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
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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.
And so, after the Revolution was finally over, there was a third war between Pennsylvanians and the Connecticut born settlers of the Wyoming Valley. This time, the disputes were focused on, not the land grants of King Charles but the 1771 land sales by Penn family, most of which conflicted with land sales to the Connecticut settlers by the Susquehanna Company. The Connecticut settlers felt they had paid for the land in good faith and had certainly suffered to defend it against the common enemy. The Pennsylvanians were composed of speculators (mostly in Philadelphia) and settlers (mostly Scotch-Irish from Lancaster County). Between them, these two groups easily controlled the votes in the Pennsylvania Assembly, leading to some outrageous political behavior which conferred legal justification on disgraceful vigilante behavior. For example, once the American Revolution was finally over (1783) the Decision of Trenton had given clear control to Pennsylvania, so its Assembly appointed two ruffians named Patterson and Armstrong to be commissioners in the Wyoming Valley. These two promptly gave the settlers six months to leave the land, and using a slight show of resistance as sufficient pretext, burned the buildings and scattered the inhabitants, killing a number of them. One of the weaknesses of the Articles of Confederation was thus promptly demonstrated, as well as the ensuing importance of a little-understood provision of the new (1787) Constitution . No state may now interfere in the provisions of private contracts. Those with nostalgia for states rights must overcome a heavy burden of history about what state legislatures were capable of doing in this and similar matters, in the days before the federal government was empowered to stop it.
A flood soon wiped out most of the landmarks in the Wyoming Valley, and it had to be resurveyed. Patterson, whose official letters to the Assembly denounced the Connecticut settlers as bandits, perjurers, ruffians, and a despicable herd, boasted that he had restored, to what he called his constituents, "the chief part of all the lands". The scattered settlers nevertheless began to trickle back to the Valley, and Patterson had several of them whipped with ramrods. As the settlers became more numerous, Armstrong marched a small army up from Lancaster. He pledged to the settlers on his honor as a gentleman that if both sides disarmed, he would restore order. As soon as the Connecticut group had surrendered their weapons, they were imprisoned; Patterson's soldiers were not disarmed at all and assisted the process of marching the Connecticut settlers, chained together, to prison in Easton and Sunbury. To its everlasting credit, the decent element of Pennsylvania was incensed by this disgraceful behavior; the prisoners somehow mysteriously were allowed to escape, and the Assembly was cowed by the general outrage into recalling Patterson and Armstrong. Finally, the indignation spread to New York and Massachusetts, where a strong movement developed to carve out a new state in Pennsylvania's Northeast, to put a stop to dissension which threatened the unity of the whole nation. That was a credible threat, and the Pennsylvania Assembly appeared to back down, giving titles to the settlers in what was called the "Confirming Act of 1787". Unfortunately, in what has since become almost a tradition in the Pennsylvania legislature, the law was intentionally unconstitutional. Among other things, it gave some settlers land in compensation that belonged to other settlers, violating the provision in the new Constitution against "private takings", once again displaying the superiority of the Constitution over the Articles of Confederation. It is quite clear that the legislators knew very well that after a protracted period of litigation, the courts would eventually strike this provision down, so it was safe to offer it as a compromise and take credit for being reasonable.
It is useful to remember that the Pennsylvania legislature and the Founding Fathers were meeting in the same building at 6th and Chestnut Streets, sometimes at the same moment. Books really need to be written to dramatize the contrast between the motivations and behavior of the sly, duplicitous Assembly, and the other group of men living in nearby rooming houses who had pledged their lives and sacred honor to establish and preserve democracy. To remember this curious contrast is to help understand Benjamin Franklin's disdainful remarks about parliaments and legislatures in general, not merely this one of which he had once been Majority Leader. The deliberations of the Constitutional Convention were kept a secret, allowing Franklin the latitude to point out the serious weaknesses of real-life parliamentary process, and supplying hideous examples, just next door, of what he was talking about.
Most Americans would like to lose weight, particularly if they could eat, and eat some more, at the same time. Dick Watson recently told the Right Angle Club about an adventure cruise on a sailing ship in the South Pacific, where he and everyone else ate huge mounds of delicious food, but still lost 12 pounds in a month. About twenty of these voyagers spent eight thousand dollars for the privilege of working as sailors for a month on an authentic pre-steam brigantine, sailing from Aukland to Easter Island. Dick took fourteen hundred beautiful photos of the experience, but most of his audience sat transfixed at the description of the horrors of sailor life. Not your average luxury cruise.
