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.
Until the time of our Civil War, a lawyer had two sets of books on his shelves, roughly equal in size. One was the Common Law, evolved by the Courts over thousands of years. The other was Statutory Law, created by Congress and the Legislatures in about a hundred years. Today, the Statutory Law is vastly larger in size, as our elected representatives keep adding to it. Thomas Jefferson would be greatly pleased with this result, disappointed only that it was not even more unbalanced. John Marshall is the name most often associated with resistance to this trend. Marshall and Jefferson hated each other.
Sir Francis Bacon
There are many ways to define the essential difference between the two kinds of law, coming down ultimately to the question of Who Decides. The Common Law was created by judges, who purport to be experts or at least serious students of the subject, attempting to be impartial referees of people with major disputes. If they are running smoothly, the judges leave things alone. In the early part of the Sixteenth Century, Sir Francis Bacon was instrumental in organizing the Common Law process into an acknowledged pattern much like the scientific method being developed at the same time by people like Galileo. A theory was propounded, and then tested by actual disputes; when the theory was found to be flawed in some way, it was modified and offered for further testing. The Law evolved. Oliver Wendell Holmes is famous for the remark that "The life of the law has not been logic, it has been experienced." But Holmes' quip is incomplete; the common law is logic, constantly tested by experience. And a major feature of the experience is that if things are running well, remain silent.
Statutory law bases its claim to preeminence on the reasoning that elected representatives in Congress assembled are more likely to express the collective wishes of the whole nation that are a cloistered minority who spend their lives listening to disputed arguments. One group tends to develop an inflated view of the importance of mass opinion, while the other group is perhaps a little too disdainful of it. In the end, the authors of the Constitution elected to set the two against each other, hoping the tension would reach a balance point.
There were historical reasons for concern, both ways.
When William Penn extended an invitation to all religions to come to a place of religious freedom, he really meant it. All religions were welcomed and tolerated, but the English government was deathly fearful of French Catholics in Canada, and Spanish Catholics in Florida. The Stuart kings were Catholic, sort of, but the important issue was protecting colonial real estate more than protecting doctrinal purity. When they picked up immigrants at European ports, the ships had to make a stop in England, and any Catholics aboard were removed.
So one very large and important cultural group never had much influence in America, particularly in Philadelphia. The Holy Roman Empire, that large loyally powerful European Catholic group in central Europe and southern Germany, just never got here in any great number. Americans eventually came to hear there was an important culture of some sort centered in Vienna, full of fat jolly folks who danced waltzes, but these apparitions were seldom seen in person and were never much thought about. The steel mills of western Pennsylvania drew in large numbers of Hungarians, and they told of Vienna's rival capital in Budapest, but that rivalry was apparently like Penn and Cornell or maybe Harvard and Yale, and what difference. Occasional visitors from those regions would grow strangely hostile upon encountering this indifference to what seemed pretty important back home. But one must remember to be more polite when around guests, that's all.
It took the Second World War and its attendant cultural struggles to bring a real wave of immigrants to America from Vienna. And these people were neither poor nor uneducated. They quickly moved into the classical music world and assumed roles that were not only important but culturally more advanced than we were accustomed to. They entered the universities and quickly rose to the academic peaks. Many of them could out-sing, out-dance, out-conversationalize any little group of provincial folk who happened to encounter them. Their names began to appear in the social pages, marrying debutantes. To a large degree, this singular immigration movement came to an end when the Cold War did. And that's rather a pity; we could really use more people like that.
Marie Therese, Austrian Queen of Louis XIV
One unusual exile from that movement lived for a long time next to the Haddonfield Quaker Meeting, or at least just down a little wooded lane to the rear. The occupant of that house was John Waite, a Quaker who really looked like a Quaker.
