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

204 Topics

Right Angle Club 2012
This ends the ninetieth year for the club operating under the name of the Right Angle Club of Philadelphia. Before that, and for an unknown period, it was known as the Philadelphia Chapter of the Exchange Club. www.philadelphia-reflections.com/topic/175.htm

Right Angle Club 2011
As long as there is anything to say about Philadelphia, the Right Angle Club will search it out, and say it.

www.philadelphia-reflections.com/topic/158.htm

Right Angle Club 2010
2010 is coming to a close, a lame-duck session is upon us, and probably after that will come two years of gridlock. But the Philadelphia Men's Club called the Right Angle, keeps right on talking about the current scene. A few of these current contents relate to speeches given elsewhere.www.philadelphia-reflections.com/topic/137.htm

Right Angle Club 2009
The 2009 proceedings of the Right Angle Club of Philadelphia, beginning with the farewell address of the outgoing president, John W. Nixon, and sadly concluding with memorials to two departed members, Fred Etherington and Harry Bishop.

Right Angle Club 2008
A report, to the year 2008 shareholders of the Right Angle Club of Philadelphia, by the outgoing president, Neale Bringhurst... www.philadelphia-reflections.com/topic/120.htm

Click for more Topics

Philadelphia Reflections is a history of the area around Philadelphia, PA ... William Penn's Quaker Colonies
plus medicine, economics and politics ... 1797 articles in all

  • Try the search box to the left if you don't see what you're looking for.

Decline and Fall of Philadelphia

We talk high finance here, so perhaps a simple story from Wall Street is needed to introduce the topic to a non-Wall Street audience. Following the 1929 crash, and consequent to the Glass Steagall Act, Morgan Stanley was the only American investment bank in existence. It was the first of a new kind, and barely in existence, doing something like $300,000 worth of business in 1933. As finance adjusted to the new ground rules, Morgan Stanley grew in size, commonly referred to as the "White Shoe" investment bank. That term was an allusion to the Ivy League background of its partners, who came from colleges which affected white buckskin shoes among their more elite students. It also referred to the fact that almost all Morgan Stanley partners were pretty rich and fairly young, entirely able to live by a code of behavior which might be summarized as, "We don't find it necessary to cheat." Buried within that motto was the idea that Morgan Stanley was as good as its word, and tried very hard to avoid doing business with anybody who did cheat. In a business where a great deal of business was transacted too quickly for written contracts, or vetting by law firms, that meant a lot.

Morgan Stanley soon climbed to the top of a very tough heap, and stayed there for fifty years. Many of its partners were millionaires in their twenties, but so what, they were mostly pretty rich before they joined the firm. The company ran as a partnership, with the capital they leveraged coming from the personal fortunes of the partners. Under these circumstances, it is not surprising that many partners retired in their forties, taking their enhanced capital with them. The Glass-Steagall Act (now being imitated by the Volcker Rule within the Dodd-Frank Law) made it illegal for a depository bank to be under the same roof with an investment bank. Much of the capital in the pre-1929 days had been supplied by the deposits in the depository bank, but Glass Steagall cut that off when it created depository insurance, on the theory that deposit insurance was a Federal gift, and its "moral hazard" should not flow through to the speculation of investment banking. That comment was tinged with a little populism, with the dubious implication that those who are two generations off the farm are less likely to cheat than those who are five generations off the farm. So the depository bank of Morgan Guaranty was split away from the investment bank of Morgan Stanley, which was the three-step process by which Morgan Stanley eventually grew so big it could no longer be sustained by leveraging the personal wealth of the partners.