Moshulu
A brigantine is about an eighth the size of the Moshulu parked in Penn's Landing, and definitely does not plow the waves. Bobbing like a cork with every ripple, the ship "rode" waves throughout this "Pacific" cruise that averaged six meters or about twenty feet high. It thus follows that every single voyager was deathly sea-sick for the first two or three days; welcome to the bounding main. In spite of excruciating incapacity, sailors are not excused from standing watch; that's just about the first law of the sea. However, after a few days, this problem seems to go away for almost everyone and becomes only an initiation rite in retrospect. What doesn't go away is the wind, the cold, and the rain. Climbing the rigging gets you up to the fighting top, a wooden platform forty feet above the deck. Bigger ships sometimes have a hole in that platform to crawl through, but brigantines don't have rubber holes. You climb the mast and work your way out to the edge of the platform hanging upside down, then drag yourself up and over the edge. Once you are there, you can attach your safety belt, but the transition depends entirely on having enough strength in your hands to hold on while the ship rocks from side to side, forty feet below. Above the fighting, the top is another fifty feet of climbing, as the shrouds (ropes) which are attached to the top narrow down to the point where there is no longer room for your foot unless you turn it sideways. Ballet dancers learn to walk on their toes, but walking and climbing on the side of your foot is a step beyond excruciating.
Perhaps it is the good thing our ancestors came over to settle America that way. Except for a few people like Benjamin Franklin they gladly gave up all thought of returning to the home country. However difficult it may have seemed to cope with the Indians and all, they were going to be Americans forever. Other people could fight wars about events that took place in 1384. We weren't going to worry about that sort of thing because we were not going back, ever.
MICHAEL Bolton, Vice President of the Opera Company of Philadelphia, recently addressed the Franklin Inn Club, giving one of the more informative descriptions we have had about the inner workings of a philanthropic entertainment. We are very grateful to him for being so frank and open about an important perplexing issue.
The Academy of Music was originally designed as an opera house but served for many years as the home of the Philadelphia Orchestra as well. We formerly had two Opera companies, but the audience couldn't support two before they merged. Things are now definitely looking better for opera in Philadelphia; the recent presentation of La Boheme , for example, was one of the high points of American opera in recent memory. However, that achievement has been made with struggles and a certain amount of patchwork. For example, the Academy of Music is owned by the Philadelphia Orchestra, which now has its home in the Kimmel Center, and rents the Academy building to the Opera. It's hard to know who makes out better in this circular arrangement, but there is little doubt the Opera Company is pinched by the rental fee of $45,000 per performance, which probably partly goes to subsidize some of the financial troubles of the Orchestra that have recently been in the papers. It ends up costing a million dollars to put on a performance at the Kimmel Center, nearly two million to put one on in the Academy.
It's true that our opera costs (and ticket prices) are less than in many other cities, most notably the Metropolitan Opera in New York. But it's more important to know that only half the budget is spent on performers. When you hear of the prices paid to performers, particularly soloists, it's easy to imagine this is the main source of financial strain. But the issue is not what people are paid, but rather who is overpaid. At the top of the list has to be the stagehands, whose hourly wages Mr. Bolton declined to specify. But I recently had the opportunity to overhear a conversation on the train between a stagehand and his friends. With great glee, the gentleman described how few hours he worked, how little needed were his services, and how soon he expected to retire. Even making some allowance for boastfulness, this recital was a little hard to take on the day after I had sat in a hundred-dollar seat.
The Academy of Music
The management of the Opera certainly seems to be thinking hard about how to rein in expenses. Perhaps a little too hard, when you notice the orchestra pit has been filled in to allow for several more rows of up-front seats. The consequence of this economy, however, is that it's nearly impossible to put on Wagnerian opera, or even some of the more elaborate operas of Puccini and Verdi. There have been complaints from some of the front-row customers that they have trouble looking upward at the libretto titles which are shown on the Proscenium. Something may have to be done about this.
Philadelphia wants to put on more and better operas. There are so many applicants for positions that the junior nonfamous singers are charged $300 by the agents, just to have an audition. Voice teachers command several hundred dollars an hour to coach aspiring performers. There is a great oversupply of performers in the local market; the problem is inadequate demand, resulting in part from high prices. No doubt this situation will correct itself, partly, when the economy recovers. Unfortunately, however, some of us old-timers can remember the Japanese recession which is in its seventeenth year, and our own Great Depression of the 1930s, which lasted fifteen.
