Alexander Hamilton and the first compulsory health insurance law

July 30, 2023 Check out STAT+

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By Torie Bosch Editor, First Opinion

My new favorite cocktail party factoid comes from a book excerpt First Opinion published this week. (Please note I'm using "cocktail party" figuratively here. Does anyone still have cocktail parties? If so, why am I not invited?) Liran Einav and Amy Finkelstein, authors of the fantastic new book "We've Got You Covered: Rebooting American Health Care," write that in 1798, thanks to Alexander Hamilton, the U.S. instituted a program that "bore an eerie resemblance to the 21st-century Obamacare: an insurance mandate, coupled with a fine for noncompliance. … [W]henever a U.S. ship arrived back from a foreign port, each ship owner had to deduct a tax of 20 cents per sailor per month at sea from the sailors' wages, and pay it to the customs agent who then transmitted this money to the federal government. Ship owners who were caught avoiding the tax faced a $100 fine."  The goal was to keep sick seamen from overwhelming port hospitals. According to Einav and Finkelstein, Hamilton wrote "to Congress urging the adoption of the policy, the need for it stemmed from 'humanity's … tendency to protect from want and misery … a very needy class of the Community.' " Ultimately, Einav and Finkelstein write, this urge — "to protect from want and misery" — continues to infuse the patchwork U.S. health care system, but the reluctance to admit it makes care both more expensive and less accessible. This is a big week for First Opinion for two reasons: On Wednesday, we ran the final episode of this season of the "First Opinion Podcast," which will be back in October. (The "First Opinion Podcast" makes a great summer road trip binge listen! Tell your health-nerd friends!)  And on Tuesday, we released a STAT Report titled "Patients speak out: learning about health care first-person," made up of First Opinion essays in which patients, family members, and others talk about their first-hand experiences with the medical system. I did a Q&A with my colleague Erica Goode, STAT's special projects editor, about the report. Also in First Opinion: OB-GYNs in states that ban the practice of abortion should provide referrals for out-of-state care. Immigrants are being shut out of important maternal health programs. The mammography wars will not end anytime soon. How doctors' personal political beliefs affect patients. And more!  Stay cool out there, and share your thoughts and ideas for First Opinion at first.opinion@statnews.com. Also, are you on Bluesky? I am! I'm @thekibosch.bsky.social. And I have two referral codes for anyone who wants 'em — just reply to this email.

Adobe Enough with the health care policy patchwork. It's time for universal insurance There is only one way to fulfill our innate societal instinct to help those who are ill and lack the resources to care for themselves. By Liran Einav and Amy Finkelstein Doctors in states that ban abortion can still refer patients elsewhere. Why are so few doing that? No state law explicitly bans the sharing of abortion information. Yet doctors are reluctant to refer patients out of state or give them info. By Michelle Oberman and Katie Watson and Lisa Lehmann Why new guidelines recommending screening at 40 can't end the mammography wars Mammograms may be performed 40 million times each year in the U.S., but it remains one of the most deeply contested topics in medicine. By Asia Friedman Adobe Q&A: Giving voice to patients navigating cancer, rare disease, and more Health care is about many things — treating disease, developing new drugs — but at its core, it all comes down to the patient. By Erica Goode Why physicians should let patients call them by their first names Stephanie W. Edmonds and Ginny L. Ryan discuss their viral First Opinion piece on the honorific "doctor." By Torie Bosch Marc Tessier-Lavigne's resignation shows what happens when you don't pay attention to lab culture If approval and rewards at work are directly linked only to results, not process, where do you put your efforts? By C. K. Gunsalus Adobe Drug pricing and the 'impossible trinity' for patients Patients want three things from insurers: access to new drugs, low out-of-pocket costs, and low drug prices. They can't get them all. By Keith Ericson and Tal Gross How do doctors' personal political affiliations affect how they care for their patients? We looked at what the research shows about the way physicians' political beliefs affect the way they see patients. By Anupam B. Jena and Christopher M. Worsham Many immigrants are ineligible for important U.S. maternal health initiatives States need to expand access to Medicaid reforms providing a full year of postpartum coverage to include all immigrants. By Maria W. Steenland and Rachel E. Fabi and Laura R. Wherry

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