Eventually, the pressure to raise money by selling stock to the public could no longer be resisted. The rich partners became even richer by selling stock on the stock exchange, the company did grow enormously, and a lot of new stockholders got rich, too. Unfortunately, when you sell stock you also sell voting rights, so the sale transferred voting control of the company to the new stock purchasers. It did not take many years before the white shoe atmosphere was a thing of the past, along with the discipline that atmosphere imposed on the rest of corporate America. When the 2008 crash came along, there was enough questionable behavior on Wall Street to justify a populist President of the United States to tolerate, or even encourage, a witch hunt of Wall Street bankers for ruining the country. Even so brilliant an economist as Paul Volcker has encouraged the idea that separating the two forms of banks was an unmitigated blessing which must be restored, while in fact it is only justified by the gift of Federal Deposit Insurance to the depository arm, not the Investment Banking Arm. It seems only a matter of time before there will be agitation to extend the insurance to the investment arm, so we will be chasing our own tail, of extending insurance to encourage risk-taking, instead of using demand deposits to do so. And thus inviting another crash.

No matter. The point of the story is not the value of Glass Steagall, but rather the enormous power of Wall Street to force a partnership to become a stockholder company, even so mighty a company as the House of Morgan. Because I have become persuaded, and hope to persuade the public, that this is the main mechanism which humbled Philadelphia from being the mightiest industrial engine in the world, in less than twenty years. Like the perfect storm, it took three other forces to make it quite so violent, and quite so swift. They were the first World War, the 1929 stockmarket crash, and Prohibition. The central operational lever of force was exerted by converting industrial corporations, from partnerships into stockholder corporations. That was the tool which destroyed the old Philadelphia, the other three forces simply made it happen in certain ways and at certain times.

One way or another, converting partnership or family businesses into stockholder organizations was a universal outcome of both World Wars, all over the world. The phenomenon can be looked at as one way of extracting frozen wealth to pay war debts. It is accompanied by an increase in national indebtedness, so it makes civilizations less stable. Scraps of partnership control do continue to persist in remote developing countries, and in tiny principalities like Luxembourg, but it seems only a matter of time before the public buys them out. Tightly held countries are tightly held by force, as in Russia, Saudi Arabia, and Monaco, usually because of a monopoly grip on oil or other natural resources. But even those governments could probably be toppled, except for fear of ensuing chaos, just as did happen to many former dictatorships, and was a source of fear in Philadelphia. A case can be made for populism, if it be kept small and under control. Hardly any case at all can be made for chaos.

For those of us who love Philadelphia and wonder what happened to it, let me point out three defining local peculiarities. Prohibition was more of a factor than we like to think, because Philadelphia's Tenderloin was the former Brewerytown, filled with Beer Gardens, refrigeration plants (Lager beer is brewed in the cold) and beer distributors. The passage of the Volstead Act suddenly transformed the largest alcohol-production center in the country into the largest alcohol-consuming area, from River to River, from Franklin Square to the Schuylkill. It was concentrated in the Brewerytown by being illegal, and somewhat secret. Brewerytown soon turned into the Tenderloin, and the Tenderloin into Skid Row, cutting off North Philadelphia from law and order, but in time it was alarming in a different way to see speakeasies spread into other sections of the city. Much as it tried, even the Mafia couldn't control the influx of amateur criminals, when the Tenderloin essentially cut the city in half. When the great migration from the South occurred after WW II, the immigrants turned North Philadelphia into a slum. Cutting I76 along the same center-city lines helped shrivel North Philadelphia and hustle its flight to the suburbs. Some misadventures of Philco and Ford, Baldwin and Stetson hastened the process, and may have caused some of it.

America grew into a mighty industrial nation as a result of becoming the Arsenal of Freedom in the Civil War and two World Wars. The nation needed to expand its industrial base from the essentially monopoly corridor of the Pennsylvania Railroad, and it had the money to do so. Land was cheaper elsewhere, labor was nonunion elsewhere, and air conditioning made the South bearable. Wall Street saw an enormous opportunity to buy stock from the family partners of Philadelphia industries, and sell it again to the world. These new owners had no interest in preserving lovable Philadelphia; they wanted to reap the harvest of expanding what we had, to the rest of the country, maybe even the rest of the world. Once a spiral like this gets started, it runs by itself. The owners of the mansions on the hills, proprietors of what were big businesses by Victorian standards, sold their partnerships, their children were converted into coupon clippers, and their grandchildren into trust-fund babies. If you really have nothing much to do, why not do it in California next to the beaches? Hollywood made trust fund babies seem glamorous on the Main Line, just as Madison Avenue had once made expatriots on the left bank seem fatally attractive. Those movies and novels made somebody pretty rich, but whoever it was, doesn't live there, any more.


