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.
Some recessions and deflations have lasted a long time, in spite of every effort to reverse them. The cause and cure of deflation remain uncertain.
It's uncomfortable to notice that Japan almost couldn't recover from its fifteen-year depression, or deflation, in spite of numerous suggestions from economists, and in spite of the Chinese boom, right next door . It's even more uncomfortable to reflect that -- just as America has -- Japan experienced first a wild stock market bubble, then an incredible real estate bubble, or asset inflation. Soon came their stock market crash, followed by the very stubborn deflation which they are only starting to cure. Sounds ominous for us, except maybe we still have a chance to head off deflation, avoid the quicksand. Since it has previously been unprofitable to heap blame on industrial overcapacity and various other economic instabilities, let's have a look at the central unchallengeable truth of economics. Let's look for flaws in the marketplace.
During a recession, prices return to pre-boom normal. But during a depression, prices go lower than that and keep going lower. Something causes the buyers to expect even lower prices, something persuades the seller to lower his price. In a recession, both buyer and seller remember prices before the boom, expecting present prices to return there. In a depression, everyone looks into the future and fears prices will go much lower than that. The signals of the marketplace persuade the seller to lower prices while he still has a chance to sell, while the buyer waits for still lower prices. Things are bad, going to get worse. So all we have to fear, is fear itself?
Franklin Roosevelt showed that rhetoric might win elections, but couldn't reverse a deflation. It's been said that Roosevelt proved that only a world war would cure deflation, but that's wrong, too. World War II may well have reversed that particular deflation, but the huge war expenditures also demonstrated that the American economy had lots of money all during the depression and just wouldn't spend it. That's not invariably the case; England very nearly ran out of money and had to sell its empire, but we had wealth and were scared to spend. In spite of wealth, we had no money, showing there can be a real difference. That's a clue, but in fact, no one is certain how to combat deflation. Deflations do eventually end, but what cures them is elusive.
Increase liquidity. Some historians believe the confiscation of Catholic Church property by Henry VIII released wealth into the economy of Great Britain which then released prosperity, although it is also argued that the Spanish gold captured by Sir Francis Drake performed that function for Elizabethan England. This analysis of Tudor success puts its focus on the long dark ages after the fall of the Roman Empire, where inadequate banking systems paralyzed the bottled-up economy of Europe, and today is perhaps only partially useful as an example.
Wipe Out Bad Debt. The apparent solution to Japan's fifteen years of deflation was inadvertent and certainly surprising. The Japanese had seemingly tried everything, without effect. Interest rates had been driven to zero or even effectively below zero; huge government projects of bridges and tunnels to nowhere had not budged the economy. And then, private housing construction was stimulated by the government, with the result that increased supply made home prices affordable. Banks finally became willing to liquidate bad loans to meet the new demand, and the Japanese economy finally began to pick up. The paradox was that deflation was corrected by lowering prices on the one commodity which had seemingly maintained its value. Japan had plenty of money, plenty of liquidity and savings, but they were locked in the banking system by the unwillingness of bankers to admit they had over-loaned during the earlier boom times. This certainly sounds like a very special case, but perhaps it illustrates a more fundamental truth which future historians can explain to us. There's a hint here, just a hint, that prices will move up and down in harmony until one major commodity gets stuck and remains high. And the whole economic system refuses to rise, until that one discordant factor -- falls.
Since American relations with France are a little strained at the moment, it may not be completely welcome to hear it said that Philadelphia food is Creole. The reference is not to the several downtown French restaurants of outstanding quality, but to the two episodes when Philadelphia experienced waves of French immigration. The first of these was during the French and Indian War, when the Acadian French ("Cajun") were driven out of Nova Scotia, largely went to Louisiana and then were allowed to return. A lot of them stopped off in Philadelphia both going and coming. Henry Wadsworth Longfellow depicted, in his poem Evangeline, the tearful reunion of Evangeline and Gabriel in the hospital. And since for sixty years the Pennsylvania Hospital was the only hospital in the country, Longfellow had to put them here.
