The musings of a physician who served the community for over six decades
367 Topics
Downtown A discussion about downtown area in Philadelphia and connections from today with its historical past.
West of Broad A collection of articles about the area west of Broad Street, Philadelphia, Pennsylvania.
Delaware (State of) Originally the "lower counties" of Pennsylvania, and thus one of three Quaker colonies founded by William Penn, Delaware has developed its own set of traditions and history.
Religious Philadelphia William Penn wanted a colony with religious freedom. A considerable number, if not the majority, of American religious denominations were founded in this city. The main misconception about religious Philadelphia is that it is Quaker-dominated. But the broader misconception is that it is not Quaker-dominated.
Particular Sights to See:Center City Taxi drivers tell tourists that Center City is a "shining city on a hill". During the Industrial Era, the city almost urbanized out to the county line, and then retreated. Right now, the urban center is surrounded by a semi-deserted ring of former factories.
Philadelphia's Middle Urban Ring Philadelphia grew rapidly for seventy years after the Civil War, then gradually lost population. Skyscrapers drain population upwards, suburbs beckon outwards. The result: a ring around center city, mixed prosperous and dilapidated. Future in doubt.
Historical Motor Excursion North of Philadelphia The narrow waist of New Jersey was the upper border of William Penn's vast land holdings, and the outer edge of Quaker influence. In 1776-77, Lord Howe made this strip the main highway of his attempt to subjugate the Colonies.
Land Tour Around Delaware Bay Start in Philadelphia, take two days to tour around Delaware Bay. Down the New Jersey side to Cape May, ferry over to Lewes, tour up to Dover and New Castle, visit Winterthur, Longwood Gardens, Brandywine Battlefield and art museum, then back to Philadelphia. Try it!
Tourist Trips Around Philadelphia and the Quaker Colonies The states of Pennsylvania, Delaware, and southern New Jersey all belonged to William Penn the Quaker. He was the largest private landholder in American history. Using explicit directions, comprehensive touring of the Quaker Colonies takes seven full days. Local residents would need a couple dozen one-day trips to get up to speed.
Touring Philadelphia's Western Regions Philadelpia County had two hundred farms in 1950, but is now thickly settled in all directions. Western regions along the Schuylkill are still spread out somewhat; with many historic estates.
Up the King's High Way New Jersey has a narrow waistline, with New York harbor at one end, and Delaware Bay on the other. Traffic and history travelled the Kings Highway along this path between New York and Philadelphia.
Arch Street: from Sixth to Second When the large meeting house at Fourth and Arch was built, many Quakers moved their houses to the area. At that time, "North of Market" implied the Quaker region of town.
Up Market Street to Sixth and Walnut Millions of eye patients have been asked to read the passage from Franklin's autobiography, "I walked up Market Street, etc." which is commonly printed on eye-test cards. Here's your chance to do it.
Sixth and Walnut over to Broad and Sansom In 1751, the Pennsylvania Hospital at 8th and Spruce was 'way out in the country. Now it is in the center of a city, but the area still remains dominated by medical institutions.
Montgomery and Bucks Counties The Philadelphia metropolitan region has five Pennsylvania counties, four New Jersey counties, one northern county in the state of Delaware. Here are the four Pennsylvania suburban ones.
Northern Overland Escape Path of the Philadelphia Tories 1 of 1 (16) Grievances provoking the American Revolutionary War left many Philadelphians unprovoked. Loyalists often fled to Canada, especially Kingston, Ontario. Decades later the flow of dissidents reversed, Canadian anti-royalists taking refuge south of the border.
City Hall to Chestnut Hill There are lots of ways to go from City Hall to Chestnut Hill, including the train from Suburban Station, or from 11th and Market. This tour imagines your driving your car out the Ben Franklin Parkway to Kelly Drive, and then up the Wissahickon.
Philadelphia Reflections is a history of the area around Philadelphia, PA
... William Penn's Quaker Colonies
plus medicine, economics and politics ... nearly 4,000 articles in all
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Philadelphia Revelations
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George R. Fisher, III, M.D.
