Under the Constitution, states were to handle domestic health care issues, and the federal government foreign ones.
The Federal Government is “to certify with exact truth, for every vessel sailing from a foreign port, the state of health respecting this fever which prevails at the place from which she sails,” however “the state authorities [are] charged with the care of the public health.”
In 1792 when New England was suffering a crisis in one of its most important economic industries (fishing), some Congressmen proposed that federal funds be used to subsidize the troubled industry.
Those who proposed the Constitution knew, and those who ratified the Constitution also knew that this is . . . a limited government tied down to specified powers. . . . It was never supposed or suspected that the old Congress could give away the money of the states to encourage agriculture or for any other purpose they pleased.
If Congress can employ money indefinitely to the “general welfare,” and are the sole and supreme judges of the “general welfare,” then they may take the care of religion into their own hands; they may appoint teachers in every state, county, and parish and pay them out of their public treasury; they may take into their own hands the education of children, establishing in like manner schools throughout the United States; they may assume the provision for the poor; they may undertake the regulation of all roads other than post-roads; in short, everything from the highest object of state legislation down to the most minute object of police would be thrown under the power of Congress, for every object I have mentioned would admit of the application of money, and might be called, if Congress pleased, provisions for the “general welfare.”
A revolt over healthcare during the 1790’s: http://www.npr.org/templates/story/story.php?storyId=113543985