Payment for Medical Care of the Poor

in about Warren

Date: January 10, 1771

“Province of Massachusetts Bay to Jos: Warren

To 730 Visits at 1/6 pt Visit from May 1769 to May 1770  £54/15/0

[the document goes on to list 30 people, of which 3 include “for Wife” and an added two “& Child” Line items for these people, added to the £54/15/0 totals £180/3/10 on the first page of the document. An additional 18 people/line items on the second page gives a grand total of £198/2/4]

“Boston, January 2nd 1771. We the Subcribers hereby Certifie that the with in Accounting D.r Joseph Warrens amounting to One Hundred ninety eight pounds, two Shillings & 4d is right cast, and that the Persons therein named are Strangers, and not Inhabitants of my Town in this Province; neither had they wherewithall to support themselves


Joseph Jackson

John Ruddock

John Hancock

Saml Pemberton

Henderson Inches

Jona Mason

[Reverse of page labelled ]Jany 10th-1771: – ”

Source: John Collins Warren Papers, Boston: Massachusetts Historical Society, Ms. N-1731, box 2 of 23

Commentary: Joseph Warren received fee-for-service reimbursements from the Province of Massachusetts from May 1769 into 1772 for his care of poor and destitute patients at the Boston Almshouse and Manufactury. This is a receipt for payment to Dr. Warren from this period.

The context of the document was a government program to finance health care for designated poor people. Dr. Benjamin Church held the province medical appointment prior to Joseph Warren’s tenure. Loyalist Samuel Danforth displaced Warren in 1772.

Apparently the program was controversial in its time to a limited extent as an arena for a patronage appointment of the physician by the Governor’s Council . The discussion was about who would get the appointment – Tory or Patriot-leaning physician – rather than any fundamental concern with governmental involvement in the finance of health care for those who could not afford it. The program in modern terms would be most comparable to a state Medicaid program, if such existed with the government naming the physician providers of care and setting reimbursement rates as a single payer.

This aspect of colonial life in Massachusetts can be politically charged to some current observers, who view askance any government involvement in health care finance, much less precedents involving Founding figures like Joseph Warren and John Hancock. Of course, in the late Colonial period there was no U.S. Federal government and therefore no federal health programs of any kind. See the January 3, 2012, entry in J.L. Bell’s Boston1775 for further elaboration of the historical program, its place in Joseph Warren’s medical practice,  and modern politicized views of it.

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