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.
Events at the time of the introduction of the Clinton Health Plan to Congress were a confused jumble, but one vignette stands out in my memory. The five hundred or so members of the secret work group were all invited to the White House for a big party, with saxophones and all. On a television interview at home in Minnesota, Paul Ellwood said he wasn't going to the party. Indeed, he looked rather morose and had little to say. It is clear he had advance notice, before the plan even reached Congress, that things were not going the way he wanted. Since the public, even Congressional leaders, were still unclear just what was to be proposed, Ellwood's dejection, or rejection did not come from them. No one has said so, but it must be presumed the rejection came from his sponsors, the business leaders. Business, in short, had pulled out; responsibility probably lies with no more than half a dozen CEOs who continue to be anonymous fifteen years later.
At that confusing time, the reasoning of the masterminds was obscure. Perhaps they decided HMOs were no good; perhaps an outrageous political demand had been linked to the proposal; or there was to be too much political control, too little business control; or perhaps government costs had been shifted onto the backs of employers; perhaps the whole idea sounded too leftist to be comfortable. And perhaps a lot of other things, who knows. Even today, no one has written a book or even listed a few plain sentences of reminiscence.
What is known is that major business employers immediately launched a nationwide initiative to go ahead with a strong push to convert employer-based plans from fee-for-service to managed care HMOs. This was to be the way employers handled health care they were paying for; the government could do as it liked. It must be admitted it was a bold stroke, quite effectively handled. When you consider the rather uncertain legal right they had to impose a system of health care on their employees, it took more audacity to go ahead than you would suppose they could summon. It was a gamble that the Clinton White House would lack the courage to challenge a private initiative to go ahead with what they had so publicly endorsed, and that providers would be so surprised by the concerted coup that they would hold back legal challenge until evidence of antitrust or conspiracy emerged. It was a sort of Battle of the Bulge in reverse, and it might well have been hugely successful except for one thing they did not anticipate. Their employees almost universally hated HMOs when they tried them out. No one likes to be hustled into something he doesn't understand, no one likes to change doctors, no one like to be told he can't have what he expects to have. Employers expected resistance of this sort, but it simply had to be done to save the fiscal health of the business. Unfortunately, what emerged was that it didn't save much more money than its own extra cost to administer. The hard reality of business life is you regularly have to bully people in order to make any money. But bullying people without making any money is a quick route to dismissal. No wonder there have been no memoirs written.
A quick re-appraisal of the Clinton Health Plan was that the two systems, Medicare for people over sixty-five and employer-based for people under sixty-five, were to be merged into a single system for efficiency and better control. There were to be local, regional, and national governing bodies; evidently, the purpose of the National Business Coalitions for Health was to supply a unified business hierarchy to match it up and down the line. Hated politicians, hated bureaucrats and hated unions could be counted on to apply strong pressures; business would have to remain well informed, sternly disciplined, and speak with a single voice for any hope of surviving in such an environment. It is my surmise that such a prospect seemed to guarantee failure for a business. No, we're sorry, Business would draw a bright line at age sixty-five, and run its own show where it ruled the roost.
Steep yield curves (the normal situation) are good for banks; inverted curves (a rarity) are not. The 2006 inversion was caused by the bond market accepting abnormally low long-term interest rates, so the "spread" between risky loans and safe ones displayed a diminished "risk premium".
The Federal Reserve then lowered short-term rates by printing more currency. This caused an inverted yield curve to return to its normal shape, but the 2006 problem was caused by too much(Chinese) money and this action added to it. The banks were rescued, but the currency was inflated.
This innovative response will probably become a standard readjustment. But it only keeps the ship from tipping over after a sudden wave; it doesn't address the approaching storm.
Risk premiums soared in August 2007.
What seemed safe, abruptly was risky, and only available at higher prices.
What happened in August?....The "risk premium" --and, consequently, mortgage interest rates-- suddenly went back to normal. About $90 billion of foreclosures seemed probable. We had built far too many houses for people who couldn't afford them. Surplus houses remain for ten years, depressing all real estate prices, making everybody feel poor. Recession, anyone?
