U.S. Public Health Service

Indian Country & Health Care Reform

By Mark Trahant

          Seattle-based Amazon.com, the world's largest online retailer, will move into its new headquarters near Lake Union next year. Then Amazon will leave an old Art Deco building, once known as the U.S. Marine Hospital.

          What if we took this empty building and turned it into a hospital? What if we staffed it with federal employees? What kind of health care would that look like?

          The answers are in our history. Congress passed a law in 1789 that provided for health care for sick and injured merchant seamen. But the thinking, even then, was broader. Philadelphia faced an extraordinary Yellow Fever outbreak in 1783 that killed more than 4,000 people (out of a population of 37,000). And therefore the primary mission of the new health service was to intercept diseases brought home by sailors returning from sea.

          The Public Health Service and the marine hospital network eventually expanded across the country. This was the first "public option" because this government plan was funded by a monthly deduction from the seaman's wages. The scope of medical activities grew as well, ranging from the treatment of epidemic diseases to industrial hygiene.

          The PHS could have become the basis for a national, federal health care delivery system. By the 1970s marine hospitals and clinics served American Indians, the urban poor, as well the agency's traditional clients of merchant marines and some federal retirees.

          "These hospitals have a record of service to this nation, and especially to its merchant seamen, which is long and distinguished," President Richard Nixon wrote in a veto message to Congress over the funding of public health.