PHILADELPHIA REFLECTIONS
The musings of a Philadelphia Physician who has served the community for six decades

207 Topics

HSA BOOK
An originator of Health Savings Accounts describes their advantages over the Affordable Care Act. Six improvements are suggested, plus a lifetime HSA version, which substitutes whole-life approaches for pay-as-you-go. This new version would require legislation, but reduces health costs considerably.

Obamacare: Spare Parts for a Book
Maybe these should have been included, but it was decided to leave them out.

.American and European Unions, Compared
The (1648) Treaty of Westphalia created the modern nation-state by respecting sovereignty within agreed boundaries. Soon, everyone had a sovereign King. Today, Europeans live in republics, but wish to unite for economic benefits. Like others however, they found that hard to do, and so began with monetary union, alone. Unlucky timing: world monetary crisis suddenly struck.

Health Savings Accounts, Regular, and Lifetime
We explain the distinction between Health Savings Accounts, Flexible Spending Accounts, and Lifetime Health Savings Accounts. Sometimes abbreviated as HSA, FSA, and L-HSA. Congress should make it easier to switch between them. All three are superior to "pay as you go", health insurance now in common use, only slightly modified by Obamacare. It's like term life insurance compared to whole-life. (www.philadelphia-reflections.com/topic/262.htm)

Confederation Congress, 1781-1789
New topic 2012-08-06 12:22:08 description

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CHAPTER FOUR: The Math of Predicting the Future

The accuracy of predicting future longevity, future health costs, and future stock markets -- is very low, so don't let the specific numbers fool you. The purpose of deriving them (Mostly from CCS data) is to surmise whether it is safe to proceed with a trial of concepts. The differences are so great the general direction is pretty clear: HSA would surely save a great deal of money, compared with Obamacare, and compared with Medicare. Transition costs are not estimated, however.The HSA cost is inversely related to the income earned; three levels are presented.

It will be noted that with 6% compounded interest income, Health Savings Accounts would have a lifetime out-of-pocket cost of $58,000, calculated in year 2014 dollars, although present law permits $3300 annual deposits to age 65, or $132,000. Depending on the interest rate actually achieved, and the choice between maximum allowable or zero interest, lifetime Health Savings Accounts could cost somewhere between 58 and 132 thousand dollars, lifetime total in year 2014 dollars. A Medicare escrow part of that would be $10,000, and Catastrophic coverage for 18 years of Medicare life expectancy would add $18,000. The HSA escrow deposit costs for the Obamacre years 26-65 would total $10,000, and estimated Catastrophic insurance would add $16,000, to a total of $26,000.

Compare: the cheapest bronze Obamacare cost (covering 60% of healthcare, age 26 to 65) is $288,000. Adding Medicare adds $95,400, made up of $23,800 of payroll deductions, $23,800 of premium collections, and $47,700 of debt. Total average lifetime costs are thus calculated to be $383,300, plus the 40% estimate of uncovered ACA costs under the Bronze plan. Considering different inflation assumptions and rounding errors, that's pretty close to the $325, 000 which was calculated by Michigan Blue Cross and confirmed by federal agencies, for year 2000.

This outcome makes us absolutely confident that the lifetime Health Savings Account would create immense savings, which by our rough calculations would be somewhat less confidently stated to be $190,000, in year 2014 dollars, per lifetime. Multiply that times 300 million citizens, and you get a result in the trillions.

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Yearly Personal Expense for Forty Years, Age 25-64 (HSA vs. Obamacare)

Health Savings Account Deposits
@ 10%.....$65
@6%......$400
@ 2%......$2200
....$3300(Maximum Legal Limit)............
(All HSA premiums are plus $1000/ yr. for Catastrophic coverage).
Affordable Care Act "Bronze" Premiums $7200, for 60% coverage of Healthcare)

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Medicare Advance Payments, Age 25-83 Under Two Systems (HSA Escrow vs. Medicare Costs)

Health Savings Account,Escrow Deposit............|...................................... Medicare Yearly Costs......................................

@10%...............@6%...................@2% ................|....Payroll tax...................Premiums......................Debt............
$45.................$250.00.............$1400................| .......$1320......................$2640 (x18yrs).............$2725 (x18yrs.).............

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Comparisons of Health Savings Accounts Escrow for Medicare Costs (est.)

Lifetime Health Savings Account (68 yrs.)............vs................Medicare alone.

..............$80,000 single payment(40 yr. deposit of $850=$32,000 cost, 68 yrs.@4% cmp. Interest)..

..............$160,000 single p. plus debt service (40 yr. annual deposit of $1700=$68,000 cost, 68 yrs.@4% cmp. Interest)..

..............$219,000 both + Stock Market luck (40 yr. annual deposit of $850=$32,000 cost, 68 yrs.@8% cmp. Interest)..

..............$1,460,000 delusion (40 yr. deposit of $3300=$132,000 cost, 68 yrs.@10% cmp. Interest)..

..............$68,000 (Catastrophic Insurance, est. @$1000/yr)

Total Cost per Individual including Catastrophic for 18 yrs. estimate: $87,500 (75-100,000)

Present Medicare Pre-payment Costs: $196,200 plus 196,200 in debt.

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Total Cost per Individual including Catastrophic for 68 yrs. estimate: $127,500.

Total Cost if health insurance were tax deductible including Catastrophic for 68 yrs. estimate: $88,800.

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Limit per Individual, Exclusively used for Medicare Pre-payment: ($3300/yr x40= $132,000, realizing $1,460,000 at age 65 @10%.)............................

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Multi-year Health Savings Account (40 yrs.)............vs..............80% of Affordable Care alone.

...............$56,000 (1800-58,000)............................$288,000

....................($83/mo)...................................................

Total Cost per Individual, median estimate.

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Multi-year Medicare Escrow Deposits (40 yrs.)............vs..............80% of Affordable Care alone.

...............$80,000............................$288,000

Multi-year Medicare Escrow Deposits (40 yrs.)............vs..............60% of Affordable Care alone ("Bronze").

...............$80,000.($850/yr @4%, 150/yr @10%, contributing from age 25-65 ). ..........................$288,000

Estimated $18,000 Catastrophic Coverage Escrow (18 yrs.), escrow released at age 65

...............$ 8000 ($200/yr @4%, $40/yr @10%, contributing from age 25-65)

Total Medicare Escrow Cost per Individual, median estimate: $89,600 ($1050/yr @4% investment income, $190/yr @10%)

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Lifetime HSA plus Medicare............vs................Affordable Care plus Medicare

.........$120,000 (1800-58,000)............................$484,000 plus 196,000 in debt.

................($166/mo}.......................................................................... Total Savings per Individual, median estimate: $190,000

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All costs assuming age 25 to start depositing. Transition costs at later ages are not calculated. ---------------------------------------------------------------------------------------------------------------------------------------

Accumulating the Necessary Money for Lifetime Healthcare

Because it's easier to explain, let's begin at the far end of the process, the day after death, and look backward. This proposal isn't a Medicare proposal, but the most factual health data come from Medicare, so the reader quickly gets acquainted with the situation by starting there.

At present costs, statisticians currently estimate average lifetime healthcare costs at about $325,000 in year 2000 dollars; we could discuss the weaknesses of that estimate, but it's the best we have. Women have about 10% higher lifetime health costs than men. Roughly speaking, that's how much the average individual somehow has to accumulate, in order to spend that much by the time of death. It's unnecessary to predict the last dime to be spent on the last day of life, however, and incentives should be arranged to have people oversubscribe their deposits, letting their executors dispose of excess funds. That means the policy issue is to provide useful alternatives. People over 65 (that is, those on Medicare) spend at least half of that $325,000, but just what should be counted is a matter of argument (see below.)

Current law permits an individual to deposit $3300 per year in a Health Savings Account, starting at age 25, and ending when Medicare coverage appears. Congress can certainly change that, but if eligible, anyone under age 65 could start an account tomorrow. And hypothetically, if anyone could live to his 65th birthday without spending any of the account, a prudent investor would have accumulated $132,000 in pure deposits on his 65th birthday. If he is paid investment income on the deposits, he could have much more. Please hold your questions, until we finish outlining the plan.

