PHILADELPHIA REFLECTIONS
The musings of a Philadelphia Physician who has served the community for six decades

274 Topics

Pearls on a String:Further Extending Health (and Retirement) Savings Accounts
Pearls on a String: Further Extending Health (and Retirement) Savings Accounts. HSAs are the string. Retirement saving, Privatizing Medicare, and Shifting Childhood Costs-- are the Pearls.

(3) Obamacare: Speeches
New topic 2015-09-25 21:48:47 description

Introduction: Surviving Health Costs to Retire: Health (and Retirement) Savings Accounts
New topic 2016-03-08 22:42:53 description

...Ratification, Bill of Rights and Other Amendments
The 1787 Constitution lacked a Bill of Rights. Few except Madison himself were opposed to adding one, but many other delegates would have failed election without promising it. Negotiations at the Convention had proved so excitingly innovative that time ran out before the Convention had to adjourn with only a promise of a Bill of Rights, first thing. Almost immediately, political America was thrown into a year of state ratification conventions. Massachusetts initiated the concept of ratifying the Constitution, attached with eight or nine amendment proposals for the Bill of Rights. When the First Congress finally convened, it faced almost two hundred proposed amendments, and Madison made sure he was chairman of a committee to deal with them. Practically alone he pared them down to a succinct twelve which survived as the first order of business of the new Congress. Almost unnoticed, he made a deal with Oliver Ellsworth the leader of the Senate, to pass the Bill of Rights in exchange for passing the Senate's Judiciary Act in the House of Representatives. Out of this combined beginning, the power and scope of the Judiciary Branch was born. But while that is a subject for later chapters, Madison never achieved a more skillful moment in his political life, than this pivotal one.

Right Angle Club: 2016
In progress.

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Re-funding Medicare, Part 2

So we end up funding Medicare mathematically, but with misgivings about the politics of it. It would not be the first time America has launched an adventure without the money to finance it, as we do almost every time we start a war, or face a depression. In fact, we have invented the term "existentual" to describe a threat of annihilation so grave its consequences must be shrugged off. But the fact that 70 million people died in recent wars does not suggest that approach was good planning. The factors which would lead America to embark on a financial crusade so radical are not to be found in mathematics, or even in one-man logic. They are cultural and emotional, evolving out of endless simplification and repetition.

How Would This Combined Approach Make Medicare Solvent? We have already explained, that on paper it works out. Most people do not trust their own judgment of complicated math, so we have made it simple. So, if it's simple, there must be a dozen other simple approaches. But if so, I cannot imagine them. It is surely not the case that every solution is either too complicated to understand, or too simple to be believable. Every grand proposal from Otto von Bismarck through the European systems, to Blue Cross/Blue Shield, followed by Harry Truman, Hillary Clinton's foray into HMO, to Barrack Obama's ACA, has proved to be overambitious at the beginning, and woefully inadequate at the end.

Like the rest of them, Medicare's original design has become so over-extended it has exhausted conventional approaches. Like any other proposal that might work, our own plan relies on approaches which are usually best avoided. So the first fundamental is to keep the core of it simple, but be willing to discard the embellishments as circumstances undermine them. The doctors should devise the medical choices, the patients must control the finances, paying only for what pleases them. Government has a limited role in market failures, but very little role in defining them. The goal is to eliminate disease, ultimately reducing its cost to a framework of the first year of life and the last year of life. Anything else must defend itself against an effort to eliminate it.

First of all, our own proposal depends on such long time periods that unexpected events would be the rule, not the exception. Many Congresses of many political parties would have to understand the basics and leave them unharmed for a century. Secondly, such huge amounts of money are involved that tampering, embezzling and fraud are not merely possible, but inevitable. These two problems would confront any reformer. From these two obstacles emerges a third one. Individual Health Accounts would have less risk than gigantic single payers, but inevitably some people will be stupid, reckless and venal. If you make up your mind in advance that you will rescue everyone who doesn't succeed, the whole system will be no better than a single gigantic reinsurer overseen by either an idiot or a crook. The opportunities for illegal gains will exceed the opportunities for honest managers. Therefore, smaller is better than bigger, simpler is better than complicated, and success is never guaranteed.

Medicare financing, possibly yes, retirement income, probably not. To do the quick math in your head, it is useful to remember money at 7% doubles in 10 years. Current interest rates do not achieve that, but current rates seldom do. During the eight years of the Obama administration, low-cost total market indices averaged 11% gain. Most people would never have guessed that outcome at the time. Much of it never reached the average stockholder because the finance industry absorbed it, but things seem to be changing quickly. The pharmaceutical industry may possibly be over-compensated, but we are proposing to make the average patient become an average stockholder, with some measure of participation. Let's take the four components of the proposal:

#1. The Contingency Fund. is designed to be overfunded for contingencies, so it is hard to say how much it should be. The most conservative investment period would terminate at death, but expand to whatever age is necessary, up to age 105. That means the $500 initial deposit never varies. Congress might, however, decide to vary the initial deposit but keep a shorter time period. It makes no mathematical difference, but its political difference might be considerable. Over time, a sweet spot should emerge.

#2. Delay Liquidating the HRSA at death. Although things get a little threadbare beyond this point, there is no reason to hold back borrowing for actuarial volatility. We are at the point in the compound interest curve where holding the funds for ten years after death would multiply the original subsidy by 128 instead of 64; even 256 is conceivable. We are paying the Chinese much less than that for the Treasury bonds, and they would probably be greatly relieved to see a way of recovering their investment. #2 may not sit very well with some people, but it would surely guarantee repayment. At the moment, repayment looks rather chancy.

#3. Investing the Pay as You Go. The problems created for others in the payment process have to be reckoned with. We propose the individuals continue pay/go temporarily for half of the withholding tax receipts, effectively unchanged because half the cost has been transferred but the withholding tax revenue remains constant. What is essentially involved is to balance the problems of the current bureaucratic staff against the problems of passing acceptable legislation. But once more, the mathematical "sweet spot" is comparatively easy to calculate, but the political effects are more intangible. It is probably impossible for an outsider to have a firm opinion.

Additional unknowns in this equation are how much nursing home costs from state Medicaid plans would eventually emerge in the form of Medicare deficits. It is common knowledge that although custodial costs are not allowable costs, states have found ways to make them a federal responsibility. We also understand the HRSA owner may get less than 7% income on his deposits. Although the Chinese debt would stop rising, past indebtedness remains unpaid. Current Medicare bills would have to be paid for probably another decade, and may well rise in size. Ultimately, the way to balance the books is to raise the contributions. So, privatizing Medicare might or might not make it costless, but would greatly relieve its present costs. Funding of retirements will have to come from other sources. However, right now contributions from the two contingency funds could easily be increased.

#4. The Last Four Years of Life Half of Medicare costs appear in the last four years of Life. By reimbursing Medicare for the last four years from other sources, Medicare's average cost is cut in half. but the withholding tax remains the same. Therefore, we come closer to breaking even in several decades, although we still probably won't quite make it.