What did the Federal Reserve do? To protect the banks, Bernanke dropped short term interest rates. (This steepens the yield curve.) As the panic spread, he dropped rates some more (This floods the country with money). Inflating the currency cheapens the dollar, which robs foreign investors. Foreigners sold stock to escape, prices fell. Seeing prices fall, everybody else sold a stock. 1929, anyone?
So what? They're only foreigners. If Bernanke raises interest rates, we get a recession. If he keeps them low for too long a time, we may get hyperinflation. So, he probably hopes to drop them for a few months, then raise them again. Jimmy Carter got "stagflation" trying this sort of thing. Green eyeshades, anyone?
Remember how naughty "redlining" was? Well, now we bash the banks for "stupid mortgages". Banks issued cheap mortgages for inflated real estate -- and immediately sold the "subprime loans" to investment bankers as "collateralized bonds". We are still uncertain who holds these things, but at least $40 billion were in the hands of Wall Street when the music stopped. Wall Street had to sell perfectly good (?) stock to pay their debts. Blue chips, anyone?
Why was the risk premium so low? The Far and the Middle East had something to do with it. But mainly, securitization led to undue emphasis on statistics. In a housing boom, foreclosure rates seem to go down but are really only being diluted by new loans. The fall of BNP Paribas was a sudden wake-up. Then, the computers of the "quants" exposed a flaw in their programs when they detected heavy selling of perfectly good stock and announced the End of the World..
Thank heaven it happened before things got serious.
The Right Angle Club was recently edified at lunch about wind-power generated electricity, by Craig Poff of Iberdrola Renewables, the largest producer of renewable-source electricity in the world. Iberdrola is a Spanish firm, headquartered in Bilboa where they have Basques, near where the Spanish Armada once started its ill-fated journey to battle Sir Francis Drake. Furthermore, it's near where there are caves with wall paintings several thousand years old. Craig is pure American, however, with a background in real estate sales. That isn't as remote a connection as it may sound, because it takes several years and a lot of salesmanships to assemble the leases necessary to create a windmill farm.
We've all seen photographs of these silvery towers, with what looks like aluminum propellers glinting in the sun. They are actually made out of fiberglass in much the same way boats are made, and quite often both are made in the Trenton region. So to speak, two hollow clamshells are held together with masking tape to form a propeller blade. Eventually, it revolves slowly, slowly in the wind, starting around 15 miles per hour, and getting turned off when the wind gets so fast it's dangerous. The blades modify their pitch at different speeds, and the entire contraption rotates to meet the wind. Sometimes one windmill will "steal" the wind from its neighbor, so the middle ones get turned down or turned off. There are local "met masts" to measure the wind and its direction and respond with appropriate directions via computers. There are also regional computer centers, and finally, electric power distribution is controlled by computers in Bilbao. Electricity can't be stored very well, so sometimes a perfectly good wind must be ignored when electricity isn't needed. Scientists are working on big batteries, and also on storing energy by pumping water uphill into storage reservoirs or compressing air into caves. Storing wasted electricity is a major issue, and high hopes are held out for innovation in batteries.
Senator Ted Kennedy
A typical tower is about 123 meters high, with a wingspan of about 300 feet; the towers are separated by roughly 1500 feet, but by much more when they are downwind. It's easy to see how negotiations with local farmers can be difficult, requiring months of public relations in a new community. Sometimes they encounter someone like Senator Ted Kennedy, who just plain dislikes how windmills look. Negotiations have to be conducted to obtain access roads to the wind farm, and access to the power transmission grid. Negotiations have to be conducted both before and after construction to satisfy game commissions who worry about the birds and the bats. As it works out, a farmer gets about $7000 a year to lease out his land, but windier areas are more prized, so jealous bargaining abounds. It's probably no wonder only 2% of electric power is presently generated this way, even though Pennsylvania law requires the power companies to reach 18% by 2020. Requires? What's the reasoning behind that? At present, the windmill nearest to Philadelphia is in Pottsville.