If someone makes a single deposit of $80,000 on his/her 65th birthday, there will accumulate $190,000 in the account over 18 years, the present life expectancy if he spends nothing for health and invests at 5%; and $190,000 is what the average person costs Medicare in a lifetime. Since the average person spends $190,000 during 18 years on Medicare, enough money will accumulate in Medicare to pay its expenses, and after some shifting-around, this should make Medicare solvent, without any need for payroll deductions or premiums. Moreover, the average person would suppose that eliminating the cost would justify stopping the premium collection and returning the "unconsumed" payroll deductions. That might imply that only $40,000 is needed. But that's wrong, because the costs remain the same , and previously the government has been borrowing half the money from foreigners. In effect, the subscribers have been paying the government in fifty-cent dollars. There has been an exchange of one form of revenue for another, so the required revenue actually does demand $80,000 for a single deposit without payroll deductions or premiums. The government would put an end to further borrowing, but the previous debt remains to be paid. I have no way of knowing how much that amounts to, but it is lots. What we can more confidently predict is the limit that young working people can afford to put aside for the sole purpose of paying off the Medicare debts of earlier generation.

They would have to set aside an average of $650 per year (from age 25 to 64) to achieve $80,000 on the 65th birthday, assuming a 5% compound investment income. They might well complain about that, but it still does not pay off the debts of the past. To double it in order to pay off past debts would require an additional $ per year escrow, for each year's debt accumulation. At present, roughly $ 5300 per beneficiary, per year is being borrowed, and there are roughly twice as many current beneficiaries as people in the tax-paying group, but only 18 years, as compared with 40 years as a prospective beneficiary. So that comes to liquidating roughly $1300 a year of debt to balance the two populations, or $2600 a year to gain a year. That's for whatever the debt happens to be, which surely someone knows. To accomplish it, one would have to project an average of % income return. That's definitely the outer limit of what is possible, and it probably over-reaches a little. Therefore, to be safe, one would have to assume some other sources of income, a change in the demographic patterns, or an adjustment with the creditor. Assuming inflation will increase expenses, equally with inflation seems possible. And it also seems about as likely that medical expenses will go down, as that they go up. You would have to be pretty lucky for all these factors to fall in line over an 80-year lifetime.

It is this calculation, however rough, which has made me change my mind. It was my original supposition that multi-year premium investment would only apply up to age 65, and that would be followed by Medicare. In other words, it should only be implemented as a less expensive substitute for the Affordable Care Act. It seemed to me the average politician would be very reluctant to agitate retirees by proposing a plan to eliminate Medicare. They would feel threatened, the opposing party would fan the flames of their fears, and the result would be a high likelihood of undermining the whole idea for any age group, for many years. Better to take the safer route of avoiding Medicare, and confining the proposal to working people, where its economics are overwhelmingly favorable.

But when the calculations show how close this proposal under optimistic projections would come to failure, and when nothing remotely close to it has been proposed by anyone, the opportunity runs the risk of passing us by. So, I changed my mind. The moment of opportunity is too fleeting, and the consequences of missing it entirely are too close, to worry about the political disadvantage of doing the right thing. The transition to a pre-funded lifetime system will take a long time to get mature, and the political obstacle course preceding it is a daunting one.

========================================>/p> So we guess the average life expectancy where things will eventually flatten out will then be about 91. (Be careful, most life expectancy figures are for life expectancy at birth.) But you would have to be lucky in everything: a very favorable investment climate for the right ten-year period, plus a favorable health situation which avoided expensive illnesses just at the age when they would begin to threaten. Using a lower goal of $60,000 and a lower interest rate of 7% is considerably easier to achieve, but the limitation which might be reached first is the $3300 yearly contribution rate, and someone might be forced to pay all medical expenses out of pocket in order to make the investment fund stretch. The individual who came up short would still be considerably ahead, but we are using a precise match of revenue and expense, to simplify the examples. Someone who sells his business at age 63 might have the cash, but still have trouble because of the $3300 per year limit. It seems pointless to squeeze through a narrow window, and much better if the window were enlarged to permit lump-sum deposits up to a $132,000 lifetime limit. With that sort of cushion, plus a stretch of reasonably good health at the right time of life, it would become considerably safer to take the risks. At age 65, a lifetime of health costs is already in the past, but the curve of health expenses starts to curve up at age 50, at a time when college expenses for children may be persisting, and the house isn't quite paid for. It seems a pity to cripple a good idea with pointless contribution limits that almost stretch far enough, but leave people fearful. If Congress develops a serious interest in lifetime insurance, the yearly contribution limit should be revisited.

The simplified goal is therefore to accumulate $60,000 in savings by the 65th birthday, remembering that savings get a lot harder when earned income stops. With current law, you would have to start maximum annual depositing of $3300 by your 50th birthday, to reach $60,000 by age 65, and you would still need generous internal compounding to make it. But notice how easily $100-200 a year would also get you there, starting at age 25 (see below) and less optimistic investment income returns until age 65. Many more frugal people might skin by with looser rules; It could rather easily be subsidized for poor people and hardship cases. If you are going to cover lifetime health costs instead of just Medicare, many more will need $80,000 to do it, and have something left to share with the less fortunate. But to repeat once again, that still compares very favorably with the $325,000 which is often cited as a lifetime cost.

Starting with the Medicare example. Notice that forty years of maximum contributions, would amount to far more than the necessary $40-80,000 by age 65. We haven't forgotten that the individual is at risk for other illnesses in the meantime, so in effect what we need is an individual escrow fund for lifetime funding intended (at first) only to replace Medicare coverage. (We are examining lifetime coverage, piece by piece, trying to accommodate an extended transition period.) Depending on a lot of factors, that goal could cost as little as $100 a year deposited for forty years, or as much as the full $1000 per year. It all depends on what income you receive on the deposits in the interval. In a moment, we will show that 10% return is not impossible, but it is also true that a contribution of $1000 per year would not seem tragic, compared with the present cost of health insurance (now averaging over $6000 a year). I have unrelated doubts about the current $325,000 estimate of average lifetime health costs, but that is what is commonly stated. For the moment, consider these numbers as providing a ballpark worksheet for multi-year funding, using an example familiar to everyone, but not necessarily easy to understand after one quick reading.

The Cost of Pre-funding Medicare. Rates of 10% compound income return would reduce the required contribution to $100 per year from age 25 to 65, but if the income were only 2% would require $700 contributed per year, and at 5% would require $300 per year. Remember, we are here only talking of funding Medicare, as a tangible national example, Obviously, a higher return would provide affordability to many more people than lesser returns. Let's take the issues separately, but don't take these preliminary numbers too literally. They are mainly intended to alert the reader to the enormous power of compound interest. Let's go forward with some equally amazing investment discoveries which are more recent, and vindicated less by logic than empirical results.


Cost Shifting: Indigent Care Out, Outpatient Revenue, In

{Safeway Store}
Safeway Store

The CEO of Safeway Stores recently offered his company's preventive approaches as an example of what the nation can do to reduce health costs. He's undoubtedly sincere, but quite wrong; Safeway just shifted costs to Medicare. This is only one of several ways, major ways, cost-shifting is misleading us. Let's explain.

Average life expectancy is increasing at more than two years per decade, but of course people eventually die. Since health care costs are heaviest in the last year or two of life, extending life will soon push nearly all those heavy terminal costs from employer based insurance -- into Medicare. To die at age 64 costs Blue Cross a lot; but to die at 65 gets Medicare to pay for it. Either way, the cost is exactly the same, it doesn't save Society as a whole any money at all. Let's put it another way: dying at age 64 costs the employer and the employees; but dying at 65 costs the taxpayers. This means Medicare costs will surely rise, but in this case it's a reason to rejoice.

Increasing longevity is constantly pushing more costs from employers to Medicare, and not just in Safeway; the prospect is that soon substantially all major sickness costs will shift into Medicare. (To explain the failure of most employer insurance premiums to fall comparably in response to this shift, one must look elsewhere). But just a minute. Medicare is 50% subsidized by the government, and the employer writes off half of the cost as a business expense. That ought to mean it doesn't make much difference to anyone involved, except for one thing. Some employers have two employees and some have two hundred thousand employees. The amount of tax write-off is multiplied by the number of employees, so some employers can only write off a little, while an occasional employer might even make a profit on using health insurance for calisthenics. Economists agree that fringe benefits eventually and proportionately come out of the pay packet, so ultimately the employed patient benefits from the reduced bill, his employer pays less, and the Medicare costs the taxpayers more.