What Other House?

Before the First World War, it was common for prosperous families to have two houses, like migrating birds. There was the big house in center city, and a second place to go in the summer to get away from typhoid and malaria. In the early days before municipal water departments, sources of clean water for home use and sewage disposal often dictated the location of such annual migrations. In time, a wider variety of destinations appeared. Summer arrangements might be a summer cottage on a lake, or a mansion in Bar Harbor. Friendly local Indians and good land for fresh vegetables or milk cows made an attraction. Usually there was some sort of recreational attraction, perhaps a summer hotel where the family went every summer, located along a railroad for easy commuting. Along the East Coast, it was common to own a beach house along the Jersey shore, and for fashionable people it was common to have a summer place along the Main Line. Germantown was the first summer colony, started by the Allen family and soon followed by the Chews at Cliveden, who also had a house on Third street next door to George Washington, and to Powell, the Mayor of the city. There were Germans in Germantown, of course, but they were not in the same circle, any more than the "permanent residents" of the New Jersey barrier islands mix in with the "summer folk", today. If you look at the big houses along Spruce and Pine Streets, you will see little neighboring houses in the next-door alleys. Sometimes these little houses had three rooms on three floors, and were called "Father, Son and Holy Ghost" houses. Sometimes these houses were for servants, sometimes for local tradesmen.

It later turned out that the geographical size of the city was to make a significant difference. In a small village, there is little difference between the town and the countryside, but after a while significant differences in taxes appear, particularly when our system of government begins to encourage federal, state and local taxes to become the legal or traditional province of a particular level of government. The tendency was for taxes to focus on government services from which people would be reluctant to flee. If people lived in the city for the schools, school taxes were applied to real estate. The federal system of dependence on income taxes on the other hand, reflected an indifference to where you happened to live. This started a cat and mouse game among municipalities,states and counties, which unfortunately contributed to the direction of tax flight, when there appeared to be a reason to flee.

During the Depression of the 1930s, that new threat appeared. Maintaining two houses soon seemed a needless extravagence, and it made sense to sell one of them. At that point, a choice had to be made, and the advent of the automobile made it entirely practical to live in the suburbs and commute to the city. A small town found it made little difference, but a medium sized city gave the suburbs an attractiveness. In the case of Philadelphia, the city-county consolidation widened the geographical reach of city taxes, before taxes and land values reached the inviting cliff where they abruptly fell to rural levels. By that time, clean water and friendly Indians were less important than taxes and upkeep. Some people had very bad luck in the Market, sold the big house, and moved into the little house behind it. More often than not, the big, house was converted into apartments or just plain torn down, or else it fell into shabbiness and the whole neighborhood deteriorated. After twenty years, everything got so bad in Society Hill, that you could buy any one of the mansions for $1500. It was a spiral, of course, and although you could buy a house for $1500, and resell it twenty years later for a million, during the intervening twenty years it was worth your life to go out on the street at night. Or so it seemed, until Richardson Dilworth built a brand-new mansion on 6th Street, and Society Hill started its revival. So, with this little bit of real estate history you ought to be able to summon up the tolerance to smile, when a senior partner of a law firm at a party tells you, "Philadelphia declined because everybody had two houses, and sold one of them." Not exactly everybody, but mostly everybody in the leadership did.