It's nice this electricity gets generated by a source so clean, which also can't be shut off by the Iranians. But awkwardly it's expensive to make electricity this way, particularly if you include the subsidies it enjoys. Yes, yes, it's true that lots of things are receiving dubious subsidies, and some of them are competitors to wind power. But the unwillingness of wind power advocates to acknowledge the relative costs of their product suggests to any skeptic that relative costs must be extremely high, indeed. Yes, it's clean, but it's expensive and needs a subsidy. Industries that consume large amounts of power have been offered power purchase agreements that constitute a hedge against future cost volatility for many years in the future. That's both a hedge against rising costs and a promise of reliability; some businesses will pay for that. The competitive economics are that the initial cost of wind power is quite high, but future maintenance costs are quite low. More typically, most household consumers feel they have a right to know more precisely what the competitive prices really are, absent loss leaders, subsidies and hype. When we know that for sure, we consumers will decide whether a somewhat cleaner environment is worth the price. The investors in this technology must gamble they can persuade us that it is, and one can be fairly certain competitive energy producers will seek to persuade us that it isn't. What the farmers who lease their land think, also matters. But the farmers will mostly matter in the legislature voting on clean air mandates, where city dwellers tend to lose their influence. You can sort of see how the legislators think: the farmers know how much they have been offered for the land leases, but the city dwellers can only guess at how clean the environment will get, and how much the electric costs will rise.
Here's some advice for new authors of books: You can't write the first chapter until you have written the last chapter. That is, you have to hit the reader between the eyes in the first chapter, draw him into the argument, making a pauseless transition from a general statement of the author's thesis into a relentless march of evidence toward the conclusion. This general design comes easier with practice and is therefore much harder for beginners to accomplish. But even experienced authors are usually unable to keep the overall design of their message constantly in mind, to be able to sit down and write the book straight through from beginning to end. It's true that Sir Walter Scott was said to turn over the last page of a book, and immediately begin writing the first page of the next one without getting up from his desk. But we aren't talking about pot-boilers, we're talking about serious books. That includes almost all non-fiction and the great majority of serious fiction.
As a matter of fact, the description includes the majority of short articles as well; newspaper editorials would be a good example. Although the style of an editorial is to start with a generality, marshal a description of some recent events, and end up with a short summary, that isn't in fact how it is usually composed. The editorial writer starts with a one-liner, or call to action, organizes some recent events and some historical arguments as a reason to issue such a call, and then ends up by summarizing things in the first paragraph. Having mentally designed the editorial into such a three-step pattern, with experience a professional editorialist can sit down and write the editorial from beginning to end and, after a few touch-ups, it's ready for the printer. He really has gone through the organizational process which a book author needs to go through, but the article is short enough so that reconstruction is performed in his head. In a book, it is generally necessary to write out the chapters in a jumbled way, and later re-organize them. A new author with his first manuscript generally doesn't adequately appreciate the truth of this and has to be muscled by the editor, at least just a little bit. One of my editors summarized his job as follows: you tell every new author to take the first four chapters of his book and throw them away,
That's cruel, of course, and is seldom accepted graciously. The brusqueness is justified by understanding that the fresh new author thinks he's all finished when he isn't. He's silently telling himself he means to tell that editor, "Don't you touch a single comma of it." In the old days, authors were rare and had to be coddled. Book publishers in the Eighteenth century purchased the manuscript in its entirety, either then losing money or making a huge fortune, but leaving the author with only his manuscript price. At that time, publishers called themselves booksellers. As things evolved, booksellers often had to support a starving author while the book was being written, offering an "advance" payment to be deducted from royalties paid after final sales to readers. Author royalties were about ten percent of sales. The royalty system persists today, but advance payments are uncommon and negotiated around the tax code effects. All of these payment evolutions reflect the underlying issue: good authors used to be rare, but now are frequent. Book publishers used to be wealthy, but now are rapidly going bankrupt and extinct. Authors of excellent books have a hard time finding someone to publish them. The advent of the personal computer around 1980 is what caused this.
In 1980 I published a book, writing it on my brand-new Radio Shack TRS-80, Mod I. The editor of the publishing house had never heard of such a notion, scoffed at it, and declared he would never touch such a thing as a computer. In 2010 there were more than 800 million personal computers manufactured and sold, and by this time almost no publisher will accept a manuscript without an accompanying magnetic disc to make revisions cheap and easy, and to shift the costs of key-entry from the publisher to the author. At first, manuscripts were shipped to India for key entry. Now, it is the diskette which is mailed or e-mailed to India, and the editor is often located in India. We are soon approaching a day when the keyboard and author remain at home, sending material to gigantic server computers in China, from which the editor anywhere in the world can retrieve the material and revise it, returning the material to the server computer where the author can comment on the revisions without moving from his desk. After that stage, looms the prospect of the reader paying a fee on his credit card to access the "book" directly from the server, and reading it at home. At that point maybe the book will have been completed, and maybe it will be revised some more. In a sense, a book will never be definitely finished and allowing the public to read it will only be an episode within an unending process of revision. Newspapers, magazines, and books are all struggling to find a way to cope with this unpredictable evolution. Like most revolutions, this one doesn't have a clear idea where it is going.