{Medicare}
Medicare

But instead of going down that trail, let's look at a second form of cost-shifting. Government payers and a few other monopolists are able to pay hospitals less than actual costs, and get away with it. The worst offenders are state governors administering Medicaid, where the underpayment is roughly 30%, in spite of federal reimbursement to the states for most of it, at full price. The resulting profit is used for various state purposes, mainly nursing home reimbursement. For the most part, such diverted funds are used for purposes not easily eliminated, so it is unlikely there will be much cost reduction for government if the scam is acknowledged and merely shifted to a different line in the ledger. To avoid bankruptcy, hospitals raise the rates for other health insurance plans -- and the uninsured. Employers are paying for most of it, so they stand to gain from reform, only to face higher state taxes as matters readjust. We have yet to learn where these costs will shift if the federal government takes over the costs of the uninsured; the current Obamacare plan is to shift 15 million uninsured persons to Medicaid. To a major degree, the federal government and its taxpayers are already paying for a lot of this uninsured cost, through the Medicaid shift. So its present dilemma is whether to continue to pay for it twice.

There's still a third cost-shift. In 1983, Medicare stopped reimbursing hospitals fee-for-service (itemized inpatient bills are still prepared but are meaningless fictions) and for thirty years has paid by the diagnosis, not the service, for inpatients. Consequently, per beneficiary inpatient costs have only risen 18% in five years, while outpatient costs have risen 47%. Costs are not the same as prices, which are even worse distorted. To a large extent, changes in costs are really changes in accounting practices, driving changes in actual practices. Skilled nursing and home care costs are rising even faster. When you hear fee-for-service payments attacked, it is this apparent overpayment of outpatient costs which is the source of complaint. But to pay out-patient medical costs in any way other than fee-for-service would imply an almost unimaginable restructuring of the medical system, without any proof it would save money. It will be very interesting to learn what contorted proposal is about to emerge.

{top quote}
Medicare +6% Medicaid -30%
Private Insured +32% {bottom quote}
58% Hospitals Lose Money

Not only do these shifts provoke inpatient nursing shortages, they start a war for patients between hospitals and office-based physicians. Hospitals are winning this war for business, but are losing money doing so. If the public ever demands a stop to loss-leaders, net insurance premiums will probably rise. The difference between a hospital which makes money and one which loses money is based on whether there is enough extra out-patient revenue to compensate for the hidden tax which the state effectively imposes on hospitals in order to pay for nursing homes. The obscurity of the present payment system is quite expensive, and the present beneficiaries of it are the Medicaid nursing homes. Obamacare essentially provides health insurance to 15 million uninsured by the process of placing them on Medicaid, so the consequences are going to be an interesting juggling act to watch.

{top quote}
5-year Change:
Inpatient +18% Outpatient +47% {bottom quote}
5-Year Hospital Costs

Just notice, for example, that neither Medicare nor private health insurance pays below costs, if you look at total national balances. Private insurers are paying hospitals 32% more than actual inpatient costs, while Medicare is paying 6% more than national cost. And yet 58% of hospitals are losing money. The magic in this formula lies in the losses incurred by state Medicaid but shifted to other payers. It could fairly be said we are just looking at a maldistribution of the uninsured, as a cost, and a maldistribution of non-inpatient revenues, as a profit, among the nation's hospitals. To what extent such maldistribution reflects uneven patient quality, as the loser hospitals claim, or provider inefficiency, as the winner hospitals would say, -- merely starts a distraction of attention which could last twenty years while we examine it.

And disruptions enough to take decades to fix.


CANDIDATE MAIN PAGE

As I was rushing out of my office one evening, trying not to be late for a rather large gathering of constituents, I was suddenly confronted by a nice young lady holding a piece of paper, closely followed by a young man with a big professional TV camera. I like to think they were lying in wait for me, but more likely they were haunting the Starbucks across the street.

The question was fired at me, what did I think about Governor Christie suing the Supreme Court about gay marriage? I had to admit I don't watch TV all day long, so I hadn't heard about it. Well, do you think it is appropriate for the Governor of a state to sue the Supreme Court? Huh, do you? Caught totally by surprise by a question I don't know much about, I answered, or mumbled, that it seemed to be a lawyer's question, and I'm not a lawyer. I do know that the U.S. Supreme Court will refuse to take a case unless the plaintiff can show he has sustained personal loss of some sort. But I don't know anything about the New Jersey Supreme Court or its rules, and the whole thing seems to me to be above my pay grade. Or something like that.

If I had had more than ten seconds to think about it, I might have said, "What you really are asking me is Don't you think Christie is a bad, insensitive person?" And my answer to that question if put a little more plainly, would be, "No, I like Governor Christie a lot and I trust a former U.S. Attorney to know the fine points of law better than I do, so I support him."

And if I am wrong, and the real question you are asking me is Am I gay? Then, my answer would be, "No, I'm not gay one bit. But I am inclined to let other people do as they please, as long as it is harmless to others."

And if the hidden question is do I approve of people being gay, I would have to answer that if everybody were gay, it's pretty hard to see how the human race would survive. Now could I ask you a question. Who are you, and who is paying you to ask me slanted questions?

Follow-up, written the next day: The next day's newspaper gave an entirely new slant to this little episode. It seems the decision was made by the Superior Court, not the Supreme Court, and Governor Christie appealed the decision, he did not sue anybody. So the whole interview process was a put-up job, slanting the attention away from a record-breaking court decision to Governor Christie, who was dutifully responding to a Superior Court ruling which overturned a state law. All the rest of it was either intended to shift attention, or else to tangle me up in a confused reaction to some events which didn't happen at all.

In that case, let me state my central position. Governor Christie is a great guy, who definitely needs to win re-election next month. And I am running for the role of Assemblyman for the 6th District, prepared to help him in every way I can.

Follow-up, written two weeks later: Presumably, after a week or two of consultation with experts, and watching for public reaction, Governor Christie withdrew the state's appeal of the Superior Court decision. That would appear to be the end of this phase of the matter, because there is no one else with the "standing" to appeal a state law, and gay marriages will at least go ahead, unrestrained by the State of New Jersey. All sorts of things might or might not happen, like passing a new law that answered the Court's objections. Or someone might feel injured by the present state of affairs, and sue for redress of damages. After wracking my brain to think of someone who was injured, let's consider some elderly couple without children. Since state marriage laws are primarily designed to protect mothers and dependent children, gay couples would appear to be in much the same situation as non-gay couples unable to have children. I have never heard of anyone protesting that couples unable to have children are receiving preferences they don't deserve, but it could happen I suppose, and the non-gay couples might lose some legal advantages they had grown accustomed to, feel aggrieved about it, and sue somebody because they lost those advantages. It sounds pretty far-fetched, so in likelihood no one will sue, and in a few years the matter will fade away. Some other state might keep the issue alive by its courts deciding differently, of course. But generally speaking, it looks as though the issue of gay marriage is settled in New Jersey, and the legislature can turn its attention to less exciting subjects, like dredging the Delaware, or building new houses at the shore after Hurricane Sandy. Or, what in the world are we to do about all those people who have been relegated to New Jersey Medicaid by the federal Obamacare legislation. Oh, yes. There's that matter of high state and local taxes.


What Is the Right Shape For a Legislative District?

At first it comes as a surprise, but soon seems natural, that the first question people ask me is, "What's the Sixth District -- do I live in it?" So the answer is: it stretches along the White Horse Pike from Pennsauken to Voorhees, including about fifteen towns, listed at the top of this page. A considerable number of people are uneasy that some of these towns will get consolidated to reduce expenses, but you usually hear that from established residents. The newcomers, mostly younger people, have fewer local loyalties, but the fact is most residents of a town seem to know very little about the other towns in their district, except for high school football rivalries.