#5. Simplicity, Simplicity. To begin with the opposite of simplicity, two quite unacceptable new ways to manage the medical payment system suggest themselves. One alternative is to consolidate the whole industry, with one corporate administrative arm assuming the payment tasks for everybody, along with the whole delivery system. That scarcely seems appropriate management for a health complex which is already too big to manage. But it seems to generate many current proposals, especially those coming from the bureaucracy itself. Another idea, based on its resemblance to whole-life insurance, proposes a giant company or government department to concentrate on health finance, doing it for everybody. It might seem suitable for an insurance company, a medical school, a computer company, or a medical society. That seems to be what these organizations would like, but it immediately creates additional complexity, because computers only work if you specify some response to every contingency in advance. In a sense, this version of "Single Payer" would be a throw-back in thinking to the days when only a big company or a big government could afford to own a computer.

Is medical finance really so complicated most people couldn't handle it by themselves? Let's remember the anguished words of the Tzar: "I don't run Russia. Ten thousand clerks run Russia." What the Tsar was saying, was the problem isn't individual complexity, the problem is the huge volume of simple problems. For example, if we proposed to butter everybody's bread, it wouldn't be hard to do, it would be hard to manage.

{top quote}
Is medical finance really so complicated most people couldn't handle it by themselves? {bottom quote}
For Health and Retirement Savings Accounts, Transfer Slips, and Monthly statements, Only. So, yes and no to computers, which is what all this amounts to. Abundant cheap computers tempt us to use them for simple tasks, at the risk of making the simple task complex. (In another generation, self-correcting code may correct this problem, at the same time it widens the opportunity for vandals.) The proposal made here instead, is a confederation of otherwise free-standing organizations (The Pearls), hiring their own experts, feeding into a common channel of Health Savings Accounts owned by individual patients (The String). Individuals could hire consultants if they pleased but the decisions should be so simple the average high school graduate could cope with them.
One standardized lifetime account form, which serves as a transfer system for a single person's various balances. Sort of like a lifetime check-book. It provides a common incentive to be frugal for future retirement, and a common way to multiply such savings.
If that won't suffice for some tasks, we are travelling down the same path as the income tax, and should re-consider such high-handedness.

There might be many networks, as long as their balances are uniformly transferable and they each link ultimately to a transferable retirement fund (The Goal) and a transferable investment fund (The Multiplier). Such networks might grow very large, but still remain quite simple, and decisions which belong to the patient would remain within his control. The only outward purpose of such paperwork would be to transfer credits of the owner to debits of the same owner or vice versa, with the adjusted balance ultimately coming to rest in his retirement account, creating a common incentive to be medically frugal. They would maintain adequate records (which mostly no one ever reads), an information source, and a designated HSA representative, but their outward form and purpose would remain a transfer slip. If you want a simple system, give it to individuals who have an incentive to keep it simple. Don't give it to people who have an incentive to make it complicated.

{top quote}
If you want a simple system, give it to individuals who have an incentive to keep it simple. {bottom quote}
This particular feature has a political element. The American public now imagines it gets a bargain with Medicare, somehow getting a dollar of healthcare for fifty cents, and therefore a treasure they are unwilling to surrender. In all probability, no organization except the government could participate long with such a deficit, so taking the deficit away from the government necessarily places it in the hands of someone who must balance his books. Somehow, legal protections for the patients against the debts of organizations which participate in the confederation must be established, so they can occasionally provide benefits at a loss, but only within stated limits. Called a "loss leader", the situation is a common one, but the effect is quite different from making the government a payer of last resort. Two additional savings multipliers must be added, although they will be explained shortly, along with two important investment designs.

Investment Mechanisms.We promised to discuss two investment mechanisms which might help matters. The first is the tendency of compound interest to rise with time. We have already shown above that adding another decade to the example will have an exaggerated effect on the outcome. This is an inherant quality of compound interest which crept up on us as science has conquered early death, and should have wide application in the future. As we learn how to avoid borrowing and learn how to be successful creditors, it should become a commonplace to rearrange financing to optimize it.

The second new model is index investing. As international borrowing has vastly increased the money supply, interest rates seem to have settled at a new low. Bonds have always been a zero-sum investment, but recent trends seem to set a new lower boundary. Common stock has more risk and volatility, but John Bogle and others have shown that it is practically useless for an ordinary person to buy anything but total-market common-stock index funds ("passive investing"), since the fees charged by intermediaries tend to wipe out the profit from active investing. We recommend a heavy emphasis on this method. Beyond that basic approach, other strategies may be considered as a way to add fractions of a percent to total returns, best avoided by people without experience, or lifetime years to recover from investment misjudgments.

In Final Summary of Privatizing Medicare. Even with considerable twisting, Medicare is so underfunded, no way can be found to self-fund it without adding two to five hundred dollars per person as a pump-primer. That's a great bargain compared with a hundred thousand dollars of medical care later, or course, but it will meet far more resistance than five hundred dollars is worth. Even then, it would require forty or fifty years at the most optimistic to show a profit. In the Pearls on a String concept, the deficit might be made up by surplus generated by other programs, but Congress is unlikely to be able to identify such a donor. The Affordable Care Act does not look as though it is going to generate a surplus, for example.


Medicare: 80 Percent of a Pearl on the String

Now that we have described Health Savings Accounts as the string linking a string of pearls, it is time to examine the pearls, one by one. For this we start with Medicare which seems politically invulnerable, but is actually in such precarious financial condition, it threatens normal mechanisms of rescue. For example, supplemental insurance. Medicare reduces its responsibility to paying only 80% of its costs through adding a 20% co-payment feature. Most people then try to carry "supplementary coinsurance" for the remaining 20%, but a lot of them can't afford it.

Consequently, such people fall back on Medicaid coverage for the difference, and get misleadingly described as "dual eligibles", because they can't completely afford Medicare -- and Medicare can't afford to subsidize them. They migrate from 50% State responsibility to greater federal responsibility, but technically not to full Medicare obligation. In ordinary commercial transactions, a 20% copayment represents 20% of whatever may be true for the entirety. But Medicare runs a 50% deficit financed by debt, so it is possible to describe the co-insurance as covering 40% of Medicare revenue but none of its debt. The proportion borne by supplemental coinsurance is thus considerably leveraged against non-government insurance companies who must balance their books. Eventually, this leverage is what might threaten ACA with ruin, but that issue gets us off the topic of Medicare. We only talk in this section about the 80% (current cost, net of prior debts) and return to the 20% in the following section, as if supplemental insurance were a separate pearl along the string. It isn't exactly separate, but obeys different rules.

