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.
In more recent writings, Jacob S. Hacker seems obsessed with social inequality, but while he was a graduate student he wrote an excellent and objective book, The Road to Nowhere containing unique insights into the politics of the Clinton Health Plan of 1993. After that hubby was over, he interviewed most of the important actors in that drama, at least those active in the liberal politics of it, and they talked freely. Like the rest of us, he was unable to identify let alone talk with the leaders of big business, who are of course still pursuing their original goals. What emerges does sound roughly accurate; Hillary Clinton and Ira Magaziner designated to find out what this health business was all about; solicit every proposal on the mind of political, particularly congressional, allies; gather and examine all the useful ideas in circulation in academia and the insurance community; and negotiate possible solutions with a surprising new ally, the big corporate employers. A huge semi-secret task force was then assembled to exchange ideas, discard really bad ideas, and work the proposal into legislative form. There would be internal inconsistencies and conflicts but no matter.
William Clinton
Congress would work it out, differing versions would appear in House and Senate bills, and President Clinton himself would eventually be able to intervene when things got to the House-Senate Conference committee. Since the Clintons really had no pre-conceived ideas on this complicated topic, the will of the people would emerge from a huge debate, and the will of the people would prevail.
That's one version. The other way to picture this circus would be that a highly skilled politician would offer everybody a chance to propose pet projects, and those who failed adversary process would be obligated to support the ones who did prevail. Trade-offs would be made, as needed, and the political ringmaster in the White House would have the final say.
But the final version was the one that came through to the public and the leaders of big business. You weren't going to know what the plan was all about until it was too late to do anything but accept it after a big sales talk full of snake oil. Big business, which had a serious interest in a particular outcome, also had an army of experienced Washington lobbyists. These people were aware of the unpredictable quirks of the house-senate conference system, were completely confident that the membership of that committee would be stacked in favor of a particular outcome, and knew that a congressional staff with agendas different from those of business would, in the end, be perfectly capable of stealing the show. For major employers, that settled it.
Big business had been wavering about whether to go ahead with their own plans, anyway. They had listened politely and carefully to what the government wished for its own insurance plans, Medicare and Medicaid, and were probably willing to agree. But as matters approached a unified approach, too many things surfaced they didn't like, and too much chance the decisions would go against their wishes. There was too much to lose, too little to gain, and well, we're sorry, we can't go along. This or something rather like it seems to have been the final outcome. The press had been furious about exclusion from major news items, coupled with annoyance at the favoritism toward Mr. Weinstein of the New York Times. The whole medical industry was jittery about exclusion from consultation or even notice; the insurance industry was pretty comfortable with the status quo; the public was in a state of utter confusion After the main partner dropped out, the proposal never even came up for a vote in Congress.
After ordering some campaign letterheads, and cards, and writing my political "CV", what am I supposed to do now? Get a haircut, maybe, and get my car washed. Be sure to say "Good Morning" to everyone I meet and don't forget to go to church. Perhaps this lull is the time to write a campaign speech, so here goes my first try at one.
CAMPAIGN SPEECH -- Fisher for Assembly.
Good afternoon, fellow citizens of the 6th District. I'm here to ask for your vote to become your local representative in the State Assembly. (at this point, insert a joke).
This district's voter registration is 60/40 in favor of my opponents, so I have to work hard as a Republican, and I've got to convince some Democrats to vote for me. I've never met my opponents, so I have no reason to dislike the poor souls, except to note they are on my road, and everybody likes to be given a choice. They are incumbents, but since I have never heard of them before, their incumbency is probably a criticism rather than an asset. I'd be very happy to appear on the same platform with them in a debate, but the League of Women Voters report this is a request which is invariably declined. So, until their campaign managers say something bad about me, I'm not going to be the one to start negative campaigning. Besides, at my age, anything bad about me might be taken as a compliment.
When the Assembly was first started, right here in Haddonfield at the Indian King Tavern, the British were making it difficult to conduct a town meeting, so it seemed best to elect representatives who could assemble in some safe place and conduct business in whatever way they could. The representatives wanted to do what their townspeople wanted, but often they had to guess what was best and take the consequences if they were wrong. Generals Wayne, LaFayette, and Pulaski were rushing around doing the nation's business, but the Assemblymen had to keep the local candles burning.