The second wave of French immigration was provoked by the guillotine in Paris, and the black revolution in French Haiti. Most people today are unaware that Talleyrand lived here, and LaRochefoucauld. The Duke of Orleans, future king of France, lived at 4th and Locust Streets, proposed to a (rich) Philadelphia lady, and was rejected by her father ("Sir, if you do not become king of France, you will be no match for her, and if you do become king, she will be no match for you.") Napoleon's brother Joseph lived at 9th and Spruce, and one of his marshals lived at 6th and Spruce. Really. Talleyrand had a deformed foot, and this somehow made him pals with Governor Morris who had a wooden leg. This friendship was part of the reason the Louisiana Purchase was possible, because they shared the favors of the same French lady, and had frequent occasion to meet. Both Franklin and Jefferson were ambassadors to France, it may be remembered, and for a while, Jefferson was quite a fan of the French Revolution, although the treatment of LaFayette by the French Revolutionaries did not exactly encourage that. The French treated Franklin like a God, but then so did Mozart and the King of England, and Franklin harbored many bitter memories of the French and Indian War all the while he was romancing the French into bankruptcy to pay for our revolution. The French refugees from Haiti brought Yellow Fever with them, and Dengue too, thus definitively terminating Philadelphia's hope of remaining the permanent capital of the nation.
It was during this Francophone period that Philadelphia cuisine acquired some characteristics which allow some food historians to call it Creole. Philadelphia Pepper Pot soup, for example, substituted tripe for terrapin. Those who know about these things say that many dishes now thought to be distinctly Philadelphian in fact had a French origin.
Although it has older origins, Roberts Rules of Order provide a place in every meeting for remarks "for the good of the order", suggesting there should always be an opportunity to deviate from strict germaneness to speak about something which is clearly worth talking about. Although meetings for business usually appoint a chairman, speaker or clerk to preserve order and germaneness, the truth is that most meetings which lose the opportunity to introduce something worthwhile which is a little off the subject, do so because of habit and tradition rather than devotion to focus. In recent years, remarks for the good of the Order have become so uncommon that speakers tend to rise on "a point of personal privilege", although provision for this had in mind birthday greetings and the like.
I suggest it might be a useful and entertaining thing to devote some meetings of the Franklin Inn to discussions of ways we could improve the club, and if the club has seemingly already reached perfection, to ways of improving Philadelphia and its Commonwealth.
The Franklin Inn
Such an effort will struggle at first, so it needs a core group to assure hesitating attendees that something worthwhile will be said. That core group may include officers and officials who are charged with running the club, the city or the state, but the opinions of the meeting should carry no enforcement powers other than their intrinsic validity. Admittedly, there is a natural restlessness of independent thinkers that their ideas should go somewhere, so the meetings should maintain minutes, perhaps on a website.
The attendees should pay for their lunches with meal tickets, but should also maintain a book of tickets for invited guests, and sell tickets to uninvited ones. If the present markup for tickets is maintained, an attendance of six regulars would sustain the invited speaker ticket book, and the attendance of six uninvited (no-club members) would make subsidy unnecessary. For the initial year, however, the club itself should subsidize speaker lunches. If there are conflicting meetings the Meetings for the Good of the Order should move to the second floor, and perhaps that is the best place for all of them.
These meetings should not fall into the trap of grieving that their innovative suggestions are not adopted, although they may be forgiven for celebrating the occasions where an idea does get implemented. The goal is to help an idea grow legs, and then watch it travel, ever mindful that much can be accomplished when we disregard who gets credit for it.
THE oldest annual awards for scientific achievement, probably the oldest in the world, are the gold medals awarded by the
Franklin Institute of Philadelphia for the past 188 years. Nobel Prizes are more famous because they give more money, but that in a way involves another Philadelphia neighborhood achievement, because Nobel's investment managers have run up their remarkable investment record while operating out of Wilmington, Delaware. In the past century, one unspoken goal of the Franklin Institute has been to select winners who will later win a Nobel Prize, the actual outcome more than a hundred times. That likelihood is one of the attractions of winning the Philadelphia prize, but in recent years some Nobel awards have acquired the reputation of being politicized particularly the Peace and Literature prizes. Insiders at the Franklin are positively fierce about avoiding that, so the Franklin Institute prizes have become known for recognizing talent, not merely fame.