In fact, that was seemingly true for everybody, because the cohesiveness of Philadelphia culture led the followers to follow. But there was a next stage, after that. Bargain hunters found their bargains, word spread among immigrants from the South, and mansions turned into slums. To some extent, this migration was balanced by a white migration to the South, seeking cheap land and fleeing expensive union labor. Before long, air conditioning made this a natural, bearable counter-migration. In colonial days, just about everybody had a summer house for mainly health reasons, but now there was a new force causing people to relocate entirely in the suburbs. The tax cliff created by the city-county consolidation artificially raised city land values in anticipation of expanding settlement. It suddenly became cheaper to relocate or rebuild an entire facility just over the city/county line, in accordance with newer concepts of one-story buildings instead of three-story factories near a waterfall. And then a new way of life grew up around this necessity, with only the leaders returning to the city for banking, clubs, and opera "during the season". Invisibly, sanitation and air conditioning had removed the economic reason behind the former social structure, but permanent Philadelphia residents continued its customs while the Gilded Age was invisibly making it all a little silly. But hit it with a depression, ruin the industrial base supporting it, and then watch it disintegrate. Housing patterns didn't cause the problem, but new ones certainly made it hard to recover the good old ways, once they disappeared.


Old Blockley (P.G.H.)

{Old Blockley}
Old Blockley

For a long time, the Philadelphia General Hospital was the largest hospital in town, even growing briefly to seven thousand patients during the Civil War, but leveling off at about three thousand at the beginning of the Twentieth Century. At the end of world War II it had shrunk to about 1500 beds, but it was Medicare and Medicaid in 1965 which finally did it in. By 1977 it was costing the City of Philadelphia about five million dollars as year beyond its revenues to run the place with only 300 patients, while the running expenses of the local private hospitals were actually less, per patient. Titles XVIII(Medicare) and XVIV(Medicaid) of the Social Security act constituted Lyndon Johnson's Great Society, and in effect they made every patient at PGH resemble a walking government check in the mind of hospital administrators. The local hospital association made the argument to then Mayor Rizzo that everybody would be better off if the hospital closed and those government checks were directed to the local voluntary institutions. After a few years, the federal government inevitably squeezed the generosity out of the bargain they would of course now like to abandon. But that's the way it goes. PGH is gone and it isn't coming back. The eighteen acres in Blockley Township, now West Philadelphia, were given to the University of Pennsylvania next door, and gigantic amounts of federal money were contributed to the building of skyscrapers replacements for the original PGH. Ironically, the two hundred children's beds now on the location are fewer in numbers than the three hundred adults once considered too uneconomically few to maintain, and the cost per day of hospitalization is roughly ten times the PGH cost which had been described as unsupportable. The rest of the real estate is built up with buildings involved in medical research, which is also an activity dedicated to working for its own extinction. Discovering a cheap cure for cancer would quickly create a need to fill the vacancies with something else. No one regrets this system of creative destruction, but everyone should regret the diminution of the spirit of local philanthropy which underlay it.

PGH was one of a dozen or so big-city charity hospitals, like Bellevue in New York, Charity in New Orleans, or Cook County Hospital in Chicago. Of these hospitals, PGH had surely been the best, and at the turn of the Twentieth Century a Mayor's commission issued a report about the place which began, "Philadelphia can surely be proud...." Having worked in Bellevue and having visited most of the rest, I can testify that was likely true. When PGH was finally torn down, the walls and floors had such substantial construction that changing the wiring and plumbing to some other purpose had become almost impossible. The PGH nurses were famous for running. Although the alcoholic and drug addicted patients might be called the dregs of society, but the alacrity of the student nurses in running them bedpans or answering other calls, was spectacular to watch. When doctor came on the floor, they jumped to their feet, and were usually ready with the patient's charts, unmasked. Unlike Bellevue, where the floors were creaky and wooden, the open wards at PGH were spacious, clean, well maintained and equipped. At Bellevue the forty bed wards were crowded with sixty or seventy patients, so close together you could almost roll from one end of the room to the other without touching the floor. I can remember seeing one seventeen year-old Bellevue student nurse tending such a ward at night alone, the intern sharpening needles, and the medical resident developing electrocardiograms in the darkroom. None of this would have seemed acceptable at PGH.