Obituary
George R. Fisher, III, M.D.
Age: 97 of Philadelphia, formerly of Haddonfield
Dr. George Ross Fisher of Philadelphia died on March 9, 2023, surrounded by his loving family.
Born in 1925 in Erie, Pennsylvania, to two teachers, George and Margaret Fisher, he grew up in Pittsburgh, later attending The Lawrenceville School and Yale University (graduating early because of the war). He was very proud of the fact that he was the only person who ever graduated from Yale with a Bachelor of Science in English Literature. He attended Columbia University’s College of Physicians and Surgeons where he met the love of his life, fellow medical student, and future renowned Philadelphia radiologist Mary Stuart Blakely. While dating, they entertained themselves by dressing up in evening attire and crashing fancy Manhattan weddings. They married in 1950 and were each other’s true loves, mutual admirers, and life partners until Mary Stuart passed away in 2006. A Columbia faculty member wrote of him, “This young man’s personality is way off the beaten track, and cannot be evaluated by the customary methods.”
After training at the Pennsylvania Hospital in Philadelphia where he was Chief Resident in Medicine, and spending a year at the NIH, he opened a practice in Endocrinology on Spruce Street where he practiced for sixty years. He also consulted regularly for the employees of Strawbridge and Clothier as well as the Hospital for the Mentally Retarded at Stockley, Delaware. He was beloved by his patients, his guiding philosophy being the adage, “Listen to your patient – he’s telling you his diagnosis.” His patients also told him their stories which gave him an education in all things Philadelphia, the city he passionately loved and which he went on to chronicle in this online blog. Many of these blogs were adapted into a history-oriented tour book, Philadelphia Revelations: Twenty Tours of the Delaware Valley.
He was a true Renaissance Man, interested in everything and everyone, remembering everything he read or heard in complete detail, and endowed with a penetrating intellect which cut to the heart of whatever was being discussed, whether it be medicine, history, literature, economics, investments, politics, science or even lawn care for his home in Haddonfield, NJ where he and his wife raised their four children. He was an “early adopter.” Memories of his children from the 1960s include being taken to visit his colleagues working on the UNIVAC computer at Penn; the air-mail version of the London Economist on the dining room table; and his work on developing a proprietary medical office software using Fortran. His dedication to patients and to his profession extended to his many years representing Pennsylvania to the American Medical Association.
After retiring from his practice in 2003, he started his pioneering “just-in-time” Ross & Perry publishing company, which printed more than 300 new and reprint titles, ranging from Flight Manual for the SR-71 Blackbird Spy Plane (his best seller!) to Terse Verse, a collection of a hundred mostly humorous haikus. He authored four books. In 2013 at age 88, he ran as a Republican for New Jersey Assemblyman for the 6th district (he lost).
A gregarious extrovert, he loved meeting his fellow Philadelphians well into his nineties at the Shakespeare Society, the Global Interdependence Center, the College of Physicians, the Right Angle Club, the Union League, the Haddonfield 65 Club, and the Franklin Inn. He faithfully attended Quaker Meeting in Haddonfield NJ for over 60 years. Later in life he was fortunate to be joined in his life, travels, and adventures by his dear friend Dr. Janice Gordon.
He passed away peacefully, held in the Light and surrounded by his family as they sang to him and read aloud the love letters that he and his wife penned throughout their courtship. In addition to his children – George, Miriam, Margaret, and Stuart – he leaves his three children-in-law, eight grandchildren, three great-grandchildren, and his younger brother, John.
A memorial service, followed by a reception, will be held at the Friends Meeting in Haddonfield New Jersey on April 1 at one in the afternoon. Memorial contributions may be sent to Haddonfield Friends Meeting, 47 Friends Avenue, Haddonfield, NJ 08033.
Survivors of the Great World Depression of the Thirties need no convincing about the catastrophe of deflation, but even they would have trouble defining it. Deflation is, well, something that was caused by the 1929 stock market crash, or maybe it was Herbert Hoover's fault, or maybe Hitler's fault. It is enough to know it was bad, that it's all over, and that it is on page six of the newspapers, below the fold. Unfortunately, it has returned again to crush the poor Japanese for the past fifteen years, but still, no one seems willing to say what causes deflation, or what will cure it. So, let's venture.