Some of that may be caused by rather regular re-arrangements of the districts, which in turn is occasioned by the steady growth of population. Camden County is gradually coming to the end of a transformation of a farm county into a suburban county, and when that settles down the area should become more stabilized. That probably accounts for the rather large number of people who call themselves Independents. There are more Independents registered in this district than people affiliated with a party. Newcomers generally feel uncertain about local issues and uncomfortable about taking a position on them without more information. Judging from the poll results, it looks as though Independents are more likely to vote a straight-party ballot, just the opposite of what might be supposed. Not knowing the local issues, they vote for national ones or just stay home at election time for local issues. Gerrymandering probably is involved in this mix. Local observers say you can predict the politics of the next ten years if you know how to interpret the gerrymandering after each census. In fact, those who have studied the long-term history of the state, say they can see the trends in ten-year waves.

A "Voting District" is itself a local New Jersey phenomenon. There was a time when each county had a state senator, while the Assembly was divided by population. That led to a regular division of urban versus rural, reflected in a rural Senate and an Urban Assembly. That tended to slow down legislation, just as it is now seen to do in Congress, but it gave County politicians more power. A Constitutional revision in New Jersey eventually broke this tradition. We now have "Voting Districts", each one with one Senator and two Assemblymen. Students of political science favor a bicameral legislature, with the two houses elected by different means, deliberately designed to slow down concentrated power plays. Essentially, New Jersey now has what amounts to a unicameral legislature, according to this view of things. So there you are. New Jersey tried it one way, and switched to the other. It may not make a great deal of difference, since the real political division is between the Northern end, oriented toward New York, and the Southern end, oriented toward Philadelphia. As Benjamin Franklin once put it, New Jersey is a keg, tapped at both ends.


So, What is so Good About Christie?

Governor Christie

My daughter lives in Pennsylvania and therefore doesn't know what's what, recently confronted some New Jersey Republican politicians with a question. "Governor Christie is a great politician, and I love his confrontational style. But tell me truthfully, just what has he done that's so great?" Great question, daughter, and I'm going to give you a straight answer.

In the first place, he attacked the 800 or so committees created by the legislature, and cut them down to about 300, by threatening to reveal their existence, and the hundreds of paid stipends they passed along. And then he made great strides toward a balanced budget, protecting New Jersey municipal bonds from default, in spite of opposition majorities in both houses of the Legislature. Remember, since the biggest item in the New Jersey budget is for pensions for state employees, he's making substantial progress toward converting defined benefit pensions into defined contribution pensions. You don't need a detailed explanation of what that means, beyond knowing it would make a substantial reduction in future pension costs, as would some other reasonable suggestions, like 401(k). The IBM Corporation was the first to start such a change, and believe me the unions fought it, but now are glad they got it because it is portable. The bond markets are heavily influenced by public opinion, and the opinion became, this Christie guy is serious.

And to repeat, all this was accomplished with both houses of the Legislature controlled by the opposite party. Contrast this with the insults and misrepresentations by President Obama of his Congressional opponents. Nobody could expect much cooperation from the loyal opposition after attacks like that. Christie may have implied some threats, but he had the good sense not to project nasty insults, and remains on good terms with his opponents, in forgivably Jersey style. In fact, he gives them a certain respectability they lacked before he convinced them the old ways, just couldn't continue.

And then there is the astonishing move toward wedging part of the Union movement from its former perpetual affiliation with the opposite party. Some racial and religious population groups once made the same political mistake: the Republicans wrote them off and the Democrats took them for granted. Either way, they failed to achieve the clout they were entitled to. It just isn't a smart way to behave in a democracy, and the Unions have fallen into the same trap. Or, maybe union leadership is now waking up.

The American union movement is divided into industrial unions in the private sector, and government employee unions in the public sector. The government unions are gaining members, while the industrial unions are steadily losing members, for reasons I'm too polite to mention. Give Christie credit for starting a tectonic shift with a hint to the industrial unions, implying every time the public sector got a raise, the private sector got a tax increase. In New Jersey, that hurts, because government employee unions and industrial unions are not a natural mix. After all, Christie balanced the budget without a tax increase for two successive years.

That's part of the reality in Deptford Township of Gloucester County, where Sunoco decided to get out of the refinery business. Hundreds of union members are out of a job, still facing the second highest taxes in the nation, if they continue to live there.


What Lessons Can We Learn From the Mt. Laurel Decision?

Let's be clear; Mt. Laurel isn't in my district, which is District #6. Nevertheless, the courts have decided in two cases (Mt. Laurel I and Mt. Laurel II) that the little town next to the Turnpike Exit had to provide the area with a certain minimum amount of "affordable" housing, and that decision does considerably agitate District 6, along with most of the rest of the state. That was forty-three years ago, and lawsuits delayed implementation until 13 years ago. Both the legal cost of this episode, and the rancorous discord, were enormous. The New York Times recently published a follow-up story about the improvements that had occurred in the lives of the 140 families in Mt. Laurel, arguably as a result of better homes than they previously could afford, better schools, a safer environment, and maybe, better neighbors. The reporters said they could find no evidence of increased crime in a peaceful town, or uproar, or major resentments.

The resounding response that I have heard is to the effect that "The Mt. Laurel decision isn't about Mt. Laurel, it's about a lot of other towns." It's hard to know whether that response means to suggest that anticipation is more destructive than the event, or that Mt. Laurel was exceptional. Some of it surely reflects the opinion that the sweeping generalizations of the court are not applicable to some other towns. It is fairly observable that the officials of towns and local real estate interests are far more upset than the general public is, although people are ready enough to agree when someone in the building trade brings the matter up. Some of that is a local issue: the post-war de-industrialization of Philadelphia and Camden City created many scenes of neighborhood abandonment, when lower income people moved into a depopulating area. Sometimes in-migration was a cause, sometimes it was an effect, but local people are well aware of what can happen when panic breaks out about falling real estate prices. A house is normally the most valuable property anyone has. The Times article was meant to reassure such people, but it is probably going to leave many unconvinced. For one thing, the Commission established to implement this court decision has not adequately restrained the zealots in their midst. It is clear this is a touchy issue, and needs to be treated as one. Haddonfield, for example, does not have a single vacant lot, and feels needlessly hassled when it is criticized for lack of affordable housing./p>

The same needs to be said of the court. It could have made a much narrower ruling, perhaps confined to Mt. Laurel or to growing towns. That surely would have disappointed the individuals who brought the lawsuit, but thirty years of subsequent litigation suggest that a more gradual approach would have been more useful. Perhaps we should not entirely shield our legislative politicians from criticism. They ducked the issue for a long time, until the Court finally felt justified in forcing the issue.


Fisher on the Coming Physician Shortage

Caroline Casagrande

The 11th Assembly District is somewhere to the North, and two Republican ladies, Caroline Casagrande and Amy Handlin, are running for Assembly, the way I am in the 6th District. I don't know them, but I approve of their message in their local newspaper. They feel that Obamacare is going to create a physician shortage, and it certainly does feel as though it's already getting hard to find a doctor. If you think about it, you'd have to agree that giving health insurance to many extra millions of uninsured people would likely put strains on existing supplies of doctors. But there's a related point to make.

Amy Handlin

I'm quoting Roger Egeberg MD, here, who was General MacArthur's chief medical aide in the Pacific. He later became Assistant Secretary of Health, where I got to know him. He expressed disapproval of salaries for doctors in the strongest possible terms. When I asked why he would say that, he replied,"If you put doctors on salaries, you will get an instant forty-hour week, and after that you will get an instant doctor shortage." Although I don't know that it would be instant, I think he is probably right about the general idea. Piece work makes you work longer and harder, and for that reason alone a lot of people hate piece work. Doctors call it "Fee for Service", but it's piece work.

Roger Egeberg MD

In a way I'll explain in another blog, the DRG system of paying hospitals by the diagnosis rather than by itemized services, is encouraging hospitals to form satellite clinics and buying up doctors practices to fill them. That's because inpatient patients now lead to a profit of 2%, while the accident room has a profit of 15%, and satellite clinics a profit of 30%. On a national average, of course. Naturally, hospitals see their future in captive doctors on hospital salaries. Meanwhile, if a hospital gets paid by diagnosis, it doesn't matter how long the patient stays, Medicare pays the hospital the same amount. And it doesn't matter how much lab work or x-rays are done, the hospital gets paid the same. Somehow, I don't think you save money with such a system, you just get a more efficient rationing system. And that's the type of system the Affordable Care Act promotes.