If we were commercial insurancemen dealing with a failing health insurance partner, no additional money infusions would seem sensible until Medicare stopped losing so much money. Because it is the government, however, we must resort to the stance that a new program does not have to accept old debts, only new ones that it had a hand in creating. Therefore, this proposal does not include the repayment of old debts, regarding them as the government's problem to resolve. In many ways, Medicare was a noble achievement, but even the richest country in the world cannot afford to run a 50% deficit indefinitely, in an entitlement program grown so large. Undertaking to correct its mistakes does not imply assuming its debts. Furthermore looking forward, a looming retirement funding crisis, of at least equal size, threatens to replace it as the largest consequence of its heedlessness. Was this lengthening of longevity by thirty years a bad thing? Of course not. The bad thing was to let finances get into their present state before addressing them. The bad thing was to kick the can down the road, for fifty years. Because so few people seem to understand them, let's next review a quick summary of Medicare finances.

The Basic Funding Structure of Medicare. Approximately one quarter of Medicare is paid for by its premiums, often derived from reduced Social Security payments, (a circular solution, if you regard prolonged longevity as a hidden cost of Medicare). Another quarter of Medicare is paid for by a 3% payroll withholding tax on younger, working people. (Unfortunately, this money is immediately spent, in a process quaintly known as "pay as you go"). And finally, half of Medicare income isn't paid for at all, it's just indebtedness , initially paid for out of general taxation and then floated away by bond issues.

Suggested Solutions:

1. Extract Income From the Float. To attack the problem we probably need to do many complicated things, but the first step is pretty simple. We suggest a transfer-entrant into this program be required to sign an authorization to redirect payments for Medicare cost on his behalf to his own Health Savings Account. From his point of view, nothing changes except the postal address of his payments. If he is between the age of 25 and 65, his withholding tax is so directed; if he is already on Medicare, it is his Medicare premiums. That's a payment stream which stretches sixty years, overall. Depending on his present age, first it is one, and eventually it is the other. That wasn't so hard, was it?

The money now starts to earn investment income, which is new money for the program, with the surplus eventually going through the Health (and Retirement) Savings Account into retirement funds. One way of looking at this rearrangement is to say the beneficiary has been given the money to pay the bills, but relieved of the obligation to pay old debts. He has also been given latitude to invest the income and use the profit to fund his retirement. What does the government get out of it? It potentially gets an end to annual increases in debt, plus the hope the retirement incentive will restrain cost escalation. If you wish, you could say the principal value to the government is creating the incentive at the end of the program. Meanwhile both parties can pray that science will reduce future medical costs, not raise them. But however it turns out, the patients are annually $39 billion better off.

It may seem a disappointment that an effort so politically strenuous only aims to prevent future debt from rising. However, it is no mean achievement to reduce future cost escalation by 7%, or approximately $39 billion per year. Perhaps a better way to put it would be to state what a pity it is that an annual revenue increase of $39 billion is only sufficient to keep things from getting worse. Even that much promise is fragile. It depends on government projections of future costs, a return of 7% investment income (probably from low-cost total market stock index funds.) It also depends on forty years of income from 3% of payroll withholdings, followed by twenty years of current Medicare premiums. With luck, the Medicare premiums could be paid directly into Social Security, but this is by no means certain.

It is too much to calculate the variable deposits during the transition, even though the program has been in existence long enough to reach a steady state of young people entering and older people leaving. (A voluntary transition implies unpredictable proportions will elect to leave it in any given year). But it does seem reasonable to suppose that somewhere during the transition, Medicare costs would stop rising. This modest goal of price stability would not make much change in people's lives, but it might help stabilize Medicare costs. Any financial reduction beyond that, would result from subscribers responding to the incentive to be frugal medical shoppers, since further deposits up to the statutory limit would enjoy a considerable tax advantage. That is, it reinforces the incentive to be frugal with Medicare. The experience with Health Savings Accounts suggests this incentive is more powerful than it seems.

Additional Proposals to Supplement Medicare Income. Since Medicare is so underfunded, the hope of extracting additional income above 7% is pretty dim. Therefore, the hope of more cost abatement must come from three other proposals, all of which require the investment of fresh funding. That is, they are investments, not miracles:

2. The Second J-Shaped Curve, Within Medicare. All healthcare costs with the exception of premature birth, genetic disorders and the like, are migrating to older age groups. One of the main sources of disruption is the migration of costs from working people to people on Medicare.

But within Medicare, costs are also migrating into later life. Half of Medicare costs are paid on behalf of the last four years of someone's life. Since Medicare extends about twenty years after retirement, half of total Medicare cost would vanish from its annual budget as a result of placing this burden somewhere else. This might be called the Last Four Years of Life Reinsurance, a component of the First and Last Years of Life reconstruction of healthcare finance, to be described later. The consequence is funding half forward, half backward, and so reducing the transition time. That's the background.

But death is the end of the line; costs can't get pushed any later, but curiously, revenue just might be. Therefore, the unique features for transitioning Medicare to some other system reside not only in the universality, but the finality of the cost of terminal care. This entity has a soft lower border, but we know that half of medicare costs are concentrated in the last four years of life, creating a simple surrogate. Paying this cost separately allows the remaining cost of Medicare to be cut in half, by spreading it over the remaining sixteen years. Transition time is also halfed. Moreover, smaller pieces are considerably easier to fit into a transition scheme, so the ultimate product fits the cost curve more comfortably. By the way, the last years of life are not the same as the last years of Medicare, and can only be calculated in retrospect, after the death of the individual.. This is the reality which requires one insurance to be paid as costs are incurred, and a second, re-insurance, to repay the first one after the facts are in.

3. Contingency Fund. But wherever is this money, half the cost of Medicare, to come from? Terminal care is predictable the day you are born, so you might as well fund it when it is cheap. A separate fund could be imagined, but for simplicity we lump terminal care financing into a general contingency fund. So we next propose to complete the Medicare revenue issue by adding a contingency fund, essentially substituting a subsidy of $1 at birth for a deficit sixty times as large at age 65. (It may well require about $100 up front.) How fast it would actually grow in the intervening 65 years would become evident before then, and appropriate adjustments made, but the person or agency to make the decision should be specified with care. The sixty to one estimate comes from 7% doubling principal every ten years, 2,4,8, 16, 32, 64 doublings in sixty years. How much to begin with is the last step, adjusted to balance the books as experience gathers to improve this estimate.

4. Extended Contingency Fund. The contingency fund ending when Medicare begins might generate a 64 to one magnification of the initial deposit. However, it could extend tor 250 to one if its boundary were the day of average death (now 84) or 1000 to one if it added 21 years to the date of death and ended where the common law now says a perpetuity begins (one lifetime plus 21 years). Innovations of this sort make many people squirm, but the underfinancing of Medicare in the past leaves little opportunity for conventionality in the future. All of this magic is a function of the mathematics of compound interest; objections to it are sociological, not mathematical. With a leverage of 1000 to one, it is difficult to imagine an inability to pay the front-end $100, when $100,000 is so far in excess of what actually seems needed.