World Depression
The world acts as though it believes the following one-liner: The main cause of deflation is inflation. Merely keep inflation under control, and you will then avoid deflation, as well as the awkward need to know what to do about it. The main proof of this fragile argument lies in the fact that America has somehow avoided serious recession for almost twenty years by relying on "inflation targeting". It's a little uncomfortable to notice that the main proof that inflation is the only cause of deflation rests on the fact that we have had no recessions during the time we had no inflation. When central bankers are confronted with the lack of logic in that position, they appear distinctly uncomfortable. It may be correct that only inflation can cause deflation, but the proofs are unsatisfying.
Rock, Paper, Scissors
So let's retreat to a little safer ground. Let's say that massive shifts of currency can topple the stability of any government or national economy; inflation is the main cause of massive currency movements. However, it's like the old children's game of paper, rock, and scissors; you can't be sure in advance whether you want diversification, strength, or flexibility. Stability rests on long term financial commitments, like long-term bonds, or mortgages, insurance, or pension schemes. But maybe you don't want strength, you might want agility. Then, if you are in a position to anticipate currency disruption, you will shift from long-term to short-term. Panic like that undermines the people who are locked to thirty-year commitments but may not have thirty years to ride them out. The value of a national currency is tied to shifts in interest rates; that's the same thing, one within borders and the other across borders, like pushing on a balloon.
cameras
If you think government action can rescue a real panic, look at Japan. The Japanese sold good cars and cameras, acquiring a lot of foreign currency. That should have caused their own currency to increase in value, but instead, the Japanese just printed more of it to maintain the low international price of cars and cameras. All that resulting loose cash, confined within their borders, caused serious inflation of Japanese real estate and stock market prices; when this inflation shifted around, it capsized their boat. Long-term debts defaulted, eventually bringing the banks down with them.
Perhaps the Chinese have learned a lesson from Japan's experience, but don't count on it.
A year after potential financial collapse burst on the scene, the public (and Congress) are beginning to understand what collateralized debt obligations (CDO) are, and how Fannie Mae and Freddie Mac work. It begins to seem they are much the same thing in different clothes, that securitization of mortgages began with Fannie Mae if not Farm Credit in 1916, and that these bewildering new Wall Street CDO creations are just new variations of an old idea. The devil, as always, is in the details.
Freddie Mac Corp.
Originally, Government Sponsored Enterprises (GSE) began in 1916 with the Farm Credit System and entered the home mortgage secondary market in 1938 with the creation of FNMA (Fannie Mae). Populist in the first case and Depression-fighting in the other, the idea was that third-party reinsurance would make mortgages safer, and thus lower interest rates for a favored population segment (farmers and homeowners). Although no promises were made to bail out failing loans, GSEs eventually grew large enough to seem able to force the government to rescue them in the event of failure. They were claimed to be "too big to be allowed to fail". In addition to this implicit government backing, there was a twist created by making debt interchangeable with equity. "Securitization" was a process of bundling many mortgages into a package sold to the public as a stock issue. Since FNMA was a creditor, rising interest rates created profits for the shareholders, while falling interest rates depressed share prices. Steady predictable mortgage prices could be offered to homeowners, while the risk was transferred to the shareholders. To a certain but much lesser degree, some of the risks of falling real estate prices were transferred to the shareholders as well. Finally, the reduced risk in this arrangement led to lower prices for mortgages, regardless of the state of the economic cycle.
Michael Milken
To some unknowable degree, enthusiasm for mortgage-backed securities in the private sector was enhanced by fear or even loathing of government involvement in the financial system style of banana republics or the Weimar Republic in 1922. To compete with the lower interest rates of government-backed security, the efficiency of the private sector could be combined with innovations made possible by the computer. Mathematical models were devised to calculate mortgage interest rates by working backward from the default rate in a huge universe of mortgages. During the savings and loan crisis two decades earlier, Michael Milken had promoted the idea that prevailing interest rates on mortgages were higher than were justified by the prevailing rate of default in a large pool. If the uncertainty of risk for a single mortgage could be submerged within the fairly certain risk of a large pool, it should be possible to offer generally lower prices than even those of the government-backed GSE system. In spite of the recent panic, the reasoning behind both systems, government and private, seemed to suggest that securitization of debt continues to be a sound idea.
