it.

Franklin knew the majority of them already did. He knew the people.

He said to the Assembly, Here's the idea. If I and my associates can raise such-and-such an amount of money (an enormous sum for the time), you will match it, and the project moves forward.

The Assembly said, Sure! They knew Franklin could never get the funds. This way they looked generous, at no expense.

Franklin went out and quickly raised a good deal more even than the sum he'd named. He used the slightly competitive nature of the matching-funds plan to ratchet up giving. The people had been ready. The Assembly, to which he would soon be elected, and its powerful landed interests had been screwed. Franklin later said he never felt less guilty about an act of deception in his life.

That’s the story, and there’s no question as to its veracity.

As Sullivan pointed out, this foray into history and hypotheticals—the "What Would the Founding Fathers Do?” question—isn’t just “academic” in the case of health care reform: the opposition has focused, both before and after the Supreme Court decision, on the idea that laws like these were precisely what America's founders were trying to prevent—both in the design of the Constitution and in the values they sought to instill in the new nation.

Still, it’s hard to say whether this Founding Father would have advocated for publicly-funded healthcare at a scale beyond that of a single local hospital. Rather than providing a solid indicator as to what Franklin would have thought about Obamacare, the story of the Pennsylvania Hospital’s founding actually shows why it’s so difficult to guess what any of these men would have thought about modern health policy.

First: What were Franklin’s motivations for supporting the project?

In the Philadelphia Gazette on August 8, 1751, and reprinted in Franklin’s own 40-page account of the founding of the hospital (available online through the U.S. National Library of Medicine), Franklin offered one justification for his support: “This branch of charity seems essential to the true spirit of Christianity, and should be extended to all in general, whether deserving or undeserving, as far as our power reaches.”

This sort of sentence could support the idea that Franklin would have approved of government-funded universal healthcare. But taxing citizens to pay for a hospital is a far cry from mandating that everyone purchase health insurance, and Franklin’s words can also be interpreted very differently: he characterizes caring for the sick and poor as an act of charity—a religious virtue. The entire “Appeal for the Hospital,” where this famous quotation first appeared, in the Philadelphia Gazette in August 1751, was peppered with references to piety and “the Goodness of God.” And the mixing of God and government was to be discouraged in the U.S. Constitution, ratified shortly before Franklin’s death.

And yet, perhaps Franklin’s lip service to Christianity was some inscrutable joke. Consider Christopher Hitchens’s dissection of a single sentence of Franklin’s in 2005, arguing that the Founding Father had an oft unrecognized proclivity for playful language. On the subject of electricity, Franklin wrote: "It has pleased God in his Goodness to Mankind, at length to discover to them the Means of securing their Habitations and other Buildings from Mischief by Thunder and Lightning." Hitchens’s response:

Now, you may believe if you choose that the author of that sentence was sincerely of the opinion that God had decided to deny this blessing to his mortal creation until the middle of the eighteenth century of the Christian era. Or you may decide that an excess of humility led him to downplay or omit his own seminal role in "discovering" electricity. Or you may wonder whether he was deliberately ridiculing a theistic view by setting it down so innocently, yet in such a way as to actuate a stir of unease in even the most credulous reader.

Complicating the picture of Franklin’s motivations, his argument for the hospital relied not just on “the true spirit of Christianity” but also on practical reasoning: economies of scale meant that it would be more efficient for patients to travel to one place where providers and other resources were concentrated. As Franklin wrote elsewhere, and Sullivan quotes in his retelling of the story, "the good [that] particular men may do separately, in relieving the sick, is small, compared with what they may do collectively."

Franklin was a man of contradictions. But it’s safe to say he believed in the Pennsylvania hospital, and he simply used all the resources at his disposal to accomplish the task. Appealing to religious duty was just one tool for convincing naysayers to buy in to the idea; what motivated Franklin more strongly were the arguments that Bond had used to recruit him to the cause in the first place: the practicality of concentrating resources and making them accessible to all, as well as the pressing need to deal with the city’s mentally ill in some way other than putting them into prisons.

By the way, even as he was facilitating the nation’s first public hospital, Franklin was also building the first successful insurance company in America. Originally founded in 1750 for and by Philadelphia’s community of firefighters, the Philadelphia Contributorship began insuring citizens who wanted to subscribe in 1752. The government did not fund this venture.