Meanwhile, the Medical School deans are responsible for matching supply and demand, and they rather favor salaried practice. So the hidden cost here is likely to be for an increase in the number of medical schools. Cutting sixty hour weeks to forty hour weeks would require fifty more medical schools. But even then it takes six or seven years for a new medical student to become a new doctor in practice, and you have to figure on taking several years to find the money and to build a new school. So, if it gets done efficiently, it will take ten years at least to recover a balanced supply of doctors. I'm sorry, but you can't just bang your shoe on the desk and demand that something must happen.


Fisher on Representation Size

Constitutional Convention in 1787
Constitutional Convention in 1787

According to the last census, my Legislative district (#6 in New Jersey) has 224,000 residents. If I spent five minutes talking to each one, I wouldn't have time to sleep or eat. Therefore, I get mixed feelings when I hear only 43,000 of them are registered voters, and only 23,000 of them turned out for the last election. I guess I could talk to that many, but it is pretty sad only one resident in ten bothers to vote. The same number of people voted for every R candidate, and the same number of D's voted for almost every D candidate. So, it looks as though a lot of people vote a straight-party ballot.

That's something they surely wouldn't do if they knew each candidate. And that's pretty sad, because it is easily managed by party machines. I have to think these things are caused by the steady growth of the population, without comparable growth in the number of representatives, at all levels from township commissioner to President of the United States.

George Washington was bothered by the same problem. In 1787 he had nothing to say about issues during all the time he was presiding officer of the Constitutional Convention. But on the last day of the convention, he asked for permission to step down and address the group. His conviction was that no congressman should represent more than 30,000 people, and he begged for an amendment providing for it. The delegates meant to oblige him, but somehow it got lost. If they had done what he asked, we would now have about 5000 congressmen, so it doesn't sound workable. As a practical matter, in the early 1920's Congress finally limited the size of its members to 436. So now we have exactly what Washington feared, which is each Congressman represents 700,000 people, nobody knows his congressman, it costs millions of dollars to get elected, party machines dominate what decisions aren't dictated by lobbyists.

Exactly the same thing is true of legislative districts, except the lobbyists are probably less well funded. They seem to search for party machines, and spend their time (and money) on unelected party leaders. Unelected is an important word here, because many county leaders take care not to hazard their future on an election. I understand the county leader in Mercer county lives on eighteen acres in the center of Princeton. I don't know his name, in fact almost nobody knows his name, but everybody knows that God himself couldn't afford eighteen acres of Princeton. I got this from a reporter, Bob Ingle, for the Trenton newspaper who wrote a book, called Soprano State. I wish more people would read that book, so I don't have to sound so negative at times. I gather from this book, there is much to talk about.

Anyway, this representation issue is starting to hurt. I go to all kinds of meetings in my district, at least to show my face. Little did I expect I would be sitting in the audience while a professor of history, would explain that Washington's proposal was already part of the Constitution. I woke up slowly and may have got this wrong, but I believe he said it was one of the two (of the twelve original) amendments of the Bill of Rights that Thomas Jefferson recorded as not being ratified. However, Kentucky was a long way away by horseback, and the ratifiers seem to have given up on the messenger who was bringing the duly recorded, on-time, ratification from Kentucky needed to reach the required number. I guess when it got to be dinnertime they decided no messenger meant no ratification.

However, Mr. LaVerne seems to have dug up photocopies of the Kentucky document of ratification, plus the bylaws stating amendments were to be effective as of the date of ratification. Somehow, the War of 1812 got things confused even more, and burnt up enough, that Washington's pet idea sort of got lost. If that's really provable, it seems to mean we already have a mandate to have 5000 congressmen (and two or three thousand Assemblymen and women in New Jersey?). The contention seems to be that for two hundred years nobody knew what to do with this bit of history, and sort of decided to ignore it. My view is that even if you knew all about this strange history, you simply can't have it both ways. Either you get stuck with the present inability to represent all those constituents, or else you get stuck with having unworkable thousands of congressmen.

I promise to think about this. And when I get an answer, I'll let you know.


Obamacare and Pre-existing Conditions

Obamacare isn't an issue before the State Assembly right now, but that will soon come when the uninsured find themselves in state Medicaid, which isn't at all ready to take them. But that's for later. Right now the issue that pops right up and assaults you is called pre-existing condition. Those folks are waiting at the door at midnight, waiting for the office to open up, just like Apple Stores before a new model of iPhone. They are desperate to get Obamacare, because there is no other solution. And they have been told there is no other way to solve their problem, this is the last chance. Well, that's just not true. Impaired risk is an old, old problem with insurance, and there are standard ways of dealing with it. One is called an "assigned risk pool", and the other is high risk insurance. In Pennsylvania, there is a fire insurance company known as the Fair Plan, which will only accept you if some regular fire insurer has rejected you. It's owned by the other fire insurance companies, and is subsidized by them, although it often surprises itself by making a profit some years.

I've been interested in the Fair Plan for some time, so I'll next attach a blog I wrote several years ago. It's my favorite method of handling pre-existing conditions, and I was pretty disappointed when it wasn't adopted for health insurance. (See below.)

Instead, we have a law forcing everybody to have health insurance whether they want it or not, so we can play cops and robbers with people who don't like insurance, such as the Pennsylvania Dutch Amish people. Certain Congressmen have been pushing mandatory coverage for decades, and they always got laughed at. Too grandiose. Too unnecessarily sweeping. Anything with the word "mandatory" in it starts trouble. And anyway there are 30 million people it doesn't fit, like 7 million people in prison, 8 million mentally impaired, 11 million illegal immigrants. That's what you get into when you insist that "one size fits all". There might, there just might be, a trace of trying to succeed with Universal health coverage, when your main primary opponent with initials HC, failed so notably to get it passed when her husband was President.

The issue goes back to the Clinton Health Plan, so let's continue. You may remember it was never brought to a vote, because Big Business walked out. The same thing happened this time, except it is stated that big business couldn't get ready for another year. That's a nice way of saying Big Business walked out a second time, but this President was too stubborn to see he was licked. I surmise that Big Business didn't want to pay for the uninsured twice. Particularly when they were being treated to unceasing attack in the Dodd Frank legislation. Perhaps it wasn't realized that big business was already paying for the uninsured by having hospitals cost-shift the expense to their subscribers, but business knew that was true, and they didn't think it was fair to pay for it twice.

It's hard to know whether big business will relent if Obamacare can demonstrate success by laying these extra costs on someone else. Or whether the people with pre-existing conditions will push the premiums unbearably high, and the insurance companies will drop out when it results in unsupportable losses for them. A death spiral, indeed.

A former director of Medicare recently said, "Obamacare isn't about healthcare reform. It's about coverage extension." If they had stayed with coverage extension for pre-existing conditions, it would have sailed through. As it stands, we have to have a civil war to get it right, the second time around.


A Fair Plan for Fire Insurance (and Health Insurance, too?)

{http://www.philadelphia-reflections.com/images/fireinsurancecompany.jpg}
Philadelphia Fire Insurance Company

The Fair Plan (sixth and Chestnut, Philadelphia) is a fire insurance company with unusual features. Some day, it is to be hoped some scholar will write a book about the highly mixed motives of the people who created it, compared with the unexpected ways it did or did not fulfill original expectations, of both its creators and its enemies. The Fair Plan only issues fire insurance on houses, if other insurance companies have turned that house down as a bad risk. But if the clients pass that simple test, they get fire insurance at standard rates. Such risky houses would normally draw higher premiums for fire insurance, but the Fair Plan insures these risky houses at normal rates. Therefore, it loses money, which is made up by the other regular fire insurance companies in the state in proportion to the business they do, obviously thus raising the price of fire insurance for everybody. But in this way, Pennsylvania guarantees that everybody can get fire insurance at standard rates. Is this a good idea? Might this be a way to give health insurance to all those people who can't get health insurance? Let's talk about the Fair Plan.

We'll set aside discussion of whether the Fair Plan was a product of cynical politicians pandering for votes, or whether it was a noble gesture for fairness and equality for our poorer citizens. It very likely had elements of both motives in it, but that doesn't matter any more. It's a form of hidden taxation, of course, and it has the result of making Fire Insurance seem more expensive in Pennsylvania than in other places that do their social work with real taxes. Go too far with that, and people will end up buying their insurance in Bermuda instead of boarded-up former fire insurance companies in Pennsylvania.