Dr. Jan Gordon, Dr. Sean Caroll, and Dr. Cliff Tabin
Within Philadelphia, the annual awards ceremony is one of the four top social events. The building will seat 800, but reservations are normally all sold out before invitations are even put in the mail. A major source of this recent success is clear; in the past twenty-five years, the packed audience is a star in the crown of Dr. Janice Taylor Gordon. This year, she hurried back from a bird-watching trip in Cuba, just in time to busy herself in the ceremonies where she sponsored Dr. Sean Carroll of the Howard Hughes Foundation and the University of Wisconsin, for the Benjamin Franklin medal in the life sciences. Carroll's normal activities are split between awarding $80 million a year of Hughes money for improving pre-college education from offices in Bethesda, Maryland, and directing activities of the Department of Genetics in Madison, Wisconsin. His prize this year has relatively little to do with either job; it's for revolutionizing our way of thinking about evolution and its underlying question, of how genes control body development in the animal kingdom. Evolution and Development are academic terms, familiarly shortened to Evo-Devo.
Dr. Carroll's Butterflies
My former medical school classmate Joshua Lederberg, also a resident of Philadelphia, was responsible for modern genetics, demonstrating linkages between the DNA of a cell, and the production of a particular body protein. For a time it looked as though we might confidently say, one gene, one protein, explains most of the biochemistry. In the exuberance of the scientific community, it even looked as though deciphering the genetic code of 25,000 human genes might explain all inherited diseases, and maybe most diseases had an inherited component if you took note of inherited weaknesses and disease susceptibilities. But that turned out to be pretty over-optimistic. Lederberg got into an unfortunate scientific dispute with French scientists about bacterial mating and now appears to have been wrong about it. But the most severe blow to the one gene, one protein explanation of disease came after the NIH spent a billion dollars on a crash program to map out the entire human genetic code. Unfortunately, only a few rare diseases were explained that way, at most perhaps 2%. Furthermore, all the members of the animal kingdom turned out to have pretty much the same genes. Not just monkeys and apes, but sponges and worms were wildly different in outward appearance, but substantially carried the same genes. Even fossils seem to show this has been the case for fifty million years. Obviously, animal genes have slowly been added and slowly deleted over the ages, but in the main, the DNA (deoxynucleic acid) complex has remained about the same during modest changes in evolution. Quite obviously, understanding the genome required some major additions to the theory's logic.
In late 1996, three scientists met in Philadelphia for a brain-storming session. Sean Carroll had demonstrated that mutations and perhaps an evolution of the wing patterns of butterflies and insects took place during their embryonic development, and seemed to be controlled by the unexplored proteins between active genes. Perhaps, he conjectured, the same was true of the whole animal kingdom. Gathered in the Joseph Leidy laboratory of the University of Pennsylvania, the three scientists from different fields proposed writing a paper about the idea, suggesting how scientists might explore proving it in the difficult circumstances of nine-month human pregnancies, in dinosaurs, in deep-sea fish and many remote corners of the animal kingdom. Filling yellow legal pads with their notes, the paleontologist (fossil expert) Neal Shubin of the University of Pennsylvania, genetic biologist (Sean Carroll of Wisconsin), and Harvard geneticist Cliff Tabin worked out a scientific paper to describe what was known and what had to be learned. The central theme, suggested by Carroll, was that evolution probably takes place in the neighboring regulatory material which controls the stage of life early in the development of the fetus, and these regulatory proteins consist of otherwise inactive residual remnants of ancient animals from which the modern species had evolved. As the fetus unfolds from a fertilized egg into a little baby, its outward form resembles fish, reptiles, etc. And hence we get the little embryonic dance of ancient forms morphing into modern ones. In deference to the skeptics, it would have to be admitted that the physical resemblance to adult forms of the ancient animals is a trifle vague.