The reason I bring that up is I have already been deluged with questionnaires and pamphlets, and hammered with what sound like muttered threats, from Issue Groups from all over the country. I'm not sure what the Sierra Club wants from a district that is sixteen feet above sea level. And I doubt if the New Jersey Assembly has much influence over the Alaska wildlife preserve or the possible bombing of Syria. I will be very happy to discuss such issues with all of you, but please don't expect me to have the slightest influence, even if I am elected. So these national interest groups are peddling things I don't plan to spend much time on. Please don't misunderstand. Many are worthy projects, they just don't have anything to do with the New Jersey Assembly, and they stir up animosities between me and other nice guys from Hackensack or Atlantic City which are a big source of the famously bitter partisanship you hear about.
In fact, there only three planks in my platform, and the rest of the time I plan to listen. The first, of course, is Medicine. Medicine and health insurance are state regulated, so I imagine I would be put on some medical or insurance committee where I have some experience to contribute.
The second is rebuilding the dunes along the shore. I've seen articles bitterly denouncing the use of the eminent domain, taking away the property of citizens without due recompense. Unfortunately, the State of New Jersey owns the beach, so there is no eminent domain involved unless someone has changed something. On the other side of it, I strongly disapprove of neighbors brow-beating each other about something they feel strongly about. Especially when I am afraid the ocean is going to take that beach away, all too soon. My position comes down to costs. If the dunes will probably bring in more tourist revenue than they cost, I would probably agree to take the risk. I go to the shore every summer, but I'm a renter. I never thought the risk of owning a house that blows away was worth it.
The third local issue is dredging the Delaware River. Jersey owns a side of both the Hudson and Delaware, so we are involved. The Chinese are spending heavily to widen the Panama Canal, eventually leading for Atlantic Coast ports. Delaware needs to be deepened to 45 feet, the Hudson to 50 feet. I have no objection to New Jersey supporting both of them, but I am told New York is holding up the Delaware dredging in order to let New York get finished first. And I have been told, but would scarcely believe, that some South Jersey politicians have been favoring the New York position in return for enhancing their own state-wide ambitions. If there is any truth to this, you can count on me to vote the other way.
When the Democrats select their candidate for President, I will probably have more to say about their plans for paying for healthcare. Currently, Mrs. Clinton is defending Obamacare for the primaries, implying that she leans toward "Single payer" for a permanent program. If she reverts to HMOs as she once did for Clintoncare, I will definitely have something to say. At the moment, however, Mr. Sanders of Vermont looks like a promising candidate, and he is unabashedly in favor of Single Payer.
And he is supported in this by Henry J. Aaron, the economist at the Brookings Institute who for many years was a consultant for the real cause of the cost problem, the employer-based system. Other economists, such as Paul Krugman, have emerged with the cost argument against Single Payer (i.e. Medicare for everyone) that has frustrated them ever since Single Payer has been under discussion. It costs too much. Obamacare has suffered from this criticism with a budget of SEVERAL trillion dollars for ten years, which might have been sustainable under ordinary circumstances, but threatens to capsize the national economy in the midst of the worst recession in eighty years. Kenneth E. Thorpe of Emory University estimates the total ten-year spending of Mr. Sanders at above thirty trillion dollars. That's somewhat between five and ten times as much as the Obamacare era.
To repeat a point made in other places, Medicare is currently the big budget-buster. For all the premiums and payroll deductions, Medicare is supported by a 50% subsidy from general funds. General funds will not support such a deficit, so recently we have been borrowing it from the Chinese government, through the mechanism of selling them U.S. Treasury bonds. Is that what we have in mind, when we talk about Single Payer?
In the usual funding and billing operation, the main concern is finding enough money to pay the balances. In this circular system, however, if a balance keeps going around and around for generations, it will eventually reach infinity. Anticipating this loophole, with the absolute certainty that someone will try to take advantage of it somehow, the laws of perpetuity provide that inheritances may only last a single lifetime, plus 21 years. The main concern, however, is to be sure there is enough money without pooling.
In this case, what individuals have available are sixty years duration(age 25-85), or 85 years if we start the clock at birth (0-85), and maybe 90 years if longevity inches up during the 90 years of a coming lifetime. Using the 7% in 10 years doubling rule, that's 9 doublings. Compounded quarterly, these age durations create a multiplier of the $400 we plan to donate, of 64x, 256x, and 512x, leading to contingency funds at death of $25,000, $102,000, or $205,000, respectively. Those are multipliers which surprise most people. Keeping the compound interest within present Medicare ranges just isn't enough, but $145,000 might scrape by, and $206,000 is quite comfortable for the purpose. The specified goal is to bequeath, donate or tax $18,000 to the designated grandchild, and $100,000 to Medicare as a last-year-of-life reinsurance transfer, all of which grew out of the original $400.