My own suggestion is that the Italian and Central European immigrants of the early Twentieth century are disappearing, and their children have become Americanized. What we now need is to make a conscious effort to Americanize classical music, especially opera. American singers no longer adopt European stage names; it's more likely to be the other way. Let's recall that America was founded just eight blocks from the Academy. Beaumarchais, the one who wrote the Barber of Seville, ran a Revolutionary gunpowder smuggling ring in conjunction with Robert Morris. Major Andre and General Burgoyne were authors and producers of theater. If librettists get desperate, there is always Benedict Arnold the estranged hero of the Battle of Saratoga. And George Washington with tears on his cheeks as he gave orders for Major Andre to dance on the end of a rope. There's plenty of material for grand opera in this city. And most of it is even true.
Extensive premium changes in health insurance followed the introduction of the Affordable Care Act. Most changes involved an increase in patient participation in the costs, either deductibles or coinsurance, coupled with a "cap" on total patient payments. Almost all insurance seemed to grasp the futility of co-payment as a purchasing restraint, substituting fairly high deductibles for the old 20% co-pay. As election day nears, we are seeing a rash of articles about the hardships of front-end deductibles, during the first year of their introduction, and the largest patient group with this kind of experience are holders of Health Savings Accounts. A sudden media clamor about one point generally suggests some political stirring-up is taking place, but perhaps it is fast-breaking news that someone with a torn fingernail decided to bandage it herself rather than go to the accident room, all because of the shocking discovery that the days of first-dollar coverage are fast receding. The lady in the article didn't mention any other medical debts, but that is surely coming in the news.
After Medicare was introduced in 1965, I had already been in practice for fifteen years, and it did not surprise me how many patients, indigent and otherwise, had snaggly teeth, perforated eardrums, amazingly big hernias, gall stones, extensive varicose veins, and gigantic prostate glands. It was just the way things were, and doctors set about treating 'em as they appeared. What amazed me, six or seven years later, was the supply of these things had greatly diminished. Only then did I realize that people had been holding back on elective surgery because of finances. This backlog was a reasonably good measure of the benefit which Medicare was having, by giving elective surgery away free.
But that was only true if you consider every single remediable condition to be a disgrace of some sort. The people who had these conditions had weighed the costs against the benefits and had often simply declined. You could argue if you must, that poor folks just couldn't afford to get essential treatment, and that anyone who denied them this essential human right was an ogre; but that didn't appear to be the case in large measure. What was true was that the threshold for offering charity care was set to match the judgment of the decliners, rather than the level of physical perfection of an ancient Greek god. Folks just didn't think the surgery was worth the money, but when it became free, a new standard was set and they might as well get it fixed like a dent in an auto fender. Nevertheless, there's a strange fact about surgical scarcity and abundance. If you are planning on having any of these procedures, I would advise getting a surgeon with training during that catch-up period of the nineteen-seventies, because he had a lot of practice. In fact, my granddaughter flew to Nashville to have a perforated eardrum repaired by a famous expert during that period. When she recently needed a second operation after forty years, she had trouble finding a surgeon who could do it, even with half a dozen doctors in her family.
Surely a front-end deductible won't get us back to the same state of affairs, even if deductibles continue another forty years. But to some degree, it will happen, and what we once called a backlog will resurface as a debt from one time period to the next, with the threshold reset. Since we definitely need deductibles, it seems we apparently also need a small backlog of untreated elective (non-fatal) conditions, whether they do better than that in France or Sweden, or not. Since it can be safely predicted this will happen, we need to devise a way of managing the issue without provoking unsustainable costs. In the meantime, known but untreated, treatable conditions will become an accounting entry, which can fairly be attributed to the solving of our health cost issues. It's a debt, but I'm not sure total bodily perfection is the best standard of it.