{Dr. William Osler}
Dr. William Osler

Old Blockley was the place where modern systems of medical education originated. Up until William Osler came to Philadelphia, medical education mostly consisted of attending eight hours of lectures a day. Osler had an electrifying personality, and wandered among the sick at PGH with a train of students following him. He is much quoted, and once suggested his obituary ought to read, "Here lies the man who took the students into the wards." A somewhat more elegant statement of the value of practical experience was included in his dedication speech at the Boston Library: "To treat patients without books is to sail an uncharted sea. To read books without seeing patients is never to go to sea at all. Osler was somewhat underappreciated during his time in Philadelphia, and went on to found the medical school at Johns Hopkins in Baltimore. Nevertheless, the main reason he later left John Hopkins and went to Oxford was his dismay at the adoption of the "full-time" system, which is to say the faculty stopped having a private practice of their own to act as a gold standard for their research and teaching. When all is said and done, there are some areas of discomfort in the transition of students from observers to actors. The PGH system of learning surgery was commonly reduced to slogan, "See one, do one, teach one," ; things have progressed to the point where it is probably right for the public to insist on greater supervision and control than the old almshouse provided.

The disappearance of old Blockley ended a controversy, or even something of a mystery, about which was the oldest hospital in America, PGH or the Pennsylvania Hospital at 8th and Spruce. There had been a infirmary in Old almshouse at Eleventh Street, and there is no doubt the almshouse was there first. PGH grew out of the almshouse. However, there were many comments at the time of the founding of the Pennsylvania Hospital that it was now the first; that's a strange thing to say when the almshouse was three blocks away. Social historians need to look into the mindset of colonial America, which seems to have included the distinction between the worthy poor and the unworthy poor. Somehow, the founding principal of the Pennsylvania Hospital was to get people back to work who were capable of productive work, possibly even paying for itself in that way. In their minds, apparently just giving solace and help to those who were down and out was not quite the same thing.


Casino Warfare

{William Bingham class=}
Stephen P. Mullin

Stephen P. Mullin came by the Right Angle Club, and told us what happened in the casino world, in about five sentences. As anyone who reads the papers will know, four brand-new, billion-dollar, casinos are going broke in Atlantic City. What most of us didn't know was that gambling revenues are going up, nationally, and more people are visiting casinos than ever before. That doesn't sound right.

{William Bingham class=}
Ed Rendell

All it takes to understand this paradox is to look at a map of casinos in the region, with focus on the Philadelphia/New Jersey region. A few years ago, Las Vegas and Atlantic City pretty much had a monopoly on casinos in America, and then the Indians found they, too, had a special political exemption. And then Pennsylvania's ebullient governor, Ed Rendell noticed that most of the license plates were Pennsylvania plates, going over the various bridges to New Jersey. So he hired Steve to be a consultant, and sure enough, an awful lot of money made in Atlantic City was Philadelphia money. The Legislature was strong-armed into permitting slot machines in Pennsylvania, the necessary building permits were issued, and Pennsylvania started taking back its own gambling money. The New Jersey casinos promptly lost business, and the over-supply of them dragged the financially weakest of them, down the tube. Mystery solved; and that's about all there is to the story.

{William Bingham class=}
Adam Smith

Adam Smith once wrote that "The more you gamble, the more certain you are to lose." The gamblers lose money, and the neighborhoods turn sour, but this was the first I had heard that the owners of the casinos could lose money, too. And now, come to think of it, the politicians can lose money, as well. Not at first, perhaps, because a lot of gamblers want to try out the newest and latest slot machines, as well as look down on themselves through looking up, at the new mirrors on the bedroom ceilings. Speaking of that, Steve tells us that the big money is made on slot machines. The so-called table games lose money and are just for show. Which reminds me that I once ran into the man who invented the modern slot machine. He was a surgeon from the West Coast, but one of his patients complained that people were robbing the old-fashioned slots by drilling holes in the side when no one was looking. One of their buddies would come back later, and stick a metal wire in the hole, triggering a noisy jack-pot. My new friend the surgeon was a computer nut, and substituted little computers for the clunky mechanicals. That frustrated the pilferers, but it also drove away the ordinary folks who put in silver dollars instead of wires. They liked the clunking noises and flashing lights, so fake rattles and flashing lights were installed, making everybody happy again. He was tired of taking out gall bladders, anyway, so he retired to cruise ships where he could spend his time entertaining passing doctors. He was advised that was a good thing to do, anyway, in order to keep himself healthy. People who owned a lot of old clunky mechanical ones are apt to be vengeful types, you see.