We compound 7% as an example because it's easy to double every ten years in your head, but 7% relates well to a century of large-cap common stock returns at 11% (re Ibbotson), less 3% inflation, less 1% more for overhead. And it correlates well with the mode for the last 50 years of the S&P, which comes to 6.6% (see my son George's calculations in the special index.) That's in the ballpark of what we seem to need. And remember, by doing this, the heaviest and most permanent expense of life (terminal care and death) has been transferred away from lifetime cost burdens, into Medicare. (Birth costs are not saving; they are merely transferred from the mother's account to the child's). For reasons we won't go into, reducing the volatility of buy-and-hold investments might lower their transaction cost somewhat.
Obviously, someone must be designated to watch this drama unfold, with latitude to make small mid-course corrections re-aiming it toward its goal. Eventually, Congress must reserve to itself the right to change the ground rules if serious miscalculations begin to appear. It may begin to fall short, which results in raising the initial donations. Or someone may figure out a way to game the system by overfunding it, turning it into a perpetual money machine.
For that rather vague goal, I advise adjusting the choke point at age 25. That's when childhood subsidy runs out and the adult funding for death begins; in a sense, it's the beginning of financial life. It fits the existing laws about perpetuity. Every dollar you change it, up or down, can have a leverage of roughly $300 at the time of the subscriber's death. Of course, there's such a thing as outright fraud, where you ultimately have to send someone to jail rather than allow him to topple the financial system.
Essentially what you would have done, is identify a safety buffer for first and last year of life insurance, with an approximate risk cost ($400), toward which we work as scientific advances slowly modify the rest. Any other surpluses go into the retirement fund for seniors, as healthcare surpluses appear. How long it will take to come into equilibrium is uncertain, but at least it's a plan. Leftovers from the first year of life gift from grandparent to grandchild will appear at birth, but shift over to the grandchild's own account at age 25. After that, he's on his own.
Current problems of financing health care, paying for indigent care, and the corollary issue of rising costs are fairly recent developments. Major changes in the health care system passage of the Medicare and Medicaid legislation, emergence of comprehensive health insurance, and tax-exempt financing of hospitals have had a profound impact in creating the situation facing this country today. The relationship of these events to the current crisis in the system and what business can do to change the situation are discussed below.
Indigent Care Before 1965
The old system of running hospitals evolved over two centuries and was based on a realistic recognition that most individuals were not generous with regard to charity. Operating a general hospital on voluntary contributions was not feasible and using and using public taxes to pay for indigent care was not popular with the electorate. But somehow the system worked by overcharging private, invoking the Robin Hood principle, and thus finding the means, however questionable, to finance this care. Further, the medical training system helped out by providing unpaid interns, residents, and nurses who delivered free care to those unable to pay.
One underlying principle made the system work. It was essential to keep down indigent medical costs or be bankrupted by these costs, but at the same time, there was the corresponding issue of providing equal indigent and private care. A significant disparity between these types of care would have made a mockery of this generosity.
Passage of Medicare/Medicaid
In 1965 the system changed and the federal government undertook to pay for indigent care. But more important, it undertook to pay for it at the prevailing middle-class standards of convenience and amenity.
While it is true that care has been extended to some previously underserved populations under these public health assistance programs, it is also a fact that since 1965 hospital rates have gone up 77 percent, which is an inflation of unit prices. Experience over the past 17 years, and particularly during more recent times of high inflation, has prompted reductions in Medicare/Medicaid benefits. As a nation, there seems to some rethinking on the financing of indigent care through taxes. Barring a return to the Robin Hood principle, society must decide exactly how it wishes to pay for such care in the future. Failure to act will lead to a regulatory response much worse than the existing system.
The use of hospital cost reimbursement has defeated efforts to hold down costs by utilization restraint. For example, under the PSRO program, if physicians succeeded in cutting blood counts in half, the result would be a doubling in price for each blood count.
Hospital utilization has, nevertheless, been decreasing since the mid-- 1970s. As utilization has gone down, in Philadelphia for example, total hospital costs to the community have escalated at double the general rate of inflation.
The number of hospital employees and their salaries have increased during the past 17 years. Improved technology and the need for more highly skilled and specialized personnel are partly to blame, but the existence of comprehensive insurance coverage to pay the bill has been an overriding factor in promoting carefree internal hospital expenditures.
Cost Shifting and Cross Subsidies
Through Blue Cross discounts, the federal government's less-than-equishare for Medicare/Medicaid payments, and arrangements of commercial insurance carriers, cost shifting and cross-subsidies have become characteristic of the way the hospital covers its costs, and more broadly, the way the entire insurance system has created the current crisis in health care financing. This situation conceals what services/procedures actually cost the hospital, what they but the individual, and what they cost the purchaser of the services.