What appears to have been unanticipated was that house prices would rise in a bubble stimulated by a flood of money from the Far East and the Middle East. When that bubble inevitably burst, the resulting drastic decline in house prices would trap everyone who had borrowed a fixed amount as a mortgage at the top of the real estate market. Those who bought and held their houses before 1980 could ride out the gyrations of the real estate market, but everyone who bought an overpriced house after that was at risk that prices would eventually return to normal -- and bankrupts them with that high fixed debt. If these people outnumber the rest of the country, they can use their voting power to force the rest of the country to bail them out, but that's the way civil wars get started. It remains to be seen whether some political compromise can be arranged between those who bought houses at foolish prices, those who felt enriched by owning more valuable houses, and those few who watched with dismay.
Meanwhile, there is another important decision to be made, as to whether to permit either form of securitization to be used as an American scapegoat for a mess caused by Chinese prosperity. There is indeed much to be criticized in retrospect about the conduct of Main Street, Wall Street -- and K Street.
Benjamin Franklin was able to retire from the printing business at the age of 42. His partners bought him out in eighteen yearly installments. In the Eighteenth century, it was unusual to live past the age of 60, so Ben felt pretty well fixed. Unfortunately for this planning, he lived to be 82, so when he did reach the age of 60 he was forced to look around for postmasterships and other ways to survive, for what proved to be 22 more years.
This is the other side of a coin; on one side is written, "Protect your family in case you die young". On the opposite side is written, "Be careful not to outlive your savings", relying on the old Quaker maxim that the best way to have enough--is to have a little too much. For centuries, life insurance was sold to people who mainly feared the first, commonest, possibility, but never completely addressed the opposite contingency, which was growing steadily commoner. Annuity insurance ordinarily is sold for a fixed number of years, so insurance commissioners ordinarily require what is most probable. Unfortunately, this response shifts the risk of guessing wrong onto the subscribers' shoulders. Since science has unexpectedly lengthened average life expectancy (by thirty years since 1900, or by five years in the last ten), experience rather like Ben Franklin's has become a commonplace, but rather poor business judgment. The business remains solvent only as long as the decision to drop the policy is later than the life expectancy.
Retirement Saving Debt
There may exist insurance policies to address this issue, but few companies offer it. We will briefly describe this sort of policy, in case it becomes more widely available, but it is primarily described here to illustrate the issues to consider. If you can get it for a reasonable price, or if you can get it at all, the outline of the policy would be to set a premium and promise to pay 6% for the rest of your life. Underneath the promise is the reality of paying 6% for eighteen years as a non-taxable return of principal. Following that, you don't need to get a postmastership, you are paid a taxable 6% until you die. Presumably, the insurance company has actuaries to help with the math, so the company makes money if you live less than your life expectancy, and loses money if you live longer. If life expectancy suddenly extends much longer (let's imagine a cure for cancer appears), the insurance company is going to go broke. That's why insurance commissioners are uncomfortable with the concept, even though it is obvious how desirable it might be. So that's why annuity insurance typically states a fixed number of guaranteed years and expects the subscriber to shoulder outlier risk.
Any insurance has an administrative cost, so everyone must consider some non-insurance solution to the whole problem. Therefore, we propose you re-examine the old saw about "never dip into principal". If you don't have enough money, you can't do very much except depending on the government, your family, or your fairy godmother to help you out, although it must be obvious that all Americans would be wise to consider retiring five or ten years later than they hoped. Very likely, the government is going to have a difficult time sustaining even the present tax exemption of retirement funds, medical insurance, and social security. Those are called entitlements, but if the government eventually can't afford them, it won't matter what you call them. If entitlements keep getting extended, we can expect our nation to resemble the ancient Chinese and Indian nations -- able to build palaces in their golden era, but eventually crumbling into a gigantic slum in centuries afterward. So please, if you are able to do it, try to keep gainfully employed for a few extra years. If you do it (and some people can't) you may be able to realize the American Dream.