As the story is now told, the regular insurance companies had a choice of taking the "substandard" applicants in turn ("Assigned Risk") or creating a new company (Joint Underwriting Association). They decided they preferred the JUA. So a company was formed which specializes in nothing but bad risks, including a few arsonists and other unmentionables, but mostly poor people in bad neighborhoods. If we are ever thinking about following the Fair Plan model in health insurance, it would run the risk of being accused of creating a two-class healthcare system. But no one seems to bring up that rhetoric about fire insurance, primarily because there is comparatively little intrusion of politics in the matter, and anyway they provide standard fire insurance at standard premium rates. This system is given orders to spread the extra cost of universal fire insurance out to the policy holders of all fire insurance, and it does it very efficiently, without extending its mandate into setting firefighter wages, running fire departments or repainting scorched woodwork. The fundamental decision was whether to spend Society's money this way. Once that decision is taken, the task is to do it efficiently. Notice, this is not compulsory fire insurance; it is compulsory availability of fire insurance.

After the Fair Plan had been running for ten or so years, a funny thing emerged. There were years when the Fair Plan made a profit! The fire insurance industry had absorbed the Fair Plan into their scheme of things, and felt free to increase the number of applicants they rejected, during years when money was tight or business was bad. If you had compulsory availability of fire insurance, the provision of a company which could not refuse an application made it possible for every other company to refuse when it pleased. When the economy encouraged rejection, a better class of applicant came to the Fair Plan, which made the plan more profitable. When economic conditions reversed, this reversed, and the Fair Plan again lost money. For this reason, the insurance industry is very anxious to prevent the Fair Plan from becoming political, or getting tangled up in worthy but extraneous ventures. And that's probably a good model, too, if we are considering adopting a similar system for the health insurance world: stick to your mission.

Since this simple, tested idea never seems to get into the discussion phase of present agonizing over health insurance for the uninsured, it's one clear sign that such discussions at present are not terribly serious.


Fisher on Abbott Districts

The Abbott School Districts

Three decades ago, before a lot of New Jersey voters were even born, the so-called Abbott decision ordered the state to distribute money to woefully underperforming school districts to give the kids a fair chance in life. But now, thirty years later, the money routinely goes to ten or twelve school districts, and the other five hundred are suffering from high taxes. The voters in the five hundred districts are angry, and want some of their tax money to stay at home. But by any fair appraisal, the schools in the Abbott Districts are still deplorable, and a great many children are growing up without an educational chance in modern life. Both sides have a legitimate point, and neither will budge.

But now there arises an entirely different way of looking at the mess. Maybe money isn't the point, but education is the point. The purpose of the Abbott District money was not to give money fairly or unfairly. The purpose of the money was to educate children, so at least they wouldn't grow up to a life of poverty and crime. In a sense, it doesn't much matter how unfairly the money is distributed, just so the kids get an education. Do they?

Frankly, it doesn't look as though they do. After thirty years, it is not hard hearted to say the burden of proof is on those who say the money did some good. The very least that everyone ought to agree on is to perform a library search for other ideas, like charter schools, and report to a Legislative committee, followed by taking testimony from places with experience with other ideas. Because the real issue is not, how long we go on spending this money. It is, or ought to be, how long must the kids wait before something better is given a chance?

These are not easy issues. Our forebears didn't do such a wonderful job with assimilating the American Indians, but surely we can do better than that. With this horrible example before us, we cannot really expect the problem to solve itself. Nor is it a purely local problem; plenty of big cities have the same issue in a slightly different form. How are charter schools doing, for example. I have every confidence that if the local Camden County community, or even the whole State of New Jersey, could show some important progress -- money would come pouring in to help a winning project. But to keep on with the same old ideas is going to get you the same old results.

If there is a permanent moral to this vexed affair, here is the one that sticks to me. The Abbott decision seemed to be based on fundamental principles of fairness. But it could also have been described as an educational experiment, and all experiments contain a risk of failure. When courts make such an innovative decision, politics will soon lock it into place for many years longer than it takes to recognize it was a failed experiment -- if indeed it was a failure. Therefore, it is best for such experimental court decisions to set a time limit for later review and revision. Almost anyone would say this time period should be less than thirty years. Otherwise, such matters should be left to the Legislature, which is at least subject to frequent elections and can more easily devise modifications.


Fisher on Proposed Economic Zones

Governor Christie

There's an idea that politicians are all negative characters, saying nasty things. That's probably because the public only listens to them during the last week of a campaign, when campaign advisors urge them that negative works best. So, here's a positive idea. And it comes from Camden County Republicans.

There's no doubt New Jersey is in a fiscal squeeze. Our property taxes are second-highest in the nation, but our municipal bonds are regarded as risky unless we raise taxes or cut spending. If we raise taxes, people will move to other states. In fact, we mainly haven't lost population because New York City is more heavily taxed, so New Yorkers move to New Jersey. Philadelphia has lost 40% of its population since the peak, and if you ask your neighbors, many of them moved from Philadelphia. Camden City just moved away, period. The people you don't talk to are the ones who have moved from New Jersey. So we are afraid to raise taxes, and we are a little afraid to cut them for fear the municipal bond market will strangle our borrowing power. Here's the proposal.

While we continue with Governor Christie's efforts to cut spending, like getting rid of those 800 paid Committees, and seeing if defined benefit pensions can be converted to defined contribution plans, and the like, let's cut taxes where it would help the most. The Camden County Republican proposal is to cut taxes in defined enterprise zones. If we can attract some new businesses into those zones, they and their employees would pay taxes, and the gamble might pay for itself. It might not, of course, but that's the risk any businessman takes when he makes an investment.

Right now, Exit 4 on the Turnpike is not in Legislative District 6, because the borders get shifted around by gerrymandering. But it's close, and most of the business activity it has created is within District 6, along the route toward Philadelphia. Most of the theory of business clusters suggests that a cluster of business activity is most sustainable when it contains a diversity of industries, but it needs a dominant industry to get started. Tom Booth suggests medical supplies already have a big start in our geographical area, and I can agree that eighty percent of the pharmaceutical industry is located within a hundred miles of us. Burlington County has demonstrated that you can keep everybody happy if you segregate commuters and farmers, which means helping the environmentalists and the businessmen at the same time. It really can be done, and is being done by some of our neighbors. Not a bit of doubt you have to be careful about creating winners and losers, because that's where graft comes from. But there's no doubt if you succeed, you will succeed big.

Cutting (some) taxes and helping the deficit at the same time. Just think of that. And think about 13% unemployment in Camden County. We have to do something about that or it will destroy us.


Burlington Leads the Way

Somewhere in the past few decades, Burlington became quite activist. Although many tend to think of real estate planning as urban planning, this largely rural county went in for planning in a big way, deciding what it was and what it wanted to be. Generally speaking, its decision was to replace urban sprawl with cluster promotion. The farmers didn't like invasion by McMansions or industries, while the towns lost their vigor through tax avoidance behavior of the commuter residents. Overall, the decision was to push urban development along the river in clusters surrounding the declining river towns, while pushing exurban development closer to logical commuting centers, leaving the open spaces to farmers. Incentives were preferred to compulsion, with a determination never to use eminent domain except for matters of public safety.

To implement these goals, two referenda were passed with 70% majorities to create special taxes for a development fund, which bought the development rights from the farmers and -- with political magic -- re-clustered them around the river towns. The farmers loved it, the environmentalists loved it, and the towns began to revive. The success of this effort rested on the realization that exurbanites and farmers didn't really want to live near each other, and only did so because developers were looking for cheap land. Many other rural counties near cities -- Chester and Bucks Counties in Pennslvania, for example -- need to learn this lesson about how to stop local political warfare. Corporation executives don't want to live next to pig farms, but pig farmers are quite right that they were living there, first. When this friction seeps into the local school system, class warfare can get pretty ugly.