Sweeping proposals of this sort however, do tend to dump their problems at the far end, so the ultimate goal is best stated to be funding part of the individual system backward and still having a contingency fund for safety. That is, the system as a whole may be volatile and require internal borrowing, but each individual HRSA ends up with balanced books. By implication rather than calculation, in ninety or so years, you get rid of the Medicare debt. That's approximately how long it took to create it, too. The system does not "cover" retirement, except perhaps for bare-bones Social Security. It merely closes the individual books after death as described in other sections. Last-Year Coverage is also designed to save money, and thus eventually to generate some funds for retirement, but not likely at first. First and Last Year re-insurance is intended to resemble an accordion, quickly going to the first 25 years of life and the last 4 years of life, then slowly adding other years in the middle. Somewhere along the line, it might even shrink somewhat. At the moment, it appears terminal illness usually lasts four years, a process which might be thought of as "breaking the cocoon of health". Half of Medicare expenditure occurs in the last four years of life, leaving quite a surplus when the other sixteen years of cost are redistributed. In any event, the "accordion" effect is available for use in the transitions.

This completes our proposal for refinancing Medicare. It reduces itself to stabilizing cost increases by first investing the float created by the J-shaped cost curve, combined with cutting forward-financing loose from the debts of the past. Even a program allowed to concentrate on its 50% forward shortfall, must employ some novel approaches to produce annually $250-300 billion in either cost cuts or new revenue. We suggest compound interest is entirely possible to achieve it mathematically by making a total stock market investment starting at birth and continuing to death, or even 21 years after death. All that is necessary to do it on paper is to invest sufficient money at first. Unfortunately, there is an invisible limit to how much the populace is willing to tolerate as an investment, even on such bargain-basement terms, which I postulate to be about $500 per newborn child. Will that suffice for a 65-year investment? Possibly. Will a hundred-year investment cover it? Almost certainly. Do we as a nation have the patience for a hundred-year investment, or the degree of honesty in our agents to leave such huge amounts un-pilfered for a century? That's far less certain.

How Would This Combined Approach Make Medicare Solvent? Medicare has become so over-extended that conventional approaches have been exhausted. Like any other proposal that might work, this one relies on approaches which are usually best avoided. First of all, it depends on such long time periods that unexpected events would be the rule, not the exception. Many Congresses of many political parties would have to understand it and leave it unharmed for a century. Secondly, such huge amounts of money are involved that tampering, embezzling and fraud are not merely possible, but inevitable. These two problems would confront any reformer. From these two obstacles emerges a third one. Individual Health Accounts would have less risk than gigantic single payers, but some people will be stupid, reckless and venal. If you make up your mind in advance that you will rescue everyone who doesn't succeed, the whole system will be no better than a single gigantic reinsurer overseen by either an idiot or a crook. The opportunities for illegal gains will exceed the opportunities for honest managers. Therefore, smaller is better than bigger, simpler is better than complicated, and success is never guaranteed.

Medicare, possibly yes, retirement income, probably not. To do the quick math in your head, it is useful to remember money at 7% doubles in 10 years. Current interest rates do not achieve that, but current rates seldom do. During the eight years of the Obama administration, low-cost total market indices averaged 11% gain. Much of this never reached the average stockholder because the finance industry absorbed it, but things seem to be changing quickly. The pharmaceutical industry may possibly be over-represented, but we are proposing to make the average patient become an average stockholder Let's take the four components:

#1. The Contingency Fund. is designed to be overfunded for contingencies, so it is hard to say how much it should be. The most conservative investment period would terminate at death, but expand to whatever age is necessary, up to age 105. That means the $500 initial deposit never varies. Congress might however decide to vary the initial deposit but keep a shorter time period. It makes no mathematical difference, but its political difference might be considerable. .

#2. Delay Liquidating the HRSA at death. Although things get a little threadbare beyond this point, there is no reason to hold back borrowing for a purpose. We are at the point in the compound interest curve that holding the funds for ten years after death would multiply the original subsidy by 128 instead of 64. We are paying the Chinese much less than that for the Treasury bonds, and they would probably be greatly relieved to see a way of recovering their investment. #4 may not sit very well with some people, but it would surely guarantee repayment. At the moment, repayment looks rather doubtful.

#3. Investing the Pay as You Go. The problems created for others in the payment process have to be reckoned with. We propose the individuals continue pay/go temporarily for half of the withholding tax receipts, effectively unchanged because half the cost has been transferred but the withholding tax revenue remains constant. What is essentially involved is to balance the problems of the current staff against the problems of passing acceptable legislation. But once more, the mathematical "sweet spot" is comparatively easy to calculate, but the political effects are more intangible. It is probably impossible for an outsider to have a firm opinion.

Additional unknowns in this equation are how much nursing home costs from state Medicaid plans would eventually emerge as Medicare deficits. It is common knowledge that although custodial costs are not allowable costs, states have found ways to make them a federal responsibility. We also understand the HRSA owner may get less than 7% income on his deposits. Although the Chinese debt would stop rising, past indebtedness remains unpaid. Current Medicare bills would have to be paid for probably another decade, and may well rise in size. Ultimately, the way to balance the books is to raise the contributions. So, privatizing Medicare might or might not make it costless, but would greatly relieve its present costs. Funding of retirements will have to come from other sources. However, contributions from the two contingency funds could easily be increased.

#4. The Last Four Years of Life Half of Medicare costs appear in the last four years of Life. By reimbursing Medicare for the last four years from other sources, Medicare's average cost is cut in half. but the withholding tax remains the same. Therefore, we come closer to breaking even in several decades, although we probably won't quite make it.

#5. Simplicity, Simplicity. To begin with the opposite of simplicity, two quite unacceptable new ways to manage the medical payment system suggest themselves. One alternative is to consolidate the whole industry, with one corporate administrative arm assuming the payment tasks for everybody, along with the whole delivery system. That scarcely seems appropriate management for a health complex which is already too big to manage. But it seems to generate many current proposals, especially those coming from the bureaucracy itself. Another idea, based on its resemblance to whole-life insurance, proposes a giant company or government department to concentrate on health finance, doing it for everybody. It might seem suitable for an insurance company, a medical school, a computer company, or a medical society. That seems to be what these organizations would like, but it immediately creates additional complexity, because computers only work if you specify some response to every contingency in advance. In a sense, this version of "Single Payer" would be a throw-back to the days when only a big company or a big government could afford to own a computer.

Is medical finance really so complicated most people couldn't handle it by themselves? Let's remember the anguished words of the Tzar: "I don't run Russia. Ten thousand clerks run Russia." What the Tsar was saying, was the problem isn't individual complexity, the problem is the huge volume of simple problems. For example, if we proposed to butter everybody's bread, it wouldn't be hard to do, it would be hard to manage.