Inheritance Tax
The traditional American dream was to accumulate enough money to live off the income from it indefinitely, never touching principal, and then exposing the principal to destructive estate taxes after you finally die. Unless you are unusually wealthy, there isn't much left for the next generation after estate and inheritance taxes and expenses. It's a little inefficient to accumulate more than you actually need, but the government gravitates toward the least painful methods of collecting taxes. By confiscating this safety surplus, however, it declares that "Every ship (generation) must sail on its own bottom." And therefore it must acknowledge responsibility for what inheritances ordinarily pay for, like charity and good works. But there remains a quirk to this.
If Ben Franklin's partners had arranged to invest the money until he needed it, they could at least have afforded to finance two or three extra years. After inflation and expenses have eaten away at your retirement income, your principal may not generate enough income to last forever, but it is still big enough to pay for several years of retirement, which may in fact be longer than you are destined to live. Remember two things: 1) a principal sum, big enough to support you indefinitely, must be roughly eighteen times your yearly expenses. If it is only big enough to support you for fifteen years, it will seem too small until you realize you are probably actually going to live, say, five years. And 2) as far as leaving an inheritance to your children is concerned, there is a realistic probability that the government will consume most of the estate before it ever gets to the kids. These fundamental truths are presently obscured by the Federal Reserve artificially forcing interest rates to less than 1%. But if you can just hold out for a few years, it seems entirely likely that interest rates will return to 6% (meaning your principal will once again produce eighteen equal installments). But such a return of interest rates to normal levels will force the government to pay a comparable amount as interest on its bond debts (meaning it will get hungrier to escalate your estate taxes.) This isn't nearly as satisfactory a solution to the life expectancy quandary as retiring five years later than you once expected to, but you can't say we didn't warn you.
And as for what happened to Ben Franklin, you can read his will. He died a very rich man as a result of shrewd investments, later in his life. Ben left eight or nine houses, several thousand acres in several states, a gold-handled cane, and a portrait of the King of France surrounded by hundreds of diamonds. But it would not seem wise for the rest of us to count on accumulating that much new wealth, after attaining the age of sixty. The way things are going, once you attain your life expectancy, everyone should have some non-insurance plan for supporting himself for two or three extra years.
The following is an executive skeleton of Revised Health Savings Accounts. Expansions grew from 1980 concepts discovered by John McClaughry and me, among them that combining an IRA for Health, with Catastrophic (High deductible) Health Insurance, transforms simple interest into extended compound interest. That maneuver usually reduces administrative costs of both, particularly when the two age groups come to face retirement. After all, retirement insurance is just health insurance which doesn't specify the cause or location of death, and its risk is nearly 100%. Young people usually have small health costs, while old folks often have bigger costs; for both age groups health is a gamble they can"t control. But it's still a cost.
Since 1980 we added five new features building on the first two, depending on luck and inclination. That's seven in all.
1.-2. In 1980 we started by combining "the HSA for Health" with "catastrophic health insurance", canceling out some costs of both by unifying them. Young people don't have much health expense, so the HSA provides extra retirement income to the person who earned it, with the appropriate tax deduction. An older employee can spend the surplus on retirement, which he surely can use, plus a surprise tax deduction for the accumulation. Or he can just spend the money if he happens to prefer it. It's like magic, and it's legal. For decades insurance companies have profited from improved longevity; this system shifts some profit to the patient.
3. These two points are reasonably familiar, so let's just skip to a third point. Let's add optional new insurance features as needed, like "Beads on a string." Supplemental co-payments and co-insurance, for example. Or not, if you prefer to spend the money on something else. The easiest option is to split and combine the two costs into Last year of life coverage . As much as half of lifetime Medicare costs fall into the last year of someone's life; the money is already spent. There's no point in quibbling, so just pay off and save much of the administrative cost by reducing it to sample monitoring. By a combination of saving costs and shifting them to Social Security, the burden on Medicare premiums is immediately reduced. By making it optional, you reduce the transition costs, which are mainly Rube Goldberg attempts to adjust for the inevitable age of death variation.