By shifting the overhead costs, for example, patients who stay a long time usually subsidize patients who stay a short time, and patients who need laboratory work subsidize patients who don't. By using two different and unequal pricing systems, patients with commercial health insurance are made to subsidize patients Blue Cross and Medicare, and patients without any health insurance subsidize those who are insured.
Young people subsidize older people through paying the same premium but using less service. Ambulatory patients subsidize inpatients, and ambulatory care is thereby discouraged, with the result that care is provided in the more expensive setting. Through "community rating" of insurance premiums, patients in non-teaching hospitals subsidize those in teaching hospitals. By only permitting selective premium adjustments, some insurance commissioners have to it that subscribers in small groups subsidize individuals, non-group subscribers.
The income tax code extends a$27 billion exemption of health insurance fringe benefits to salaried employees that are not enjoyed by, and hence subsidized by self-employed and unemployed persons. Through coordination of benefits, the 30 million working couples in America receive only half the fringe benefits they think they are getting, so they are effectively subsidizing single-earner families.
This process extends even to the corporate stockholder level. For instance, stockholders of corporations are deprived of dividends to the extent that the company is overpaying for employee health insurance, and the customers of the company are also paying somewhat higher prices because of it. AS this affects international competitiveness, one could say that the big winners are the Japanese.
Capital Financing of Hospitals
Although this is a time of recession, many communities are constructing new wings to existing hospitals, building additional specialty units, and renovating buildings constructed only five to ten years ago.
BUilding costs are astronomical. A new 200-bed hospital will cost $70 million without cost overruns, but after 30 years of a 15 percent tax-exempt bond, the community will have paid $240 million for the structure. That is well over a million dollars per bed, most of which will be paid to banks, insurance companies, and other institutional investors. Over the 30 years, it can be conservatively estimated that the 200 beds will generate $2 billion in costs, half of which will be paid out in employee salaries. It is conservatively estimated that $200 million will be spent on administrative costs.
Hospital governance can be partially faulted for this situation. Trustees of the largest nonprofit hospital system have lost their concern with costs because society has become insulated from cost consequences by being overinsured, thereby falling victim to what is known as the "moral hazard of insurance." Since everyone is desperate to keep the government from exerting dominance over hospitals, which its financial contribution would normally entitle it to, administrators and providers have clung to the honorary trustee form of governance, for lack of a substitute. The consequence is that hospitals threaten to become employee benevolent societies, displaying a marked distaste for supervision.
Recommendations for Business
The foregoing situation increasing costs for Medicare/Medicaid, cost shifting and cross-subsidies, the moral hazard of insurance, and tax-exempt financing of hospitals present some challenges as well as opportunities for the private sector.
Although there are a number of options for business, overestimating its commitment is also a danger. In the nation's experiment with health planning, the community elected board of laymen to oversee the affairs of the local health systems agency. The laymen often quickly lost interest, and the most pressing problem often became the inability to achieve a quorum to conduct business. The original idea was that leaders in the business community would make the decisions. But in fact, the decisions were made by staff committed to perpetuating the organization, rather than advancing its mission.
Business is further cautioned against becoming involved in the minute details of the operation of hospitals and how physicians practice medicine. The medical literature includes 200,00 new articles a year: a challenge for the physician, an absurdity for the layman. Avoid being misled by so-called innovations and new trends in health service delivery. HMOs, for instance, appear to drastically reduce costs, but a more careful analysis will reveal problems of adverse risk selection.
Steps that business can take to change the system are:
* Search for ways to restore the market mechanism.
* Devise new ways to govern hospitals. Try splitting the board into a two-corporation entity. One board would be responsible for teaching, research and charity, and the endowment portfolio; the second would be responsible for running the business.
* Consider requiring that hospitals pay local property taxes; such a move might quell criticism that since the government pays half the costs of running hospitals, it should control them.
* Urge state and local governments to reassume for charity care. Because the federal government can print money, it has spent more on this item. Local and state governments would be more cautious in this regard.
* Offer employees several choices of health insurance, including plans with high deductibles and copayments.
* consider supporting a change in the tax laws to permit a health hardship exemption from tax and penalty for early withdrawals from IRAs. Such an exemption could then be used for payments of health insurance premiums.
Encourage Blue Cross to adopt higher copayments and deductibles. The intent of this is to eventually eliminate the cost reimbursement system.
Support a limitation on the tax-exempt status of employee health benefits.
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.