Elevators are a problem for any architect in any building, because they are expensive in a number of ways. If the building is no more than four stories high, it can manage to have hydraulic elevators, quite sturdy and comparatively inexpensive, but agonizingly slow. Taller buildings need high-speed electric versions, but the elevator itself is not the most expensive part. More important is that every elevator bores a hole in every floor, more elevators bore more holes, and the usable floor space on each floor is reduced. Further, the mechanical stress is mostly on the doors on each floor, which open and close hundreds of times each day, rather than the lifting engine of the cab. Elevators which seem to be breaking down continually, are mostly in need of new doors. In building a hospital, the architect confers closely with the administrator until the place is built and then the architect leaves. The administrator may leave soon afterward, too, because the hospital personnel who use the new building soon discover that when pennies were pinched, the result was fewer elevators. There's no right answer to this problem; nobody is ever satisfied.
Waiting for the Elevator
The surgeons long ago learned to cope with the problem by beginning their day before everyone else arrives. If the elevator comes immediately after being summoned and skips all intervening floors to the surgeon's destination, it can save at least a half hour of his time to make rounds at 5 AM. Multiply that imposed delay on hundreds or thousands of hospital employees, and it is possible to conjecture that hospital employees generally only work a 7-hour day, and spend the 8th hour waiting for the elevator. Whatever the actual calculation, it is a cost seldom actually calculated into the equation of constraining the installation of elevators because of cost considerations. Unwelcome crowding is a social cost, too. Bereaved relatives coming down in the elevator must meet students of various disciplines going up the elevator holding coffee cups and chattering. And all ranks and conditions must crowd into the unyielding back of the elevator when the door opens to confront a hospital bed with an afflicted patient aboard, surrounded by a team of attendants in pajamas, holding up bottles and tubes. Attempts are usually made to assign separate elevators for patients and/or equipment, but the attendants soon find out about elevators that save time, flocking to them in spite of signs, threats, administrative letters of admonishment, and dreary staff meetings. It is easy to identify new staff; they are the people who take elevators down. Everyone else learns to go to the top floor and walk down the stairwells. Outta my way!
Harry Gold
So, hospital elevators evoke recollections. Mine include the many times I rode up beside a sullen teenager named Harry Gold, who was going to the chemistry department of the old Philadelphia General Hospital. If we ever exchanged a word I don't remember it, so I have to regret that I missed out on striking up an acquaintance with a real, convicted Soviet spy, the one who passed hydrogen bomb secrets to those Rosenbergs who went to the electric chair protesting their innocence. Something to tell my grandchildren I guess.
On another occasion, Dr. John Y. Templeton was standing impatiently for an elevator at Jefferson Hospital. John was a brilliant surgeon from Virginia, one of the inventors of the heart-lung machine, and also one of the quickest, most irreverent wits in Medicine. The door of the elevator opened, to reveal a completely crowded crowd of assorted folk, with a Doctor Zimskind standing in the front. Templeton's southern accent boomed out, "Going down?" "Going dow-un?"
Lost in thought, Zimskind had trouble finding his voice and simply poked his index finger skyward two or three times. To which, Templeton shouted out, "The same to you, Dr. Zimskind. But are you going dow-un?"
And, much earlier when I was a resident wearing a long white coat, accompanied by a jolly sort named Carroll who wore the same, we got on an elevator which was empty except for a surgical resident wearing his particular uniform of a short white coat covering his green surgical pajamas. We had gossiped earlier about this surgeon, who had returned for training after some harrowing experiences in the Normandy beachhead. He was a mean, silent, sort, but Carroll was an irrepressible joker. "Well," sez Carroll, "I hear you carry a gun around with you. Do you carry it into the operating room?" To this, the surgical resident opened his jacket and, so help me, pulled out a pistol from his belt. "When I was in Germany," he murmured, "I killed lots of better men than you are." Under the circumstances, there was little more to be said, and we stopped breathing just to be sure. Those Jefferson elevators are awfully slow to reach the next floor.
And finally, there was Herman, who ran the hydraulic elevator in the original old building of the Pennsylvania Hospital. Herman the German we called him, although his accent was probably Central European. This elevator was an antique, with a big iron steering wheel that Herman turned to release the oil or water or whatever pumped the excruciatingly slow cage up two floors. There, for our contemplation, was America's first building of the first hospital, with the first operating room on the top floor. For more than a century, orderlies had to carry stretchers up and down the stairs with the apprehensive surgical patients, and then this marvel of a hydraulic thing was installed to great admiration. It has long been replaced with a fancy new self-service elevator. But so have the patients been replaced; one hundred sixty patient beds entirely replaced by administrators.
