When Horace introduced a form of health insurance at the Hazelton Hospital in 1907, he was not the first to implement the concept. Nor was Lloyd George in England. Nor was Chancellor Bismarck in Germany. Indeed, a number of European states had some limited form of health insurance schemes even before Bismarck. How to finance public health had in fact been a topic for conversation in medical circles for a long time.
In England, three original thinkers—Hugh Chamberlen, Daniel Defoe and John Bellers—had been contemplating ways to improve public health more than 200 years before.
Hugh Chamberlen is one who should certainly not be forgotten. Not only was he a colourful physician of the late-Stuart and early-Hanoverian periods, he was, more importantly, one of the first to be recorded as proposing public health insurance.
He came from a family of obstetricians, most of whom confusingly were called Hugh or Peter. His great-grandfather was a Huguenot émigré. His grand-uncle, Peter Chamberlen the Elder (1560–1631), a barber–surgeon and “man-midwife,” was surgeon to Queen Anne (James I’s wife) and midwife for Henrietta Maria (Charles I’s wife). He was, therefore, present when the future King Charles II was born. This one is said to have invented the obstetrical forceps, a device the family kept secret for several generations. He was the uncle of the surgeon and obstetrician, Peter Chamberlen the Younger, who was also a social reformer, dreaming up schemes to help the poor, arguing for some form of nationalization and for abolition of the death penalty for theft.
Hugh Chamberlen, grandson of Peter the Younger, thus came from a family of surgeons, obstetricians and independent-minded reformers—some say visionaries. As early as 1668, he was proposing ways to rid London of the plague. In 1670, after a visit to Paris, he published a translation of a book on midwifery that would remain the standard text until the middle of the following century. He was appointed physician-in-ordinary to King Charles II in 1673 and was elected a Fellow of the Royal Society in 1681. An expert in midwifery, he proposed many projects for alleviating the ordeal of childbirth. That he did not always see eye to eye with the authorities, though, is shown by the fact that the Royal College of Physicians fined him ten pounds for the “illegal and evil” practice of medicine in 1688 on pain of being sent to Newgate Prison.
He gained some renown as one of the doctors who stayed in London during the Great Plague.
Hugh Chamberlen was a man of great imagination and ambition, given to firing off proposals to parliament like fireworks, seemingly whenever he had a good idea. In November 1690, he published the first draft of Dr. Chamberlen’s Proposal to Make England Rich and Happy. While this ambitious project, involving a scheme for a national credit system secured by mortgages on landed property, was too ambitious to work, which it didn’t, his other projects stood a fair chance of improving the happiness of the English people, had they been adopted, which they weren’t.
He also advocated the union of Scotland with England, the election of representative peers to the House of Lords, the institution of compulsory education, the practice of preventive medicine and a scheme of general health insurance.
In 1694 Chamberlen fired off to parliament his ideas on public health. In A Proposal for the Better Securing of Health, Humbly Offered to the Consideration of the Honourable Houses of Parliament, he proposed a scheme to reduce the number of people dying needlessly. He argued that the laws against the sale of bad and adulterated food should be strengthened and strictly enforced and also that streets and houses should be cleaned on a regular basis, “all these being very common causes of Disease and Death.”
He proposed a scheme,
“whereby care may be taken, that all sick, as well poor as rich, shall be advised and visited, when needful, by approved, skillful physicians and surgeons; and furnished with necessary medicines in all diseases, except for the pox, mid-wifery and cutting for the stone, for which last three calamities some small additional allowance may be settled . . .all this for a small yearly certain sum assessed upon each house, not exceeding—for the greatest family, nor under—for the meanest that are not objects of charity, which respective sums shall not be the third part of what is now spent, only in apothecaries’ bills in a healthy year. And for this every individual person of the family, as well as the lodger and servants, as master, mistress and children, shall, when there is occasion, be sufficiently accommodated: whereas many at present miserably perish without the least care.”
Chamberlen laid down fourteen inducements for the “new establishment of physic.” The first was that “to preserve health and save lives is always a public good, but more especially in time of war.” Number seven was that “mountebanks and cheats in physic are found by experience to conduce extremely to the ruin of peoples’ health and loss often of their lives as well as their money.” Number eleven—a very clever one—provided that members of both houses of parliament, with their families, not being householders in town, would be attended free of charge.
The involvement of the State in using taxes to improve public health and the levy of a tax on individuals that would entitle them to medical services were revolutionary ideas indeed. Here was a doctor with progressive ideas of which Horace would have approved.