In the sloth-like progress that characterises medical history, few visionaries have lived to see their dreams reach fruition. Reformer Beatrice Webb died a tragic five years before the creation of the National Health Service she outlined in 1909. But that was nothing to John Bellers, the Quaker philanthropist who advocated a state funded health service more than two centuries before Britain’s Labour government took the hint.
A wealthy London cloth merchant, Bellers (1654-1725) never shrank from grand schemes that helped those worse off. In 1695 he proposed a “Colledge of Industry” to provide training and employment for the poor in a self sufficient community that would later inspire Karl Marx. Not confining himself to national problems, in 1710 he called for a European parliament to settle border and other disputes. But truly a man before his time, in 1714 Bellers published his plan for a national health service in “An Essay towards the Improvement of Physick. In Twelve Proposals. By which the Lives of many Thousands of the Rich, as well as of the Poor, may be Saved Yearly.”
Although he was not the first to propose universal free medical care, Bellers’ scheme was certainly the most articulate. And as his title made clear, he needed no lessons in how to win friends and influence people.
A prototype health economist, Bellers estimated that 100 000 people died annually in Great Britain for want of medical care. While three quarters of these were poor, improving health care would also benefit the rich, he argued, shrewdly calculating that every labourer who died cost the country £200 in economic loss. At the same time, with diseases and medicines “so mysterious,” perhaps half of the wealthy who died might be saved if medical knowledge were advanced. Well aware that charity begins at home, Bellers added: “And who knows whether Himself, a favourite Daughter, or his only Son, the Heir and Hopes of his Family, may not be of that Number?”
Having forcefully made his case for state funded care, Bellers advocated a far reaching primary, secondary, and tertiary service with two doctors serving every community, hospitals for the poor and for specialist care, and teaching hospitals attached to Oxford and Cambridge universities so that the students could add “Practice to their Aphorisms and Theory.” Patients’ records should be kept, outcomes monitored, and all deaths subject to autopsy, “as it is not easie for the Students to get a Body to Dissect at Oxford, the Mob are so Mutinous to prevent their having one.”
As if this were not sufficient, Bellers urged a thorough-going reform of medicine with a “public laboratory” to research and prepare all known therapies, a systematic examination of medicines already on sale to sift the efficacious from the fraudulent, and a global search for further effective treatments. Meanwhile, the medical colleges should regulate practice and both Houses of Parliament appoint health committees.
Sadly when Bellers, a lifelong pacifist, philanthropist, and humanitarian, died from a longstanding stomach complaint, neither physicians nor politicians could help him.
See John Bellers, An Essay towards the Improvement of Physick (1714); George Rosen, “An eighteenth century plan for a national health service,” in Bulletin of the History of Medicine, 1944:16:429-36.
Cite this as: BMJ 2008;337:a571