Foreign debts for Medicare. For some time, Medicare has been 50% subsidized by federal borrowing. At the very beginning in 1965, it was 100% federally subsidized, and gradually payroll deductions, premiums and new programs with better funding arrangements took over. So far as is easily determinable, no one has dug out all of the subsidies and repayments, to be able to tell us what the accumulated unpaid debt for the Lyndon Johnson entitlement programs has been. What it has accomplished is harder to measure, since it must include a share of the improved longevity during the interval. Nevertheless, we could make an effort to see what the book cost has been. Surely it has been greater than just the cost of elective surgeries. At first, the creditors were all American citizens, most taxpayers, but at least it kept the money within the domestic budget. Since we started to borrow the money from the Chinese government, it assumes a different character, one which any creditor would feel entitled to evaluate. To know what to do about this debt is above my pay grade, as they say, but at least it would seem to be responsible stewardship to make a formal accounting of where we stand, and what we plan to do about it.
Domestic Healthcare Debts. Without getting into a wrangle about the Tenth Amendment, it is fair to say that health care has long been thought to be a responsibility of the several states, so at the least, the fifty state budgets would have to be examined and aggregated, perhaps the municipal budgets as well. In Philadelphia, the deficit of PGH (Philadelphia General Hospital) was running eleven million dollars a year, when it closed in 1977. The nation's first hospital, the Pennsylvania Hospital, was created by a grant from the state legislature in 1755, at a time when Ben Franklin was active. Perhaps it is not necessary to go quite so far back to see how the books balance, but any adjustment for inflation would bring out the considerable taxpayer expenditure for health, ever since the nation was founded.
Sustainable Growth Factor. Every year since 1997, Congress has calculated the rate at which health costs should be growing, and when it exceeded that, has planned to reduce physician reimbursement to compensate. Every year Congress has relented at the last moment, but never put an end to the threat. Since the accumulation has reached a point where almost every physician in practice would have to stop the practice if Congress honored its threat, something must be done about it. Paying it all off at once would trigger a 26% drop in physician income since every physician carries a 50% gross overhead, collecting an additional 26% would be a disaster. Perhaps the two political parties each hope the other will get the blame and pay the bill. But the bill remains part of the debt hanging over the Federal Government for health entitlements, and like most of this debt, it is a question how to treat all of its inflation in the interval.
Healthcare Mortgages. Bill Dunkelberger the Philadelphia economist, recently remarked that real estate is where the rubber hits the road, the place where interest rates really matter, the place where equities collide with fixed income. For eight years past, our long term interest rates, net of inflation, have been close to zero. That allows the government to borrow free of charge, and in effect allows hospitals and universities to build buildings without much or any cost.
Unfortunately, our businessmen have not responded with a comparable spree of interest-free borrowing, because they see nothing worth borrowing to build for. Their unwillingness to spend leads to the appearance of growing earnings, which artificially supports the stock market. It's hard to imagine a stock crash just because prosperity returns, so it's hard to know what will happen if it does. Hospitals and universities think they have something to build which will generate a healthy return for them, so one builds out-patient facilities, and the other builds lavish dormitories. When interest rates return to normal (they haven't, in Japan, done so for seventeen years), it's a puzzle to know whether the economy and the stock market will tank, or will celebrate. In any event, there is a great deal of new real estate debt which must be added to the level of government indebtedness, due to health. Since nothing much could be done with such single-purpose structures, their disposal is also part of the consideration. When Jefferson University received a gift of a basic science building to house the first two years of its classes, they got a maintenance jolt. Just to heat, air condition and clean the building consumed the entire tuition of the first two years of classes.
Student Loans, broadly defined. To judge by Nineteenth-century plays and novels, medical students were traditionally impoverished. Today, students of all descriptions are carrying six-figure indebtedness, but medical students are a special case. They run up debts in order to stay in school, and the schools prosper. Then, they take jobs for several years as house officers in hospitals, who are paid by the government from Medicare funds which are used in large part to pay off their loans. And then, they go into practice, often reimbursed by salaries provided by government entitlement programs like Medicare and Medicaid. It's more than I am able to say whether these successive loans add to each other, or cancel each other out. In any event, a huge amount of money is being paid for what is described as medical education, but a certain amount of it is diverted to other university uses.
Future Entitlements. In many ways, the largest indebtedness to account for, are entitlements which have been conferred on future generations, many of whom are not yet American citizens. This is the problem most pension funds are now encountering, of whether such a future promise is a contract which must be honored, that is, whether it counts as a debt. Congress certainly acts as though it must say it is a contract, or else be dis-elected. But the rest of us would not regard that as much of a tragedy, so perhaps it isn't a debt. Whatever we end up calling it, it would surely be an improvement if we could hear it accounted for as if it were the debt of a corporation. Perhaps that wouldn't lead to improving the situation, but it would certainly feel a little better.