{top quote}
Is medical finance really so complicated most people couldn't handle it by themselves? {bottom quote}
Transfer Slips, and Monthly statements, Only. So, yes and no to computers, which what all this amounts to. Abundant cheap computers tempt us to use them for simple tasks, at the risk of making the simple task complex. (In another generation, self-correcting code may correct this problem, at the same time it widens the opportunity for vandals.) The proposal made here instead is a confederation of otherwise free-standing organizations (The Pearls), hiring their own experts, feeding into a common channel of Health Savings Accounts owned by individual patients (The String). Individuals could hire consultants if they pleased but the decisions should be so simple the average high school graduate could cope with them.
One standardized lifetime account form, which serves as a transfer system for a single person's various balances. Sort of like a check-book. It provides a common incentive to be frugal for future retirement, and a common way to multiply such savings.
If that won't suffice for some tasks, we are travelling down the same path as the income tax, and should re-consider such high-handedness.

There might be many networks, as long as their balances are uniformly transferable and they each link ultimately to a transferable retirement fund (The Goal) and a transferable investment fund (The Multiplier). Such networks might grow very large, but still remain quite simple, and decisions which belong to the patient would remain within his control. The only outward purpose of such paperwork would be to transfer credits of the owner to debits of the same owner or vice versa, with the adjusted balance ultimately coming to rest in his retirement account, creating a common incentive to be medically frugal. They would maintain adequate records (which mostly no one ever reads), an information source, and a designated HSA representative, but their outward form and purpose would remain a transfer slip. If you want a simple system, give it to individuals who have an incentive to keep it simple. Don't give it to people who have an incentive to make it complicated.

{top quote}
If you want a simple system, give it to individuals who have an incentive to keep it simple. {bottom quote}
This particular feature has a political element. The American public now imagines it gets a bargain with Medicare, somehow getting a dollar of healthcare for fifty cents, and therefore a treasure they are unwilling to surrender. In all probability, no organization except the government could participate long with such a deficit, so taking the deficit away from the government necessarily places it in the hands of someone who must balance his books. Somehow, legal protections for the patients against the debts of organizations which participate in the confederation must be established, so they can occasionally provide benefits at a loss, but only within stated limits. Called a "loss leader", the situation is a common one. Two additional savings multipliers must be added, although they will be explained shortly, along with two important investment designs. There are four large sources of new revenue within Medicare:

Investment Mechanisms.We promised to discuss two investment mechanisms which might help matters. The first is the tendency of compound interest to rise with time. We have already shown above that adding another decade to the example will have an exaggerated effect on the outcome. This is an inherant quality of compound interest which crept up on us as science has conquered early death, and should have wide application in the future. As we learn how to avoid borrowing and learn how to be successful creditors, it should become a commonplace to rearrange financing to optimize it.

The second new model is index investing. As international borrowing has vastly increased the money supply, interest rates seem to have settled at a new low. Bonds have always been a zero-sum investment, but recent trends seem to set a new lower boundary. Common stock has more risk and volatility, but John Bogle and others have shown that it is practically useless for an ordinary person to buy anything but total-market common-stock index funds, since the fees charged by intermediaries wipe out any profit from active investing. We recommend a heavy emphasis on this method. Beyond that basic approach, other strategies may be considered as a way to add fractions of a percent to total returns, best avoided by people without experience, or lifetime years to recover from investment misjudgments.

In Final Summary of Privatizing Medicare. Even with considerable twisting, Medicare is so underfunded, no way can be found to self-fund it without adding two to five hundred dollars per person as a pump-primer. That's a great bargain, or course, but it will meet far more resistance than five hundred dollars is worth. Even then, it would require forty or fifty years at the most optimistic. In the Pearls on a String concept, the deficit might be made up by surplus generated by other programs, but it is unlikely to be able to identify such a donor. The Affordable Care Act does not look as though it is going to generate a surplus, for example.


Medicare: Restating Mathematics for a Social Goal.

It's hard to believe any problem could be too big to solve, just as it boggles the mind to think of a corporation too big to fail. But if we say the same thing often enough, we come to believe it. People who tell you Medicare is the third rail of politics, are mostly telling you they hope so.

Lyndon Johnson, Wilbur Cohen and Bill Kissick did indeed bite off more than they could chew, but Medicare really isn't that complicated. It amounts to taking the employer-based health system floating on an enormous tax deduction, and substituting three ways to pay for it. The first was to charge premiums to the old folks, which wasn't enough, only covering about a quarter of the cost. The second was to apply a 3% wage tax to younger working people, called a payroll withholding tax, which prepaid another quarter of it, by means of a gimmick called "Pay as you go". And the third, which amounted to half the cost, was supplied by taxes. The year 1965 was the time when the post-war balance of American payments turned from positive to negative, and there was something called the Vietnam War to be paid for.

So after a while the national budget had to be borrowed, and after the manner of governments, it was borrowed by selling bonds. The largest purchaser of 10-year treasury bonds is China. So, in a general sort of way, half of Medicare is borrowed from the Chinese, and half is paid for by the clients. The debt service is temporarily bearable, but eventually it must be confronted, and China may have to choose between absorbing the costs or going to war. Our own choice is between kicking the can further down the road, or having the confrontation right now. That is to say, right now there is time for a long-term peaceful solution, but if we delay much more, that option will disappear.

I don't plan to run for office, so let me make a proposal. Instead of continuing the pay as you go system, the withholding tax receipts should be deposited into the Health Savings Accounts of individual citizens who earned them. They should be invested into inexpensive total stock market index funds, redeemable on the employee's 65th birthday or whenever he joins Medicare. That is, redeemable by Medicare, with the residual redeemable at the death of the subscriber. The wage owner would scarcely feel the difference, but the growth of the funds would be substantial. With luck, it would pay for Medicare's deficit of 50%, putting a permanent end to Chinese borrowing, but probably not much more. It would not, for example, pay for existing debt, or retirement costs. Remember, retirement costs are legitimately regarded as a natural outgrowth of Medicare's prolongation of longevity.

The invisible costs of Medicare would eventually be paid for in two other ways: the J-shaped costs of Medicare in the last four years of life, and the contingency fund.

J-Shaped Curve All healthcare costs with the exception of premature birth, genetic disorders and the like, are migrating to older age groups. One of the main causes of disruption is the migration of costs from working people to people on Medicare. But within Medicare, costs are also migrating later in life. Half of Medicare costs are paid for the last four years of life. Since Medicare extends twenty years and growing, half of total Medicare cost would disappear as a result of lifting this burden and placing it somewhere else. This is called the Last Four Years of Life Reinsurance, one component of the First and Last Years of Life reconstruction of healthcare finance. It will be discussed separately in later sections of this book, but a vital point is removing the cost of the last four years of life, which constitute half of Medicare cost. The consequence is to cut the remaining cost of Medicare in half, potentially funding half forward, half backward.

The Contingency Fund at Birth. And the half which is funded forward can be further reduced by investing at birth and earning investment income for eighty years. By adding the withholding tax receipts from age 25-65, the combined fund can probably pay for Medicare. Just to be certain, a contingency fund could be added at birth, amounting to around $100 at birth and growing to $25,600 at age 80, or other variations of the 256 to one ratio. We have alluded to this concept in other areas. Its power concentrates in the nature of interest rates as well as principal to concentrate at the end of a debt. That is, they rise at the end, and prolonged longevity takes advantage of this fact, parallel to the tendency of healthcare costs to rise at the end of life.