So let's reflect back on the central process of authoring. In addition to the old maxims of the trade, there is the Euclidian reality that you can't write the last chapter until you somehow write a first one. The original first chapter, the one the author struggled so hard to compose, is destined to be cast off and replaced by a new first one, one that succinctly announces what is about to be said. After that must come a new second chapter, which takes the reader from the initial disconcerting summary back to the origins of the problem now about to be clarified. Followed by a third chapter, probably one shifted forward from the assorted chapters of evidence back into prominence as the key piece of evidence which leads to other confirmatory pieces of evidence; after that marches the parade of confirmatory evidence, ending with one zinger of a conclusion.
Voltaire or some other cynic would probably comment that what has here been outlined is merely an elaborated process of what editorial writers do: start with the conclusion and find slanted facts to fit it. Some may indeed do that. But there is some hope that the inevitable impact of technology on authorship can bring us to a system where many authors will assemble the facts, and only then derive a conclusion from them. If politicians would only adopt that system, maybe we could hope for a perfect world.
The "future value" of any sum of money is the same as the total amount accumulated in a set period of time, assuming a certain average percent of the tax-exempt gain in compound interest. In matters discussed here, the future value is only generally of concern over long periods of time. Because of compounding, the future value increases at the far end. Here is a graph of the future value of almost anything at 6.5%, starting at age 80:
The hypothetical lifetime balance of the escrow portion of a New Health Savings Account would, on average, have a different shape, because the childhood portion is an inheritance at birth. It wears down over the next 20 years, so there is only a small but critical amount left over to grow during the working years, 21-66. Assuming the option is taken to fund both the first and last years this way, maximizing the income, it would look like this, assuming longevity of 84:
And for age 94, the last two curves have the same overall shape, but internally result in a surplus at age 94 of about $250 a year, because the future value curve tilts upward. Remember, this may be an artifact because there are ten extra years in which to develop new treatments to pay for.
:
It is component revenue would consist of $50 deposited in the account at 6.5% compound interest, every year from birth to death. That would vary with the life expectancy, which is now 84 but reasonably expected to reach 94 at some time in the next 90 years. When the contributions stop at death, the compound interest continues to accumulate for up to another 21 years, following the common law principle that perpetuity begins after "one life, plus 21 years".
At the death of the grandfather client, the fund is nearly depleted by his first-and-last year of life reimbursements, but that payment might possibly be delayed a few months if it exactly matched his actual expenses. It could be immediate, with administrative savings, by reimbursing all primary insurance by the average cost of all last years costs. The funds left over would be comparatively small, but they would still generate income until the account is closed. However, they are a contingency cushion, and could be modified if other requirements appear.
There is a calculation perplexity in the fact that compound interest turns sharply upward, toward the end of life. Therefore, an even distribution of deaths, both longer and shorter than the mean, leads to a "profit" from the ones who live longer. Disregarding this point, the outermost limit of contributions at this level of sharply rising returns might be as much as $832,000 for the longevity of 94 and $441,000 if longevity does not increase at all. (That's assuming Obamacare joins the same system but substitutes Catastrophic insurance for the present arrangement.) If longevity does improve, contributions of $50 a year are adequate. The longevity of less than expected (wars, famines, etc.) would mean the deposits would have to be increased. Contributions of $60 a year seem more than adequate, however.
These calculations are based on withdrawals at the time of death, for last year of life, plus the first year of life, and a small surplus to spare. For the time being, the costs and revenue of Obamacare are left to that program to worry about. These accounts continue to accumulate interest during the client's 22-66 age period, but do not affect them. The thirty million uninsureds are also excluded, but it would be my suggestion that they differ so much from each other, they ought to have separate programs for prisoners in jail, mentally retarded, etc.
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.