On a mud flat of the Susquehanna River called Three Mile Island, a nuclear energy plant had been built around 1970. The mud flat was in front of the entrance of the Swatara Creek, where Middletown the first town in the County had been laid out in 1732. Later on, the town of Harrisburg became the capital city of Pennsylvania, located a few miles north of the Swatara Creek at what had been called Harris's Ferry, later Harrisburg. For quite a while, Middletown and Hummelstown, also on the Swatara Creek, were the two main towns in the area, but the location of the state capital attracted railroads and steel mills to Harrisburg. One of its main claims to fame was that Confederate General Robert E. Lee was thought to have it as his primary objective for invading the North, frustrated in this goal of course by his defeat at the battle of Gettysburg. Meanwhile, Middletown has declined to a small country town and was therefore originally glad to have the industry of electricity generation located next to it. It's true the huge cooling towers loomed ominously, and huge plumes of evaporated water rose in clouds to be seen for miles. But Middletown slowly took on the look of a refurbished 18th Century town, fancy new restaurants and all, prosperous and waiting to be discovered as a tourist attraction. Maybe in time, it would be the next Williamsburg.
The China Syndrome
On March 28, 1979, some valve got stuck within Reactor Number Two. The plant had two reactors, each with a spare cooling tower so it looked as though there were four nuclear plants instead of two. Warning lights and whistles went off, and it is easy to imagine a general panic within the operators of the plant, especially since a popular movie, The China Syndrome had just been issued two weeks earlier, depicting an imaginary implosion of a similar nuclear plant with famous movie actresses running around screaming. It took about five days for the plant operators to make a preliminary assessment of the TMI situation, which did not seem as bad as it might have been. It would take six months to reach a final evaluation of just what had gone wrong, and why. In the meantime, almost anyone could say or imagine almost anything; no one could prove they were wrong. The local citizens held a referendum; they wanted all of the facility to be closed, permanently. Secretary of Health Gordon MacLeod wanted a somewhat more reasonable thing, which was large supplies of sodium iodide pills to be distributed to the populace to prevent the radioactive iodine content of escaped gases from being attracted to the thyroid glands of the population, especially children and child-bearing mothers. Unfortunately, he took the unforgivable step of criticizing the state government for not having stock-piled the pills, and the Governor fired him, thus demonstrating strong decisive action in an emergency. The news media were equally at sea because this was big news. When all was finally said and done, there was no evidence that anyone was injured as a result of the accident. More than thirty years later, there is still no sign that anyone was ever hurt.
Hiroshima Explosion
We might not have been so lucky, of course. When the Russian plant at Chernobyl had a worse accident in 1986, literally thousands of Ukrainians were sickened, and the death rate was appreciable. In Japan, the victims of the Hiroshima explosion were closely followed for many years, and the incidence of cancer of the thyroid among the survivors was truly frightening. However, after more decades elapsed, it was possible to determine that the overall death rate from thyroid cancer was not increased, suggesting these new cancers were not particularly malignant. But in a different set of circumstances, when the Chinese set off their tests of nuclear weapons, it became clear that these tests were followed in a few years by a world-wide epidemic of Hashimoto's Disease of the thyroid. Radioactivity in mushroom clouds is mainly radioactive iodine, with a half-life of seven days. Unfortunately, the clouds sail around the earth, eventually settling into the dirt on the ground. Grass grows there, and cows eat the grass. By this time, the radioactivity is much diminished, but the digestive systems of cows concentrate this weak radioactive iodine, which then gets into milk in a more active form. The kids drink milk and get Hashimoto's disease. Whether they will later get thyroid cancer and die of it remains unknown, but possibly not, in view of the Hiroshima experience. So, amidst a welter of conflicting evidence, it is still possible to say almost anything about nuclear power risks without fear of provable contradiction. It is only safe to repeat that radioactive iodine exposure doesn't do anyone any good.