For the purpose of the reader following this without a calculator, take the happenstance that money invested at 7% will double in ten years. In nine ten-year periods of extended longevity, money will have nine doublings (90 years). Follow the bouncing ball: 2,4,8,16,32,64,128,256, 512. In ninety years, a dollar turns into 512 dollars. If the family of a newborn, or in the case of poverty the government, deposits a dollar at birth there is a 500-fold increase at death at 90. There is no sense in being more precise about all the variables in a century, and many people are more skillful than I in manipulating them. But if to this is added another doubling, the ratio becomes 1024 to one, achieved by not liquidating the fund until ten years after the death of the owner. (This feature is added as a safety-valve.)But after the most sophisticated manipulation, it is safe to predict this outcome: The revenue would exceed the need in the last four years of life, even if the seed money turned out to be a hundred times the dollar postulated in the example. There would almost surely be money left over at the end, which might be used to supplement Social Security, although we suggest funding children as preferable during the transition phase.

So that's how you could restore Medicare to some sort of solvency, plus something left over for other purposes.


Diagnosis Based Payment: A Warning

I was sitting in the Congressional hearing room when it happened. A proposal was made to Congress in 1983 that instead of paying hospitals for each step of treatment, they should be paid by the diagnosis, and Congress soon agreed to the idea for Medicare. This system was to be limited to helpless inpatients. This idea had some good features: if a patient had to be fed with a spoon, he had little interest in the cost of his treatments. Market mechanisms would never restrain the cost of hospitalized patients. If they were anaesthetized, it was even more true.

{top quote}
DRG: An Object Lesson for Control Freaks {bottom quote}
The problem was putting a price on thousands, even millions, of diagnoses with enough difference in cost to warrant a code number. The fifty year-old coding system of the AMA, called Standard Nomenclature of Diseases and Operations had room for a hundred million diagnosis codes, of which perhaps two million were in use. It was useful in the days when hospitals and Natural Science museums were much alike, cataloging and classifying different objects. But the record librarians were in a position to see what their main activity was really like, it was gathering the various pieces of previous admissions in order to be useful in managing a new episode for an individual. For this, a new code was more useful: the International Classification of Diseases, which reduced the number of diagnoses in practical use to about a thousand. When greater detail was needed, it was simpler just to look it up, and librarians knew very few except pathologists did that. So hospitals were ordered by accrediting bodies to use ICD coding, and save administrative costs. After Congress made its payment decision, a committee was formed to cut the thousand down to two hundred with similar payments, and lo, the DRG (Diagnosis-Related Groups) were created. All hospital inpatients were assigned one of two hundred codes, within which the size of the payment was a dominant sorting feature. Before long, patients were charged one of two hundred prices. The pathologists objected, and produced their own modernized coding system, SNOMed. Forget it, it was too much work, cost too much, it was too hard.

So in this way, by arranging the assignment of costs to codes, Medicare and the hospital coding clerks took over the job of pricing, no doctor understood what in the world they were doing. And by steps familiar to accountants, the DRG was enlarged back to a thousand codes and arranged to come out paying the hospital a 2% profit margin for inpatients. Since we were running a 3% inflation at the time, the push was on to treat patients as out patients. No matter how many tests, no matter how long he stayed, the DRG came out to produce a 2% profit margin. Meanwhile, interest rates were low, and outpatient buildings were cheap. Pretty soon, hospitals were paying doctors above-market prices to fill the outpatient area. There's more to say, but the idea is clear. Once you find a rationing tool, the accountants are in charge, the doctors were out, and eventually would be really out. And the beauty of it was, no one understood what was happening, or who did it.


Social Politics

After the Second World War, the medical costs of children were small enough to be written off cheerfully. We entered an era of lavish gifts to children's hospitals, probably prompted in part by the memory of obstetrical write-offs. Many of these gifts paid for research costs, but part of them went for rather lavish hospital facilities, making it impractical to consider recovering the losses of the past. In all this uproar there was room to develop a credit system, but our mind-set had been changed. Primarily, the child was not legally responsible for the debts. From the point of view of the indigent mother, her only recourse was to disappear from sight. If she had several children, it was beyond her imagination. As it still would be today, in many cases. If we had taken the legal position that half of those costs were the responsibility of the child, they at least would not have multiplied within a multi-child family, so the prospect of a hopeless situation might not appear so soon.

Equal Pay for Equal Work(?) The same problem now surfaces when the girl first applies for a job with health benefits. She is of an age group with trivial medical costs on average, except for pregnancy and all its associated costs. Her premium cost is high, a similar male's would be quite low. Even with considerable cost-shifting, the male is a cheaper employee. In fact, males can easily take their chances on being uninsured, while females would be terrified of being uninsured. It is not going too far to suggest the whole configuration of employer-based health insurance is a result of trying to patch up this situation, working with what you have. I believe the whole system of employer-based health insurance would not have got so advanced and intractable, but for lack of alternative to this patchwork. After all, a rationalization of this issue by male-female pooling would not affect the employer, the tax deduction would be the same for him in any case. For people in marginal finances, there is too little flexibility to provide room for gradual work-arounds, and the employer generally has other things on his mind. It might take ten years to show an effect, but a system of re-assigning personal responsibility on a legal level, is the first step in taking risks with a benefit program. Let's summarize it this way: health insurance up to age 40 is insuring obstetrics plus the risk of getting sick. After age 40, it becomes less a matter of risk, and more a matter of reimbursing actual health costs. Obstetrics needs to be taken out of this equation, and the cheapest way to do it is through a hundred dollars added to the contingency fund of an HSA at the time of a birth, but that's a later step.

Mandates do get immediate attention, but the distraction often makes evasion of mandate seem a quicker route to savings than slow, steady efficiency improvement. We invite the reader to revisit the major advantages of incentives over rigid mandates. In particular, the concentration of medical care into the end of life permits idle income to be invested, creating wholly new revenue in the meantime, and making less borrowing cost necessary. Potentially, savings might be doubled by reversing some borrowers and lenders. Contrariwise, the limitation of government revenue to taxation and borrowing lowers interest rates, ultimately favoring inflation of medical costs. That's just supply and demand. It's not unusually true of healthcare financing, and we don't advocate changing it. It's just a fact we might as well use to general advantage in health insurance re-design.

Equity Investing Within IRAs. Workers tend to overvalue labor and undervalue risk-taking, so they use their voting power to force interest rates down by increasing government debt. As a consequence, interest rates are generally too low, and debt levels too high, even though demographics are now forcing nearly everybody to become an investor for his old age. Ruminations along these lines suggest a more efficient balance results from increased equity investing by everyone, regardless of how he earns his primary living. Medical care is just an example of a consumer necessity, big enough (18 % of GDP) to bend the curve back to commodity levels without undue resistance. If the topic became hula hoops, these ideas probably wouldn't work, because people would simply eliminate hula hoops. And by the way, by "equity" investing we mean the use of total market index funds, not direct investing in companies themselves.