{Burlington Bristol Bridge}
Burlington Bristol Bridge

In Burlington County, they thought big. The central project was to push through the legislature a billion-dollar project to restore the Riverline light rail to the river towns, along the tracks of the once pre-eminent Camden and Amboy Rail Road. It was an unexpected success. During the first six months of operation, ridership achieved a level twice as large as was projected as a ten-year goal. Along this strip of the Route 206 corridor, the old Roebling Steel Works are becoming the Roebling Superfund Site, now trying to attract industrial developers. The Haines Industrial Site, originally envisioned as a food distribution center, was sold to private developers who have created 5000 jobs in the area. Commerce Park beside the Burlington Bristol Bridge is coming along, as are the Shoppes of Riverton and Old York Village in Chesterfield Township. As Waste Management cleans up the site of the old Morrisville Steel plant across the Delaware River, a moderate-sized development project is becoming an interstate regional one.

No doubt there will be bumps in these roads; the decline of real estate prices nationally is a threat on the horizon, because it provokes a flight of mortgage credit. It works the other way, too, as banks decide to deleverage by reducing outstanding loans; this is the way downward spirals reinforce themselves. And anyone who knows anything about all state legislatures will be sceptical about political cooperation in a state as tumultuous as New Jersey. The Pennsylvania Railroad destroyed the promise of this state once; some other local interest could do it again. Nevertheless, right now Burlington County looks like a real winner, primarily because of effective leadership.


The King's Road

{William Bingham class=}
Racetrack Circle

Harry Kaufman is now long gone, but for decades he represented the volunteer spirit of Haddonfield, and the earnest, innocent happy way it contributed the essence of conflicted memories of its Revolutionary origins. The last time anyone counted, there were forty-two direct descendants of Elizabeth Haddon living in the borough, for example, and in a quiet determined manner they keep alive the Quaker heritage of a non-Quaker town. For example, Harry made his living as the public relations officer for the milk industry. During World War II the Nicholson family who arrived here before William Penn still had a vast dairy farm with its own port on the Cooper River. It was located where Stoy's Landing Road crosses Grove Street, where there used to be something called the Race Track Circle, in honor of the Garden State Race Track which followed the dairy farm, and preceded the big-box shopping center which is still there, without the circle. New Jersey still has over two hundred traffic circles, and those who grew up here remember them as part of the New Jersey heritage, each one characteristically having a diner restaurant, also a Jersey invention and tradition.

{William Bingham class=}
Plays and Players in Haddonfield, NJ

Harry Kaufman may not have started the Plays and Players of Haddonfield, but he certainly sparked it to a near-professional level in a town of 7000 people. The orchestra and the ballet company are particularly outstanding at the moment, the soloists on the stage quite good, although they never made the grand European tour which is thought to be the prerequisite for getting into the big time. Harry was the life of any party, and particularly good at composing little ditties, never quite getting around to stringing them together into a musical comedy until the 250th anniversary of the town. Even then, it is recalled he was shy and reluctant, and had to be pushed a little. Since The King's Road appeared shortly after Oklahoma! transformed, even revolutionized, American musical comedy, it was not only the model but the stimulus for a similar comedy celebrating the beginnings of our little state. The plot was a simple one of a conflicted love affair. The striking innovation of Oklahoma! was to crowd most of the show's songs into the first act, repeating snatches of their themes as sort of Wagnerian background commentary throughout the remainder of the play. The other innovation of what was originally called Green Grow the Lilacs was the addition of Agnes DeMille's ballet company to emphasize the real historical theme with light-hearted music. Since I was one of the original reviewers for Oklahoma! in its New Haven tryouts, I can remember the revolutionary impact of that play, very well.

{William Bingham class=}
Anthony Wayne

Harry had to go to the Historical Society for authentic details of the conflict between attraction for Revolutionary aspirations for Liberty, and loyalty to the earlier sufferings of Quakers for their pacifist leanings. Some Quakers deserted their faith to join the Revolution, and other Quakers tried to convert the Hessian soldiers. And still others were loyal to the King of England. The Revolution was almost won at this moment, as the British occupants of Philadelphia had abandoned their supplies to attack, and had to get to the British fleet, bottled up in the lower Delaware River by fortifications at Fort Mifflin and Fort Mercer on the Jersey side of the river. The Hessians had been sent to attack Fort Mercer from the rear, passing through Haddonfield and stopping one night before going on to what we now call National Park. While the Hessian officers were being entertained by John Gill with discussions of the futility of war, Jonas Cattell slipped out of town and ran to alert Fort Mercer of its danger. The guns of the Fort were turned around, and the defenders pretended not to notice the approach of the Hessians until they were ambushed and largely destroyed. If Fort Mifflin on the Pennsylvania side of the Delaware River could have held out, the starving British might have had to surrender, but that didn't happen. In any event, the New Jersey Militia did its part, and little Quaker Haddonfield helped them in a sort of characteristic Quaker way. With a ratta-tat-tat and a fiddely dee, the rag-tag swallow-tail Jersey Militia got all the credit.

The play does not emphasize that the State of New Jersey was founded at the Indian King Tavern during these commotions, or that General Washington starving at Valley Forge sent Mad Anthony Wayne to circle up and around Trenton to drive a herd of cattle back from Salem County, two hundred miles back to Valley Forge. The British sent Captain Simcoe down to Salem County to massacre the Quaker farmers who provided the cattle. These later developments are only mentioned in its anthem to "Generals Wayne, LaFayette and Pulaski", and every good resident of Southern New Jersey is supposed to know what that is all about.

The Quaker historian Rufus Jones established the enduring tradition that this split is what ultimately reduced the Quakers from the dominant religious group to a small religious sect in the three states once owned by William Penn, Delaware, Pennsylvania and New Jersey. Related to such turmoil was the claim that more battles of the Revolution were fought in New Jersey than in any other state; if you include the large privateer navy going to sea from the Jersey Pine Barrens, that is probably true. And every twenty-five years or so, we have to put on a revival of "The King's Road", and just show 'em.


The Palace on Wheels

Delhi › Jaipur › Sawai Madhopur › Udaipur › Jaisalmer › Jodhpur › Bharatpur › Agra › Delhi

{William Bingham class=}
The Palace on Wheels Tour

Monday January 31, 2011
We arrived at the Indira Ghandi International airport at around 3AM, Delhi time, and checked into The Claridges in New Delhi. Later that day we began to explore the city: perfectly safe but like all parts of India we were pursued by people trying to sell us things or take us on tours. Margaret, Miriam and Jon took the Delhi subway which is modern and efficient, although the first car is reserved for women to allow them to get away from unwanted advances. Later that day, we took a tuk-tuk around the city, stopped at a rug store, Art of India and visited the Lodi Garden where Iskander Lodi is buried.

The next two days we had a car, driver and guide to take us to the sights of Old and New Delhi: the Red Fort, Shah Jahan's Jama Masjid mosque, Humaayun's Tomb and the Qutub Minar tower.

Day 1 - Wednesday - On board
The Palace on Wheels leaves not from the main railway station but from the Delhi Safdarjung Railway station where guests are welcomed in traditional Indian style before the royal train pulls out into the night for a week-long journey through the heart of Indian tourism, Rajasthan, the home of the Princely States of the Hindu Rajputs.

Jaipur is the first stop of Palace on Wheels that enjoys the reputation of the best planned cities of the world in the bygone era. Known as the Pink City, Jaipur is the capital of Rajasthan founded by Maharaja Sawai Jai Singh II, in 1727 A.D.

Day 3 - Friday - Sawai Madhopur

Sawai Madhopur the next destination of Palace on wheels is the place where we hoped to see tigers in the Ranthambore National Park but did not.

Day 3 - Friday - Chittaurgarh
After lunch proceed to Chittaurgarh, India's Camelot, the heart of the Rajput chivalric mythology: the thrice-besieged, Chittaur Fort (garh).

Udaipur, the City of Lakes is adorned by the beautiful palaces, temples and lakes.

Jaisalmer is lies in the heart of the Great Indian Desert, Thar Desert.

Day 6 - Monday - Jodhpur
Jodhpur is the blue city, where lies the rock-solid Mehrangarh Fort. It is second largest city of Rajasthan encircled by a high stone wall with seven gates and several bastions.

