to use the word "really" implies the authors actually thought about the idea at all - pretty certain universal healthcare wasn't on the radar back in the 1780s
healthcare is necessary in order to exist - sure, a man theoritically can say "i'm never going to the doctor so i'm not paying a damn cent for healthcare," but as soon as he's lopped a finger off w/ a chain-saw he'll still end up in the ER, and the ER is required by the government to give him service, right?