Unfortunately, thirty years after the accident, we now all understand it would be a good thing to develop energy independence from Middle East sources; but we remain unsure just how unsafe we are willing to become in order to re-adopt nuclear energy. Since the accident at Three Mile Island, our government has made it impossible for a single atomic plant to be built in America. And the politicians are surely right about frightening public opinion on the topic. Just look at pretty little Middletown: it's moving toward becoming a dilapidated ghost town.
Without claiming any expertise in atomic energy production, it is possible to quote others to the effect that the hesitation of the politicians is no longer focused on the danger that a plant will explode. Rather, the real dispute is about the disposal of nuclear waste. No one wants it nearby. The French have built nearly sixty plants in the thirty years we have hesitated; how do the French dispose of nuclear waste? The answer seems to be that waste disposal is not a problem with the French methodology, but a new problem surfaces that the French approach generates a type of waste which is much easier for an undeveloped country to deploy as material for atomic bombs. So, the rumor commonly circulating is that this is really the main practical objection to constructing nuclear energy plants in the French style. As is true for the entire nuclear topic, the rumors outrun the evidence.
The Affordable Care Act was announced as mandating health insurance for everyone, but about thirty million people were specifically excluded. The healthcare problems of seven million prison inmates, eight million unemployable, and eleven million illegal immigrants were too specialized to be included in a program which hoped to be one-size fits all. Quite properly, such special outliers would be better handled by special programs designed for their special needs.
The Affordable Care Act (ACA) is now central to Administration attention, and Medicare may be deemed too hot to handle in an election campaign. Nevertheless, we elected here to discuss Medicare but not the ACA. Retirement, childhood, and how to unify complete the list--pretty much all that's left surrounding, but excluding the ACA, election or no election. That emphasizes what had been evaded or neglected, and avoids direct confrontation with the ACA, preparing for the day when that big gorilla is either confirmed or abandoned. It's obviously too expensive, and it remains to be seen whether it can be fixed, or must be abandoned. In our alternative scheme, all of the lifetime healthcare would be financially connected to a single lifetime Health Savings Account, one account per person, but the delivery systems would remain semi-autonomous. ACA could surely live in peace with the HRSAs, and could even peacefully adopt the HSA approach. That would save money, but the questions left are whether it would save enough to be worth the trouble, and whether politics will allow it. Like the European Union, it's surely easier to describe than to accomplish.
Retirement as a Medical Issue. The news is precarious for retirement funding. We begin with the far end of life, where most health cost and all retirement cost concentrates. While retirement is parallel in time to Medicare, we begin to recognize increased longevity as an outcome of better health. If one is to help pay for the other, they must, in the Medicare case, draw their funds from the same pool. That's Medicare, which most people don't want to change, but is the first thing which must change. Because unchanged it costs too much to leave anything for retirement.
Although the Industrial Revolution brought many lifestyle improvements in the past two centuries, it also brought turmoil. The idea of leisure time may once have been a reward for the upper 1%, but actually, most of the population never dreamed of any leisure time. The novels of the "Lost Generation" after the first World War often revolved around the discovery of unfamiliar leisure pursuits by members of social classes newly learning about such things. The moral, then and now, seems to be that leisure is no bed of roses.
We must assign a reasonable definition to a "decent" retirement, provide for a marginal one, and leave the rest to our own sources of wealth.
The cultural response seems to be that leisure was best reserved for retirement, although the younger generation sometimes rebelled, wanting some of it sooner. In any event, Medicare surely extended retirement longevity. (Overextended it, if you believe it will be impossible to pay for.) After all, retirement is a continuous cost, while illness is episodic. There are ways of calculating costs which depict retirement as five times as expensive as healthcare. But Medicare cost averages thirteen thousand dollars a year and rising. That's a pretty meager retirement, and when you discover Medicare is 50% borrowed, you question how many people could retire on $26,000 a year per person, on public sector revenues. If you see retirement as a couple of old folks, you wonder where they would get $52,000 a year, for thirty years. Add Medicare to retirement, and you begin to get absolutely impossible numbers. There seems no possible way to handle this except to provide for subsistence retirement, plus Medicare, and let everyone find some way to get whatever extra he needs, or defines as "decent". And that defines retirement cost as equal to medical costs when both costs could rise appreciably. The Health Savings Account method of accomplishing this is to put retirement at the end of the financial line, funded by the residuals of the other pearls on the string. You keep what's left. Another way is to retire later, or best of all, find some remunerative way to fill your time and use your experience.