{William Bingham class=}
Casino's Closing

Well, the politicians who get bribed to permit casino licenses are delighted to tell you how much out-of-state money these benevolent institutions bring into the state, $1.4 billion dollars a year in the case of Pennsylvania. So they get re-elected to office in those hide-away little rural villages which characterize America's state capitals, where a number of them have just had brass plaques attached to their portraits, at least in Harrisburg, to commemorate this or that majority leader who afterwards went to jail. As one of them just told the newmedia, "You can't change history, can you?" The City of Harrisburg just went bankrupt over some sewage disposal plant, and you may remember that Philadelphia was once the state Capital. The fact that 49 of the fifty state capitals are in small towns, without much in the way of investigative journalism, and the additional fact that most capitals have been moved from corrupt old cities to the regions inhabited by the noble savages, gives you a sign that this wasn't exactly an accident. State government is clearly the weakest part of our political system, and its operation in the dark corners of states is more cause than symptom. Some day I'll tell you the story of a multi-billionaire who asked me to suggest a good place to donate some money. I suggested that funding several think tanks in state capitals might produce a significan improvement in the environment, and he thanked me for the advice. Unfortunately, he bought the Chicago Cubs instead, so the experiment never got tried out. There's no doubt that Chicago could use a little reform movement, too, judging by some of the political specimens that have recently crawled out from under that rock. While Philadelphia is neither as corrupt nor as contented, as it was a century ago. We get our fun bankrupting casinos in other cities.

{William Bingham class=}
HMO

Just one more story. Some New York potentates once took it in their heads to buy up some Health Maintenance Organizations (HMO). Somehow my name was referred to them, and I was hired as a consultant, to put on a white coat and walk around inspecting AC's local HMO. Naturally, I was driven down one of many new highways which New Jersey had built to attract the gambling trade, although I could have gone down on one of the newly refurbished train systems with the same purpose. Inside the HMO, I must say I have never seen so much syphilis, cirrhosis, schizophrenia, and associated medical features of the gay life, and I hope never to see that sort of medical excitement again. Those were the employees of the casinos, the so-called permanent members of the community. New Jersey may have enjoyed a brief spell of prosperity with out-of-state money. But if you balance that against the present rubbish heap, I'm not at all sure the taxpayers of New Jersey were financially better off for the experiment, on long-term balance.


THIRD : Phasing In Direct Premium Payments

{William Bingham class=}
Obamacare Enrollment

Obamacare provided for a three-month open enrollment period, estimating it would enroll seven million subscribers the first year. Even acknowledging that beneficiaries of self-insured big business group-plans would have an extra year to prepare a transition, at first it seemed restrained to suppose that universal enrollment of a nation of three hundred million would have a goal of only seven million in the first year -- until the actual fiasco was observed in action. To enroll by computer implies access to a computer. Since millions of people are still frightened to touch a computer, it implies a cadre of instructors to guide newcomers through the process. And since the insurance choices confront applicants with a bewildering set of choices, someone they trust must explain it to them. Since there is no insurance system which could possibly satisfy every reluctant hesitater, a considerable complaint and re-assignment process is probably going to be necessary for years to come. Many people will choose the wrong policy, regret it, and ask to transfer to something else. If the insurers of older policies undertake a policy of passive resistance to change, things could get tangled for years. So why undertake all these headaches?