Day 7 - Tuesday - Bharatpur / Agra

Bharatpur is a bird sanctuary. Agra was the seat of power of Akbar and the location of his grandson Shah Jahan's memorial to his wife, the great Taj Mahal.

Day 8 - Wednesday - Delhi
The train arrives back at Delhi Safdarjung Railway station in the morning and it's off the train.

Bank Street

Hit play and then click on a building to learn more.

By Skye Doherty, Steve Bernard and Caroline Nevitt
Published: October 10 2008 19:22 | Last updated: November 24 2008 16:42

Click here for the FT Page


I want to thank you for this wonderful resource. I find it fascinating. May I offer one correction? In the section "Rittenhouse Square Area" there is reference to the Van Rensselaer home at 18th and Walnut Streets and its having a brief fling as a club. I believe in 1942 to about 1974/5 the Penn Athletic Club was located in the mansion. The Penn AC was a good club, a good neighbor and a very good steward of the building - especially the interior. It's my understanding that very unfortunately later occupants gutted much of the very well-preserved original, or close to original, interiors. I suppose by today's standards the Van Rensselaer-Penn Athletic Club relationship could be described as a fairly long marriage. The City of Philadelphia played a large role in my life and that of my family, and your splendid website brings back many happy memories. For me and many others, however, there is also deep sadness concerning the decline of so much of the once great city and the loss of most of its once innumerable commercial institutions. Please keep-up your fine work. Your's is a first-class work.
Posted by: John D. Mealmaker   |   Aug 14, 2014 2:24 AM
Dr. Fisher, The name Philadelphia University was adopted in 1999, as you write, but the institution dates to 1884 and has been on School House Lane since the 1940s. It acquired the former properties of the Lankenau School and Ravenhill Academy, but it did not "merge" with either of them. I hope this helps when you update your site.
Posted by: David Breiner   |   Jun 11, 2014 10:05 PM
Hello Dr. Fisher, I was looking for an e-mail address and this is what I could find. I must tell you my Mother who you treated for years passed away last May. She was so ill with so many problems. I am sure you remember Peggy Marchesani. We often spoke of you and how much we missed you as our Dr. You also treated my daughter Michele who will be 40. I am living in the Doylestown area and have been seeing the Dr's there.. I just had my thyroid removed do to cancer. I have my fingers crossed they get the medicine right. I am not happy with my Endochronologist she refuses to give me Amour. I spoke with my Family Dr who said he will take care of it. I also discovered I have Hemachromatosisand two genetic components. I have a good Hematologist who is monitoring me closely. I must say you would find all of this challenging. Take care and I just wanted to convey this to you . You were way ahead of your time. Thank you, Joyce Gross
Posted by: Joyce Gross   |   Apr 4, 2014 2:06 AM
I come upon these articles from time to time and I always love them. Is the author still alive and available to talk with high school students? Larry Lawrence F. Filippone History Dept. The Lawrenceville School
Posted by: Lawrence Filippone   |   Mar 18, 2014 6:33 PM
Thank you for your articles, with a utilitarian interest, honestly, in your writing on the Wagner Free Institute of Science [partly at "...blog/1588.htm" - with being happy to post that url but the software here not allowing for the full address:)!] I am researching the Institute, partly for an upcoming (and non-paid) presentation and wanted to ask if I might use your article's reproduction for the Thomas Sully portrait of William Wagner, with full credit. Thanks very much for any assistance you can offer here. Josh Silver Philadelphia
Posted by: Josh Silver   |   Jun 2, 2013 1:39 PM
Thank you for your articles, with a utilitarian interest, honestly, in your writing on the Wagner Free Institute of Science [partly at "...blog/1588.htm" - with being happy to post that url but the software here not allowing for the full address:)!] I am researching the Institute, partly for an upcoming (and non-paid) presentation and wanted to ask if I might use your article's reproduction for the Thomas Sully portrait of William Wagner, with full credit. Thanks very much for any assistance you can offer here. Josh Silver Philadelphia
Posted by: Josh Silver   |   Jun 2, 2013 1:39 PM
George, Mary Laney passed away last November. I was one of her pall bearers. She had a bad last year. However, I am glad that you remembered her and her great work. I will post your report at St Christopher's and pass this along to her husband Earl. Best wishes Peter Hunt
Posted by: Peter Hunt   |   Mar 28, 2013 7:12 PM
Hello, my name is Martin. I came across [http://www.philadelphia-reflections.com/blog/1705.htm] and noticed a ton of great resources. I recently had the honor of becoming a part of a new non promotional project on AlcoholicCirrhosis.com. We decided to put together a brief guide about cirrhosis, and the dangers of drinking. We have received a lot of positive feedback and I wanted to suggest that we get listed on the above mentioned page under The National Institutes of Health. Let me know what you think and if you have any further requirements or suggestions.
Posted by: Martin   |   Jan 1, 2013 8:51 AM
I FIND THIS VERY INTERESTING, INDEED. I AM HOWEVER, SEARCHING FOR THE ANCESTOR WE HAVE BEEN TOLD WAS JOSEPH M. WILSON OF JORDAN TOWNSHIP IN WHITESIDE CO. IL USA. MY HUSBAND WAS ORPHANED AND WITH LITTLE CONTACT WITH HIS FATHERS SIDE OF THE FAMILY THE 9TH OF 10 SURVIVING CHILDREN SINCE ALL ARE DECEASED BUT, ONE). I HAVE HOPED TO FIND HIS CONNECTION AS TO THE STORIES RELATED BY SEVERAL OF HIS DECEASED RELATIVES THAT WE ARE CONNECTED TO THE WILSON MILL FAMILY HISTORY. OF JOSEPH AND FRANCES. MY HUSBAND WAS ALSO, FAMILY TO: GRANDFATHER RANSOM (ISABELLA)WILSON & HIS BROTHER WILLIAM; OF ELKHORN GROVE CARROLL CO. IL USA AND HIS SON JOSEPH WILSON(NANCY). I?WE( MY SONS AND NEPHEWS NEICES AND GRANDDAUGHTERS IN COLLEGE... WERE HOPING THAT NOW THAT I AM ON THE COMPUTER AND WITH YOUR HELP THRU THE GENELOGICAL SOCIETY TO YOUR ADDRESS WE MAY FIND THE FAMILY WE SEEK. MY LATE HUSBAND AND I DROVE PAST THE SITE OF THE FIELD WHERE JOSEPH AND FAANCES ARE BURIED , THE CEDARS ARE GONE AND IT IS NOW FIELD. I HAVE BEEN HOPING TO FIND THE LINK FOR OVER 30 FAMILY TO PAY TRIBUTE TO THOSE WHO HAVE GONE BEFORE AND PERSEVERED TO BRING US THE LIFE WHICH WE ENJOY AND SERVE, TODAY. I RECEIVED ONLY THIS WEEK BY A FLUKE AN EMAIL WITH PHOTOS FROM A 3RD COUSIN THAT FOUND MY EMAIL ON A COUSINS EMAIL ADDRESS AFTER INQUIRING AND INTRODUCING HIMSLEF: AND HE TOOK THE TIME TO SEND MANY PHOTOS AND HISTORY OF GRANDPARENTS AND FAMILY AS WE HAVE HAD NONE. WE STILL DON'T HAVE A PHOTO OF HIS MOTHER AND FATHER. WHAT I HAVE OF THE TREE, I AM ANXIOUS TO SHARE WITH FAMILY THAT IS SEEKING HISTORY, AS I STILL AM HOPEFUL TO FIND IT IN TIME FOR THE DEADLINE AUG. 30 TYPED AND DELIVERED TO MY MARTIN HOUSE MUSEUM WHERE I AM A MEMBER. MY HUSBAND WAS A MASTER MASON WHILE IN LODGE WITH THE COUPLE THAT DONATED THE HOUSE TO BE A MUSEUM. THANK YOU FOR YOUR TIME AND THE GRAT WORK YOU HAVE ALL DONE ON THIS HISTORY. WE WERE LIFE MEMBERS OF THE LUTHERAN CHURCH BUT , THERE IS NOT ONE IN OUR TOWN, SO I FOUND THE REFORMED CHURCH,OF WHICH, I AM VERY HAPPY TO BE A PART. THANK YOU .
Posted by: SUSAN WILSON   |   Aug 12, 2012 12:49 AM

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