There has always been government-subsidized health care in the United States. Until just after the Civil War, when state governments took more power, most Americans assumed that their local government would tax and spend to take care of the neediest. They frequently griped about the cost of these expenditures, as complaining about taxes is a long American tradition. But for about three centuries from the beginning of British North America, almost no one thought government-provided health care for the poor should go away.
That has changed. Congressional Republicans have campaigned for years on the plank that government’s involvement in health care should partially go away, including its funding of programs for low-income Americans. The Obamacare replacement bill proposed by House Speaker Paul Ryan last month aimed to roll back Medicaid spending at the federal level, which would encourage states to do the same. That legislation failed, but Republicans in Washington continue to look for ways to curb spending on coverage. Yet these efforts to divest government cut against the long history of health care in the United States.
British settlers in North America brought with them the laws of Britain, including measures pertaining to health care. Just a few years before the settling of Jamestown colony in Virginia, Parliament had reorganized a hash of different laws into one big “Elizabethan Poor Law,” which dictated how governments assisted the poor in Britain from 1601 until a major revision in 1832. In British America, the law was adopted by the earliest colonial governments, and government’s involvement in health care was part of the civic fabric—like jury duty and rounding up stray animals. George Washington himself oversaw its provision early in his political career. Starting at age 30, Washington served on the Truro Parish Vestry, a kind of citizen board that assisted the local Church of England parish. As church and state were intertwined in colonial Virginia, this was the body that oversaw tax-supported poor relief, including health care, in that area.