{William Bingham class=}
Obama Administration

The Obama Administration will have its own set of answers to this question, chief among which is likely to be the set of imperatives which are set off by making it mandatory. We will have to let them make their own arguments, but once the mandatory feature is dropped, most such problems diminish or disappear. The Affordable Care Act does not seem to proclaim that health insurance is mandatory; it only states that a tax is required if you don't meet the requirements. The Supreme Court has mandated the tax must be a small one to avoid being called coercive on the states, while the Constitution does not provide for the federal government to regulate the business of insurance, a provision heavily reinforced by the McCarran Ferguson Act. If the Health Savings Account with an attached high deductible is allowed to substitute for the minimum requirements, the problems really do start to vanish. If the Obama Administration expresses a willingness to compromise, these are the lines it might follow. On the other hand, it if it forces the issue to the Supreme Court, the Court itself might be persuaded to follow those lines. We present three liberalizing proposals for Electronic Insurance Exchanges:

{William Bingham class=}
The Affordable Care Act

Let a Thousand Flowers Bloom. The Affordable Care Act provides for selling high-cost health insurance products, meeting certain specifications, on the Electronic Health Insurance Exchanges. It is not at all obvious why the government has an interest in promoting one kind of health insurance over another, but perhaps a case can be made. The case for excluding many existing types of policies has not been made, and this has particularly infuriated the subscribers to such policies, particularly those which are cheaper than the preferred variety. So why not enable or even facilitate the construction of such exchanges in every state which wants them, privatize the electronic programming and operations, possibly even subsidize them. And then permit every one of them to set its own rules for the products to be sold across state lines, setting its own prices as long as the prices are uniform for every state-licensed insurance company which wants to utilize the system. Nobody must use the system, but everyone may. There may be multiple exchanges in each state, but the state may set limits, and no state is required to have any. In exchange for federal assistance, the federal government is limited in its involvement to setting rules which guarantee access to every system for every insurance company, and every citizen.

Health Savings Accounts. In fact, it would be a blessing if Health Savings Accounts linked to a high deductible were available as an option among many other options in the Electronic Insurance Exchanges, thus making every option prove its worthiness in open competition. It would potentially add tax-free investment funds to the pool which helps fund the program, or fund the deficit. The windfall income could provide revenue for the costs of educating and coaxing people into making better choices, and is much less apt to provoke the hostility of mandating that people do things for their own good.

{William Bingham class=}
Tenth Amendment

Limit non-essential features. The threat of the Tenth Amendment hangs over all the federalizing initiatives in the Affordable Care Act. If Electronic Health Insurance Exchanges would limit their scope to the flexible enlargement of interstate insurance sales, they would clearly be part of interstate commerce, and thus safe from any revival of the Court-packing disputes of the 1930s. Permitting smaller states to enlarge their markets would alone relieve many of the indirect pressures now limiting competition as a force to suppress healthcare prices; and would limit the damage to established insurance carriers, who will probably need time to recover from the changes it would force on their marketing.

To allow privatized insurance exchanges to become available for all variants of health insurance: would allow time for discovering other features which might require special adjustments. After all, health insurance would remain half-state and half-federal, and undiscovered problems may yet surface. A gradual switch to individually owned and selected lifetime insurance would -- in time -- eliminate the need for pre-existing condition exclusions, and would even provide an opportunity to reduce premiums for insurance which protects against the cost of appendices, indirect hernias, cataracts, uteri, prostates and gall bladders that have already been removed. Not everyone will want such features, and that is a small price to pay for the freedom to want them. A long-term shift to lifetime health insurance may very well require other adjustments, but it might be best to wait to see what they are. Meanwhile, the public will get the idea, teach each other, and get where it wants to be in a few years. That's at least as quickly as a mandatory system can respond to industry lobbying, and still get wherever it wants to go.


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

Please Let Us Know What You Think


(HTML tags provide better formatting)

Because of robot spam we ask you to confirm your comment: we will send you an email containing a link to click. We apologize for this inconvenience but this ensures the quality of the comments. (Your email will not be displayed.)
Thank you.