Washington's demise illustrates not only how far we've come in our medical knowledge, but also the futility of trying to understand the modern health care crisis by speculating about the constitutional "intent of the Founders." Health care was not a controversial issue in the founding era, mainly because there simply wasn't much health care to be had. The local doctor might have had a few remedies in his bag, but in many ways he knew less about health care than a typical ten-year-old today. Germ theory was still generations away, for example, as were numerous advances that we take for granted today such as X-rays, anesthesia, and antibiotics.

The general lack of knowledge and technology in Washington's time meant that available medical care was fairly egalitarian - a common merchant, a blacksmith, or an esteemed landowner all received more or less the same level of care (which was not much).

Even in this low-tech environment, however, the government still involved itself in health care. For example, in 1798, the year before Washington died, federal legislation was passed creating what would today be called a socialized system of hospitals and health care for privately employed sailors.

Of course, no alarmist cries of "socialism" resulted from this federal legislation, mainly because the word didn't even exist yet, but also because the Framers understood the role of government in promoting and protecting public health. In fact, although the word "socialist" was unknown to them, the Constitution they wrote acknowledged government's duty to "promote the general Welfare." Conservatives today seem to feel that Washington, Adams, Jefferson, and Madison would be appalled at the notion of government involvement in health care, but the facts suggest otherwise. It was Adams, after all, who signed the 1798 bill establishing federal hospitals and socialized medicine.

In fact, when we consider the advances that have been made in medical technology, the conservative, anti-government, quasi-Dickensian view of health care seems to directly conflict with the public-interest values of the Framers. Today, thanks to scientific advances, extremely complex technologies are available for diagnostic and treatment purposes - MRIs, CT scans, lasers, EMGs, EKGs, ultrasounds, high-tech lab testing, drugs, sophisticated surgical procedures, etc. All of this, of course, requires a complex infrastructure of medical schools, hospitals, device manufacturers, pharmaceutical industries, research laboratories, and other technological and professional support that didn't exist in the Founders' time.

Conservatives would have us believe that the Framers wouldn't see this vast pool of knowledge and technology as a public asset to be used for the public good. In the modern conservative view, this entire network should be market-driven, largely unregulated, and therefore available only to those who can afford it. The medical advances of the last two centuries, although often made possible by government grants and research paid for by tax dollars, are a privilege available to those who can pay for it. Only a massive propaganda effort financed by corporate interests could possibly convince the public that the Framers would accept such a morally bankrupt view.

Indeed, although Washington received medical care much akin to what a common man of his time would have received (the most unusual aspect of his care being that at least three doctors attended to him in his final hours, whereas a common citizen might not have had so much attention), today's conservatives would have Washington receiving top-rate medical care at a modern hospital (and probably recovering) while an uninsured working man from a nearby village, unable to afford such care, would suffer and die at home. Call it conservative values in action.

Such is the anti-egalitarian mindset of today's conservatives, far removed from the Founders' vision. Whereas Jefferson and other elites from the founding era frequently saw their children die in infancy, it seems today's conservatives would reserve such tragedies more exclusively for the underprivileged.

What is also different about today's situation, as compared with that of Washington's time, is the dominance of corporate interests, which is the real obstacle to achieving the Founding Fathers' vision of a society that attends to the "general Welfare" of its citizens. To the Founders it would have seemed unimaginable that access to critical lifesaving technologies, otherwise easily available, would have been restricted by economic class in the name of free-market economics. The Founders valued private enterprise, but they also valued the common good. They were highly skeptical of corporate power, and they certainly did not worship high finance and corporate profit the way conservative spin doctors would have us believe.

The idea that access to health care is a privilege, available to the fortunate few who can pay for insurance, is a most un-American notion. This is not a matter of class warfare, of the poor ganging up on the rich to eliminate wealth disparity. Average Americans accept economic class distinctions, understanding that the rich can afford many things that others can't - expensive vacations, second and third homes, yachts and recreational vehicles, and other luxuries. But certainly, at a minimum, as a society we cannot honestly say that quality health care, basic procedures that might determine life or death, should be among the "luxuries" that poor and working people should often do without.

The rest of the developed world has realized this for quite some time, and it's time for America to get with the program. In modern society health care is not a luxury, not a privilege - it is a right that should be available to all.

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Text copyright 2011 Dave Niose