We previously calculated passive investment of healthcare payment float returning 7.5% might do the entire job, of reaching a lifetime individual health cost averaging $300,000 in year 2000 dollars, without private supplements. It's another way of saying equity investing could reduce costs on average by $200,000 per lifetime. But that's on average, and people get sick in bad market years, too. If you want to do it all without supplements or subsidies, you must increase the interest return, engage in risky investment, or reduce the lifetime medical cost with research. But the investing approach promises to make a substantial improvement without affecting medical care very much. That's the better approach when you have no precise way of estimating future costs. Experience is showing there are better investing years and worse ones too, but it gets pretty tough to average more than 5%, net. So if we could find 2.5% extra somewhere, a cost-free health system might be in sight. Successful corporations can probably expect to make 10% profits for their stockholders, so the addition of 50% worth of stock producing a 10% return, might result in an overall portfolio yielding 7.5%. It wouldn't be easy to get there, but it identifies the goal.

{top quote}
Protracted retirement is a hidden cost of improved medical care. {bottom quote}
Passive Investing at Birth for Medicare(?) That's only one way to put it. A radically different one would grow out of imagining a gift of $100 at birth, with a dollar a month added to the balance, starting at age 25, and assuming a 90 year life expectancy. That would cover a lifetime of medical care to a total of $300,000, assuming the account itself was generating 5% interest. That isn't precise, because people will get sick at different ages, but it clarifies a different approach to the same set of facts.

Retirement Costs Attributable to Medicare (?) However, we regard prolonged retirement as a hidden cost of improved medical care, currently unfunded except for Social Security. To cover this cost for the twenty-five years from age 65 to 90 would require an additional $876,000 at the 65th birthday, assuming we get the 7.5% return. What we have come to is the problem of making every inhabitant of the the nation into a millionaire. But compare that with $2500 at birth and $29 a month (from age 25 to 65) to supplement Social Security by $1,000 a month. Although it may not sound it, this is really a bargain, incompletely certain of success. If a married couple both did this, they would enjoy a comparatively modest retirement of $4000 per month, including Social Security. It can thus be seen that although retirement is still a bargain, it is far more expensive to provide extra retirement than the healthcare which, in a certain sense, created the need for it. In that sense, the later protracted retirement living is the most expensive part of healthcare costs. It needs no apology, it is what it is.

However, the difficulty we have in proposing a system for reducing the cost impact is primarily explained by the rather ambitious size of the cost, which is likely to get even worse. It is not entirely to my taste to propose a Scandinavian cooperative system to pay for it, and no doubt some will propose short-cuts and expedients, but at least this approach has a chance of breaking even, whereas pay-as-you-go and inflation financing just kick the can down the road, for another generation to face the grim realities of still higher costs. The only remaining alternative which might work is to continue spending as much on research as we spend on Medicare. It seems likely science will eventually cure cancer. But unless it cures cancer cheaply, all is for nothing. Even in spite of being offered a bargain, a great many people will take their chances on a government bail-out, rather than accept the frugality being suggested. That's why membership has to remain voluntary, and why hard times are surely ahead of us.

Summary. We seem to wander from the subject, but it is intentional. Emphasizing the difficulty of solving the health financing problem by conventional means, makes it easier to consider unconventional ones. We ask for sober reflection on the advantages of the following:

1.Considering at least half of the cost of Obstetrics. to be a financial debt of the child.

2.Considering each grandparent to owe a replacement debt of one grandchild's medical costs, up to age.26.

3.Considering it a government obligation to subsidize those who cannot afford these obligations.

Conflicts of Interest. In order to avoid turning this idea into either a boondoggle for hedge funds or a gigantic tax dodge, it might be wise to limit the portfolio to health-related corporations. Over the past century, we have seen Medical Societies own malpractice insurance companies, medical journals, post-graduate educational tape recordings, health insurance companies, and probably a few hospitals. Even more enticing would be drug companies and medical device makers. In all of these areas, the danger of conflict of interest would arise, but somehow it has always been managed. In fact, medical ownership or control of ancillary services has probably declined, although it is likely the medical owners have usually been happy to be rid of the distraction. Medical malpractice insurance is probably an example of medical owners filling an unfilled need. When competition returned to the field, the owners have generally preferred being rid of the unpleasantness, rather than enjoying profits from conflicts of interest.

If, to all these associated for-profit corporations, is added the educational loan system for healthcare providers, plus the myriad institutions to house the patients, it starts to become clear the danger of monopoly control is a small one. While there is no doubt local monopolies would arise, and some instances would occur of subscriber control of them, the industries now making up 18% of gross national product would greatly dwarf the number of providers. Physicians were paid 20% of the healthcare dollar in 1980, but only 8% today, as an example of how greatly the field has become dominated by non-professionals. The scientific field has become so huge and so attractive in itself, that comparatively few professionals of eminence are interested in business careers. It is true professionals lacking eminence are sometimes more attracted to such activities, but the resulting peer pressures strongly favor the power of a few eminent professionals who allow themselves to get involved. In a power play, the rest of their colleagues will support them.