4. The fourth point is seemingly unrelated. We have gone off the gold standard, found no substitute. Inflation-targeting worked for a while, then quit working. Someday, economists will explain this, but the leading contestant at the moment is destruction of investing cost by index funds and other computer innovation. That adds five or more percent to investment earnings, triggering a virtuous deflationary cycle, probably more than canceling inflation. You don"t have to understand this to take advantage of it. We had a near-death experience with inflation and escaped by luck. Yes, it will "trickle down", and yes it will hurt some people.
5. For a fifth addition add compound interest, which Aristotle called the "Eighth wonder of the world". It means interest gets bigger with time. 'Way bigger, so it's usually bigger than you expect. By adding one insurance to the end of another, you extend the duration. Since compound interest curves upward at its far end, it's much more effective than you might guess. And it's tax-free until you spend it, so it's a more powerful stimulus to spendable income. Trust funds need useful alternatives, and HSA with Congressional sanction, could provide one, by a flexible extension of the duration of perpetuities over two generations, taking advantage of compound interest rising by increasing its length.
6. Let's be patient and try that first, to see how clever lawyers discover unsuspected loopholes. The American public clearly yearns for universal free medical care of the highest quality. But even if we could afford that, which we probably can't, most of us don't trust politicians to resist public pressure to borrow, then worry about ruinous costs after it's too late to fix them. Hasty legislation always creates loopholes, as Cyprus, Greece, and England discovered in one way, and a sudden cure for cancer or Alzheimers would create in another. It surely requires testing during several Congressional revisions to get it right, long after unmanageable sums slam the exits. Ours is the only Constitution to survive two hundred years, and we still don't entirely understand why it has. Don't change it suddenly.
7. A seventh feature is a warning. A flexible savings account is not a Health Savings Account. Anyone who deliberately tries to confuse the two is potentially a fraud trying to restore lost income. Lots of people have an FSA, believing they have an HSA. Avoid such people, dis-elect anyone of any party who proposes such a substitute, and don"t return to salesmen who propose it.
There's more, but these seven points are enough.
109 Volumes
Philadephia: America's Capital, 1774-1800 The Continental Congress met in Philadelphia from 1774 to 1788. Next, the new republic had its capital here from 1790 to 1800. Thoroughly Quaker Philadelphia was in the center of the founding twenty-five years when, and where, the enduring political institutions of America emerged.
Philadelphia: Decline and Fall (1900-2060) The world's richest industrial city in 1900, was defeated and dejected by 1950. Why? Digby Baltzell blamed it on the Quakers. Others blame the Erie Canal, and Andrew Jackson, or maybe Martin van Buren. Some say the city-county consolidation of 1858. Others blame the unions. We rather favor the decline of family business and the rise of the modern corporation in its place.
Originally the "lower counties" of Pennsylvania, and thus one of three Quaker colonies founded by William Penn, Delaware has developed its own set of traditions and history.
Start in Philadelphia, take two days to tour around Delaware Bay. Down the New Jersey side to Cape May, ferry over to Lewes, tour up to Dover and New Castle, visit Winterthur, Longwood Gardens, Brandywine Battlefield and art museum, then back to Philadelphia. Try it!
Millions of eye patients have been asked to read the passage from Franklin's autobiography, "I walked up Market Street, etc." which is commonly printed on eye-test cards. Here's your chance to do it.
In 1751, the Pennsylvania Hospital at 8th and Spruce was 'way out in the country. Now it is in the center of a city, but the area still remains dominated by medical institutions.
Grievances provoking the American Revolutionary War left many Philadelphians unprovoked. Loyalists often fled to Canada, especially Kingston, Ontario. Decades later the flow of dissidents reversed, Canadian anti-royalists taking refuge south of the border.