Medicare As a Financial Issue. Medicare is about half paid-for, half borrowed, but it's really totally under water. According to Mrs. Sibelius, about half of Medicare expenditures are supported by the general fund or general taxation. The general fund is in deficit, however, providing some fairness to the description of Medicare as a fund borrowed from the Chinese, although China and Japan combined only purchase 13% of ten-year Treasury bonds. In the event of Medicare default, the main creditor victims will be U.S. citizens. The purchasers may change, but the deficit looks to be permanent. Until deficits are paid off, it will remain true that Medicare provides a dollar of care for fifty cents. That sounds wonderful until it suddenly sounds terrible. Medicare is bleeding money. If you want to know how brutal our government can get, read the section later on, about the Diagnosis Related Groups.
About half of the Medicare deficit is paid as you go, about another half is borrowed; only a quarter of the budget is current revenue from the beneficiary age group.
An accountant might say, Medicare's cash revenue is roughly divided between premiums paid by the beneficiaries, and pre-paid as a payroll tax of 3% on workers not yet old enough for benefits. (About half of this wage tax comes directly from the employee, another half from the employer. We skip over the technicalities that some parts of the program are tied to one fund, other parts to another, and also some are subject to higher income tax). About a quarter of Medicare is paid in advance on a "pay-as-you-go" basis, which is to say some people pay current costs of other people -- they are definitely not saved in anticipation of the contributors becoming beneficiaries, as the term "Trust Fund" implies.
A second quarter is indeed paid and spent by current beneficiaries as Medicare premiums. That is, about half of the deficit is paying as you go, another half is borrowed from foreigners; only half of the deficit is matched by current revenue from the beneficiary age group. Nevertheless, the payers of pay-as-you-go are about thirty years younger than the spenders of it. If we put the youngsters' cash to work for thirty years, what interest rate would it take to grow one dollar into three? The answer is about five to seven percent. For quicker understanding, a few unfamiliar tools are needed:
First and Last Years of Life Re-Insurance By far the best proposal for refinancing Medicare, however, is to anticipate the way science is going to re-design costs. In the long, long, run, there should be very little medical cost left, except for the first and last years of life. We have no idea how long it will take, but that's the direction things are almost sure to be going.
So, phase in a restructuring of funding for both children and elderly first, and then add in the rest of a lifespan, step by step. That way, you first fund an obligation you are always sure to have. Be sure to do it in such a way that maximizes the investment income at compound interest. This might be a project under construction for decades, but its first step would be to begin funding for the Last Four Years of Life, which happens to be an early proposal in refinancing Medicare. Since the reader may be unprepared for the topic, it is considered in a free-standing way, in the next section.
Pay at the time, or pre-pay in advance?> At first, it might seem frugal to have people pay for what they spend; let them pay for what it costs, when you know who ran up the cost. But in the case of birth and death, it's going to be 100%, and the amount of it is a lottery. By far the more important issue is the compound interest you earn by paying in advance. Using the rule of thumb that money at 7% will double in ten years, a life expectancy of 90 should double 9 times from birth to death. That is, a dollar at birth is worth $512 at death.
What's more, 50% of Medicare is reported to be spent in the last four years of someone's life. That's likely to represent terminal care, but it doesn't matter. If you prepay those four years, the rest of Medicare has its cost cut in half. In those two simple statements is found the nut of paying for half of Medicare for $100 -- ninety years from now. It's up to actuaries and accountants to find the "sweet spot", of the most revenue enhancement for the shortest time of investment.
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.