Haeckel's drawings of vertebrate embryos, from 1874
Embryologists have long argued about Ernst Haeckel's incantation that "Ontology recapitulates phylogeny", which is a fancified way of saying approximately the same thing. Darwin's conclusion was more measured than Haeckel's and explanations of the phenomenon had been sidelined for almost two centuries. But it seems to be somewhat true that fossils which paleontologists have been discovering, going back to dinosaurs and beyond, do mimic the stages of embryonic development up to that particular level of evolution, and might even use the same genetic mechanism. The genetic mechanism might evolve, leaving a trail behind of how it got to its then-latest stage. Borrowing the "Cis" prefix ("neighboring") from chemistry, these genetic ghosts have become known as Cis-regulatory proteins as the evidence accumulates of their nature and composition. Growing from the original three scientists huddled in Shubin's Leidy Laboratories in 1996, academic laboratories by the many dozens soon branched out, dispatching paleontologists to collect fossils in the Arctic, post-doctoral trainees to collect weird little animals from the deserts of China, and the caves of Mexico, everywhere confirming Carroll's basic idea. Even certain forms of one-celled animals which occasionally form clumps of multi-celled animals have been examined and found to be responding to a protein produced by neighboring bacteria which induces them to clump -- quite possibly the way multi-cellular life began. Many forms of mutant fish were extracted from caves to study how and why they developed hereditary blindness; the patterns of markings on the wings of butterflies were puzzled over, and the markings on obscure hummingbirds. The kids in the laboratory are now having all the fun with foreign travel, while the original trio finds themselves spending a lot of time approving travel vouchers. Many fossils of animals long extinct have been studied for their evolution from one shape to another, especially in their necks, wings, and legs. Some pretty exciting new theories emerged, and are getting pretty well accepted in the scientific world. At times like this, it's lots of fun to be a scientist.
When I had finished writing the first volume of this quartet, I considered adding a bibliography. However, it sounded sort of Stodgy, so it wasn't included. That decision appears to have been a misjudgment since some reviewers criticized the lack of references. A bibliography is therefore found at the end of this volume.
But a bibliography does not satisfy me as a description of the intellectual influences which led to this book. If anyone really cares about the matter, some anecdotes are needed.
First of all, Benjamin Franklin
However, two hundred years after Franklin's death it is possible to see some other effects and to draw some other morals about "perpetual" fire insurance. For example, the effect of compound interest is such that the lump sum payments not only pay for the insurance premium, but it also draws a very handsome cash dividend in addition. As an investment, this fire insurance is so attractive that people have actually been heard to urge a higher assessment of the value of their house, in order to qualify for more insurance! What has developed in our olde towne is a very good illustration of the principle of "adverse selection of risk". Since subscribers with spare capital almost invariably live in more substantial and fireproof houses than average, are better able to afford fire alarms, and are more likely to live near responsible neighbors, they have fewer fires. That makes the insurance less costly, but it does not reduce the legal requirements for reserves. The insurance laws force the perpetual fire insurance into a position of "over-reserving" but since the company is a mutual company, owned by the subscribers, it all comes back as dividends and fancy directors' dinners. Would anyone like more Madeira?
The power of compound interest, and the frustrating inability of most citizens to appreciate it seems to have been an obsession of Franklin's. In his will, he left $500 to the cities of Philadelphia and Boston (he was born there) to be left at compound interest for two centuries. The Boston investors did rather better and generated $xxx million by xxxx, but even Philadelphia had generated $xxx million by XXXX. Poor Richard, of course, knew that the interest growth would seem astounding, and gave the bequest in order to promote self-interested thrift among his countrymen. The idea was simple and obvious enough; Poor Richard didn't need a Hewlett-Packard 12-C pocket calculator. Even more powerful was the insight that human nature would not likely change much in the next two hundred years. People do indeed still need the message about compound interest, and people who are young enough to profit from the concept still resist the arithmetic.
What's Needed to Create an Electronic Claims and Payment System.
1. A coordinated approach. Since everyone is giving up something to get something, there must be a global agreement before anyone will move.
