An Insight into the History of Financing Health Care in America

Hospital documents on display as part of the Burns Library's Common Boston exhibit.

Hospital documents on display as part of the Burns Library’s Common Boston exhibit.

During the current government spending crisis and shutdown, a topic has frequently come up in recent news: health care. Republicans in the House want to slash Obamacare and Democrats in the Senate are fighting to keep it. The Affordable Care Act stands to not only expand Medicaid to cover low-income Americans but also eventually to cover all Americans. It is the latter concept that offends some US conservatives: insurance as a requirement instead of a choice or an option. While all this fighting occurs based on how Americans will be covered financially and how to determine what type of care individuals will receive, it is easy to forget just how much American health care has changed over the past century.

commonbostonexhibitposterCommon Boston, an exhibit currently on display at the John J. Burns Library provides an insight into America’s medical past. Included in this exhibit is an 1883 report for Carney Hospital which contains a statistical list of that year’s patients according to occupation. “Pattern-makers,” “shop girls,” “liquor dealers,” and “longshoremen” are among those who received treatment for their ailments. Common at that time were disorders of the eyes, ailments which, as evidenced by the numbers of patients who regularly see optometrists, are still with us today. Some diseases have luckily been silenced in the US—deaths due to “delirium tremors,” syphilis, typhoid and gangrene seen in the report of the 1857 Rainsford Island Hospital virtually don’t exist today. Although practitioners of health care of the late nineteenth century may have been less advanced health-wise, they may have had a better idea of the care aspect than the US does today. The Sea Shore Home’s 1888 report entered a plea for donations, and included an envelope with a two-cent stamp already attached. The 1876 Annual Report of the Hospital for Women included a lengthy statement from the Resident Physician detailing the money raised to help a patient, discretely called CA, who was completely cured but who surely would have died if she had been required to seek treatment based solely on her personal funds. Private hospitals today similarly ask for donations, but in a much less personal manner.

Front and back of a 1908 postcard advertising the Boston Floating Hospital. This postcard is now on display as part of the Common Boston exhibit.

Front and back of a 1908 postcard advertising the Boston Floating Hospital. This postcard is now on display as part of the Common Boston exhibit.

Another talked-about point of Obamacare is the expansion of health insurance to young adults. An estimated 2.5 million young adults gained coverage under the act, as parents are now required to insure their children up to the ripe-old age of twenty-six. In late nineteenth century Boston, there was a similar focus on children: the Boston Floating Hospital. The exhibit includes a post card representing the hospital with a hand-drawn boat and short description, informing the receiver that the seven permanent and one out-patient decks for children and babies help the healing process because air is good for them during summer months. The post card’s succinct text also points out that the Floating Hospital is entirely run on donations. The May 1896 report claims that over the prior five years, infant mortality rate had decreased “perceptibly” due to the “saline influence” the open sea air has on the patients on the ship. One doctor pithily quips that “plenty of air and abundant care” is what heals the children so effectively. One such example presented is an “inert motionless mass” of a baby who was pronounced hopeless only to be seen tossing a ball with his mom a short fifteen minutes after setting sail in Boston Harbor. In 1898 the Floating Hospital expanded to include overnight care and the institution implemented a policy where the Chairman, Mr. Anderson, would conduct follow ups on past patients. At the end of the report, just like on the succinct post card, the Floating Hospital appeals for funds, which would ensure “permanency of the hospital with adequate endowment.” Yes, the Floating Hospital, as well as other late nineteenth-century Bostonian hospitals, may have been playing on their benefactor’s emotions to collect funds, but what is so wrong with this? Physical health and curing diseases is only one part of health care and it was through those emotional pleas that funds were provided for children, women, and all citizens alike to receive the care that they deserved.

In the nineteenth century, health care professionals saw that every human being deserved to receive the health care they wanted, even if they couldn’t afford it. At the same time, though, they weren’t forced to seek overnight care on the Floating Hospital or quit their shop-girl jobs to receive inpatient treatment for “weak ankles” at Carney Hospital; no, they could float around Boston Harbor just for the day or seek outpatient treatments when they could. They were free to choose, but only because the funds were there to carry out the choice they made. This is the crisis I see in America’s health system today. How do we maintain freedom while still providing funds for all? Should we start sending out sentimental post cards or pamphlets with pre-stamped envelopes? I’m certainly not equipped to make this politically-influenced decision. Republicans and Democrats, as you continue to try to cure America’s health care system may I suggest a cruise around Boston Harbor? The salt air might do some good.

Check out the Common Boston exhibit to judge these health care documents yourself. These, along with many other socially and geographically relevant documents about our beloved city, can be viewed at the John J. Burns Library.

Anna Whitham

  • Anna Whitham, Conservation Assistant, Burns Library


“The Basics of Obamacare.” Online Athens. Accessed October 1, 2013.

About John J. Burns Library of Rare Books and Special Collections at Boston College

The University’s special collections, including the University’s Archives, are housed in the Honorable John J. Burns Library, located in the Bapst Library Building, north entrance. Burns Library staff work with students and faculty to support learning and teaching at Boston College, offering access to unique primary sources through instruction sessions, exhibits, and programming. The Burns Library also serves the research needs of external scholars, hosting researchers from around the globe interested in using the collections. The Burns Library is home to more than 200,000 volumes and over 700 manuscript collections, including holdings of music, photographic materials, art and artifacts, and ephemera. Though its collections cover virtually the entire spectrum of human knowledge, the Burns Library has achieved international recognition in several specific areas of research, most notably: Irish studies; British Catholic authors; Jesuitica; Fine printing; Catholic liturgy and life in America, 1925-1975; Boston history; the Caribbean, especially Jamaica; Nursing; and Congressional archives.
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