A central feature of compound interest is the quirk that the longer you invest, the higher the interest rate becomes. That's not going to change, no matter who votes against it. What did change, after thousands of years of staying the same, was longevity. The Biblical guess for potential longevity was three score and ten, but most people died in their twenties and thirties, far from the theoretical longevity of the human condition. By the year 1900, actual longevity was 47 years, and three-score and ten still seemed about right. But today longevity at birth is thought to be around 82, and what with heart transplants and all, it may level off at 90 in a few decades. The Sunday supplements are already speculating the average person may someday reach the age of 110, or more.
It's probable that civilization developed a number of conventions to adjust to shorter longevity, based on the notion that if things don't change for a century, we can make do with short-term expedients for national currencies, life insurance, mortgages and similar long-term arrangements. Stories are told of Bismarck, or was it Franklin Roosevelt, who based retirement schemes on the assumption most people would be dead at the age of 65 or 67, so there would be plenty of money to pay their pensions. But insurance companies gradually learned how to get rich on premiums based on old assumptions, but pay-outs based on a longer reality. Other long-term financiers played the same game, and governments switched from a gold standard to inflation-targeting. A fixed amount of gold drives prices steadily downward in an expanding economy; a floating currency gradually floats prices upward, but creates innumerable adjustment headaches. With periodic crashes, we manage. The present book proposes we use the quirk of rising interest rates in compound interest as a way to cope with unstable currencies, but it's only an expedient, and it may not last forever.
At the moment, it looks as though longevity will level off at around age 90, but that projects a progressively longer retirement vacation to pay for. For the time being, we appear to be leveling off at equal thirds, childhood and education until 30, earning from 30 to 60, and retiring from 60 to 90. That's pushing things a bit; no one can be sure a third of the population can, or will, support the other two thirds. It's particularly dubious when you consider about 30 million people in America will always have some degree of dependence. That's roughly seven million incarcerated in jail, eight million handicapped, and 11 million illegal immigrants. Going to work at age 25 and retiring at age 75 would provide much safer numbers, particularly if 5% of the population is normally between jobs in a mobile society, and we propose to spend 18% of national income (GDP) on healthcare for the rest. Americans like to grumble a lot, but compare how much better off we are, than the other four fifths of the world, living on something approaching a dollar a day. We like to think it is possible to get rich without making anyone else poor, but the rest of the world has been taught to make money by taking it from someone else.
So, without further illustration, Americans should adjust themselves to a century of working longer and harder, perhaps age 25 to 75, recognizing the rest of the world will out-vote us if they can, and trusting in our own resources whenever there is a choice. That's the reality underlying a preference for individual savings accounts, it really isn't safe to trust the currency forever because even our leadership occasionally disappoints us for whatever motive. And it's the reality of extending the working years, even if income falls, because the longer you are self-supporting, the shorter the time you must depend on others. And there's one other simple peasant teaching: start saving as young as you can, on the day of your birth if your family is organized that way. It was pretty useless when people lived to be 40, because compound interest scarcely had time to begin work. But the rule of thumb is that money at 7% interest doubles in ten years. If you live to be 90, that could be nine doublings (2,4,8,16,32,64,128,256,and 512) or five hundred dollars per dollar. Since you only need a trustworthy custodian to do it, it is probably the basic unit of currency, slowly changing over time. But you don't need to take it so literally, understanding the principle is more important.
The rule for health insurance (which is what we are mainly describing)is to organize the insurance to begin saving as young as possible, and to spend the money as late as possible. Health insurance is one big transfer mechanism. You earn money from 30 to 60 and you spend it from 0 to 90, but you spend the greatest amount in the first year of life and the last four years of life. Therefore, it is poor design to assign the cost of childbirth to age 30, it's mostly borrowed money, and it's spent the day you were born. You could argue before a judge the cost is partly the mother's cost, partly the father's, partly the infant's; the judge will probably assign the cost to the person with the deepest pocket. In this particular case, the deepest pocket is probably the grandparent, having six or seven doublings intervene. In fact, in a situation torn with divorce and dissension, the grandparent may be the person -- not only most able, but -- most willing to pay the bill. Skipping the process of inheritance, the donation of the money by grandparent to the baby's individual account eliminates cost and controversy, and potentially reduces the cost by 32 to 64-fold.
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.