2. The system must focus on one and two-doctor practices. At present, 14% of claims are submitted electronically, but this almost exhausts the market of large-volume provider groups. With a small-provider focus, it follows that packaged systems must be inexpensively provided and maintained by software houses; training and support must be provided by medical societies to their members in large groups. This approach requires universal standards negotiated by payors and organizations representing doctors. The small-volume provider cannot cope with or afford a multiplicity of payor protocols, nor can he cope with frequent changes of the rules.
3. The new systems must be paid for. HCFA could pay a surcharge for electronic submission ("but why should we pay people to send us a bill?"), one carrier could perform the service on behalf of all ("but why should we let a competitor see all of our business secrets?"), the doctors could pay all of the costs ("but why should we pay to do the key entry for the carriers when HCFA has rolled back our fees? "). Since possession of the interest float is a central part of the haggling, it seems easiest to capture a part of the float as the source of the needed transfer of costs within the system.
4. It is unsafe to make any national system changes without first trying a local demonstration project; therefore, negotiations should continue while a pilot program gets going rapidly. Many fears will prove to be unfounded, while many problems will have been unanticipated. The government has experience with this sort of venture and is fairly well equipped to deal with it.
5. Although everyone hates to see a new organizational layer in the system, the providers will probably have to create a new "provider intermediary" to aggregate their data for retransmission as well as negotiable at the interface with the present "payor intermediaries". This is true in part because of HCFA's insistence on the accounting principle that "the agency which prepares the bill should not also be the one to pay that bill." Since this intermediary acts on behalf of providers, will want to control it; the sticky thing is to get HCFA to pay for something which is controlled by others. The interest float seems ideal for this purpose since excessive costs would reduce the income of providers, causing them to raise questions and/or change agents. It also automatically adjusts itself to volume, so that the agency can more comfortably work with multiple payers and providers.
6. Although medical societies act on behalf of their members, their budgets are separate from the members' pocketbook. Furthermore, membership is voluntary and not universal. Therefore, what costs or benefits the members in aggregate is not necessarily the same as a cost or benefit to the societies. Any negotiating process must recognize the distinction between representing members and sharing in their finances.
7. While maximum competition between hardware and software vendors, timeshare computer companies, and long-distance carriers is desirable, there is one small computer software program to interface between provider and insurance company software, utilizing a single common protocol which will be subject to continuous revision while negotiations and the pilot program are underway.
Software developers on both sides of the interface need to know that someone will provide them with the interface so they can go ahead with their parts of the system. Since the specifications will be speculative at the beginning and subject to continuous revision, HCFA should be willing to absorb this cost of buffering, dealing with a designated vendor, in order to be able to assure the industry of stability. This piece of software should be strictly confined t the goal of permitting inputs and outputs to be untroubled by experimental variations in the interface mechanics; it should be mainly regarded as a research tool, although its final form would be operational. To repeat: anyone could develop it when the situation is stabilized, but no unsubsidized vendor could afford to develop it until then. And no one else can budge unless it exists.
Electronic Claims System From the Doctor's Point of View
The doctor would have one of several computer system choices in his office which cost about $2000, employing software which he purchased from one of many existing sources for about another $2000. He and/or his secretary learned to use it at courses provided at the County Medical Society.
When the office closes, the machine turns itself off, but turns itself on again at night and dials a number, redialing it if busy. After connection, it identifies itself and send all of the accumulated claims of the day to a file, then receiving accumulated payment bits of advice and EOB information. The machines then disconnect, but the office computer then reconciles accounts internally, producing revised balances and accounts and takes appropriate actions; it then turns itself off. Next morning, the first process after the start-up is to print out reports about the night's activity.
Back at the collection computer, the aggregated claims are sorted by carrier and transmitted. Carrier information is them received, and sorted by provider, awaiting the evening transmission.
Meanwhile, funds are electronically transmitted into an escrow account, and a money market operation invests the money for a specified period. After the expenses of the operation are deducted, the funds are either: 1) available at that bank for checking by the providers 2) electronically transferred to the providers' banks or 3) used to pay the credit card purchases of the providers on cards utilizing the account.
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.