A most interesting website, thank you. I really hope to visit Philadelphia one day, and I shall definitely consult your website. I came across this website after doing a search on Johannes Kelp / Kelpius. I had just listened to a song written about him called, 'Sighisoara' at ukuleleroadtrips.com. Sighisoara is the place J Kelpius left for Philadelphia with 40 followers. Best Regards
Posted by: Pamela   |   Aug 20, 2015 11:04 AM
I'm overwhelmed. I'm thinking of a one-line poem by William Blake: "Enough or too much" " stragglers who live from 85 to 91." Sorry to be a burden, but soon to be 91 I can still go a couple of rounds without huffing and puffing. You remind me of Dr. Melvin Konner.... professor.... anthropologist..... physician.
Posted by: Martin   |   Sep 27, 2014 5:16 AM
I want to thank you for this wonderful resource. I find it fascinating. May I offer one correction? In the section "Rittenhouse Square Area" there is reference to the Van Rensselaer home at 18th and Walnut Streets and its having a brief fling as a club. I believe in 1942 to about 1974/5 the Penn Athletic Club was located in the mansion. The Penn AC was a good club, a good neighbor and a very good steward of the building - especially the interior. It's my understanding that very unfortunately later occupants gutted much of the very well-preserved original, or close to original, interiors. I suppose by today's standards the Van Rensselaer-Penn Athletic Club relationship could be described as a fairly long marriage. The City of Philadelphia played a large role in my life and that of my family, and your splendid website brings back many happy memories. For me and many others, however, there is also deep sadness concerning the decline of so much of the once great city and the loss of most of its once innumerable commercial institutions. Please keep-up your fine work. Your's is a first-class work.
Posted by: John D. Mealmaker   |   Aug 14, 2014 2:24 AM
Dr. Fisher, The name Philadelphia University was adopted in 1999, as you write, but the institution dates to 1884 and has been on School House Lane since the 1940s. It acquired the former properties of the Lankenau School and Ravenhill Academy, but it did not "merge" with either of them. I hope this helps when you update your site.
Posted by: David Breiner   |   Jun 11, 2014 10:05 PM
Hello Dr. Fisher, I was looking for an e-mail address and this is what I could find. I must tell you my Mother who you treated for years passed away last May. She was so ill with so many problems. I am sure you remember Peggy Marchesani. We often spoke of you and how much we missed you as our Dr. You also treated my daughter Michele who will be 40. I am living in the Doylestown area and have been seeing the Dr's there.. I just had my thyroid removed do to cancer. I have my fingers crossed they get the medicine right. I am not happy with my Endochronologist she refuses to give me Amour. I spoke with my Family Dr who said he will take care of it. I also discovered I have Hemachromatosisand two genetic components. I have a good Hematologist who is monitoring me closely. I must say you would find all of this challenging. Take care and I just wanted to convey this to you . You were way ahead of your time. Thank you, Joyce Gross
Posted by: Joyce Gross   |   Apr 4, 2014 2:06 AM
I come upon these articles from time to time and I always love them. Is the author still alive and available to talk with high school students? Larry Lawrence F. Filippone History Dept. The Lawrenceville School
Posted by: Lawrence Filippone   |   Mar 18, 2014 6:33 PM
Thank you for your articles, with a utilitarian interest, honestly, in your writing on the Wagner Free Institute of Science [partly at "...blog/1588.htm" - with being happy to post that url but the software here not allowing for the full address:)!] I am researching the Institute, partly for an upcoming (and non-paid) presentation and wanted to ask if I might use your article's reproduction for the Thomas Sully portrait of William Wagner, with full credit. Thanks very much for any assistance you can offer here. Josh Silver Philadelphia
Posted by: Josh Silver   |   Jun 2, 2013 1:39 PM
Thank you for your articles, with a utilitarian interest, honestly, in your writing on the Wagner Free Institute of Science [partly at "...blog/1588.htm" - with being happy to post that url but the software here not allowing for the full address:)!] I am researching the Institute, partly for an upcoming (and non-paid) presentation and wanted to ask if I might use your article's reproduction for the Thomas Sully portrait of William Wagner, with full credit. Thanks very much for any assistance you can offer here. Josh Silver Philadelphia
Posted by: Josh Silver   |   Jun 2, 2013 1:39 PM
George, Mary Laney passed away last November. I was one of her pall bearers. She had a bad last year. However, I am glad that you remembered her and her great work. I will post your report at St Christopher's and pass this along to her husband Earl. Best wishes Peter Hunt
Posted by: Peter Hunt   |   Mar 28, 2013 7:12 PM
Hello, my name is Martin. I came across [http://www.philadelphia-reflections.com/blog/1705.htm] and noticed a ton of great resources. I recently had the honor of becoming a part of a new non promotional project on AlcoholicCirrhosis.com. We decided to put together a brief guide about cirrhosis, and the dangers of drinking. We have received a lot of positive feedback and I wanted to suggest that we get listed on the above mentioned page under The National Institutes of Health. Let me know what you think and if you have any further requirements or suggestions.
Posted by: Martin   |   Jan 1, 2013 8:51 AM
I FIND THIS VERY INTERESTING, INDEED. I AM HOWEVER, SEARCHING FOR THE ANCESTOR WE HAVE BEEN TOLD WAS JOSEPH M. WILSON OF JORDAN TOWNSHIP IN WHITESIDE CO. IL USA. MY HUSBAND WAS ORPHANED AND WITH LITTLE CONTACT WITH HIS FATHERS SIDE OF THE FAMILY THE 9TH OF 10 SURVIVING CHILDREN SINCE ALL ARE DECEASED BUT, ONE). I HAVE HOPED TO FIND HIS CONNECTION AS TO THE STORIES RELATED BY SEVERAL OF HIS DECEASED RELATIVES THAT WE ARE CONNECTED TO THE WILSON MILL FAMILY HISTORY. OF JOSEPH AND FRANCES. MY HUSBAND WAS ALSO, FAMILY TO: GRANDFATHER RANSOM (ISABELLA)WILSON & HIS BROTHER WILLIAM; OF ELKHORN GROVE CARROLL CO. IL USA AND HIS SON JOSEPH WILSON(NANCY). I?WE( MY SONS AND NEPHEWS NEICES AND GRANDDAUGHTERS IN COLLEGE... WERE HOPING THAT NOW THAT I AM ON THE COMPUTER AND WITH YOUR HELP THRU THE GENELOGICAL SOCIETY TO YOUR ADDRESS WE MAY FIND THE FAMILY WE SEEK. MY LATE HUSBAND AND I DROVE PAST THE SITE OF THE FIELD WHERE JOSEPH AND FAANCES ARE BURIED , THE CEDARS ARE GONE AND IT IS NOW FIELD. I HAVE BEEN HOPING TO FIND THE LINK FOR OVER 30 FAMILY TO PAY TRIBUTE TO THOSE WHO HAVE GONE BEFORE AND PERSEVERED TO BRING US THE LIFE WHICH WE ENJOY AND SERVE, TODAY. I RECEIVED ONLY THIS WEEK BY A FLUKE AN EMAIL WITH PHOTOS FROM A 3RD COUSIN THAT FOUND MY EMAIL ON A COUSINS EMAIL ADDRESS AFTER INQUIRING AND INTRODUCING HIMSLEF: AND HE TOOK THE TIME TO SEND MANY PHOTOS AND HISTORY OF GRANDPARENTS AND FAMILY AS WE HAVE HAD NONE. WE STILL DON'T HAVE A PHOTO OF HIS MOTHER AND FATHER. WHAT I HAVE OF THE TREE, I AM ANXIOUS TO SHARE WITH FAMILY THAT IS SEEKING HISTORY, AS I STILL AM HOPEFUL TO FIND IT IN TIME FOR THE DEADLINE AUG. 30 TYPED AND DELIVERED TO MY MARTIN HOUSE MUSEUM WHERE I AM A MEMBER. MY HUSBAND WAS A MASTER MASON WHILE IN LODGE WITH THE COUPLE THAT DONATED THE HOUSE TO BE A MUSEUM. THANK YOU FOR YOUR TIME AND THE GRAT WORK YOU HAVE ALL DONE ON THIS HISTORY. WE WERE LIFE MEMBERS OF THE LUTHERAN CHURCH BUT , THERE IS NOT ONE IN OUR TOWN, SO I FOUND THE REFORMED CHURCH,OF WHICH, I AM VERY HAPPY TO BE A PART. THANK YOU .
Posted by: SUSAN WILSON   |   Aug 12, 2012 12:49 AM

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