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.
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Philadelphia Revelations
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George R. Fisher, III, M.D.
Obituary
George R. Fisher, III, M.D.
Age: 97 of Philadelphia, formerly of Haddonfield
Dr. George Ross Fisher of Philadelphia died on March 9, 2023, surrounded by his loving family.
Born in 1925 in Erie, Pennsylvania, to two teachers, George and Margaret Fisher, he grew up in Pittsburgh, later attending The Lawrenceville School and Yale University (graduating early because of the war). He was very proud of the fact that he was the only person who ever graduated from Yale with a Bachelor of Science in English Literature. He attended Columbia University’s College of Physicians and Surgeons where he met the love of his life, fellow medical student, and future renowned Philadelphia radiologist Mary Stuart Blakely. While dating, they entertained themselves by dressing up in evening attire and crashing fancy Manhattan weddings. They married in 1950 and were each other’s true loves, mutual admirers, and life partners until Mary Stuart passed away in 2006. A Columbia faculty member wrote of him, “This young man’s personality is way off the beaten track, and cannot be evaluated by the customary methods.”
After training at the Pennsylvania Hospital in Philadelphia where he was Chief Resident in Medicine, and spending a year at the NIH, he opened a practice in Endocrinology on Spruce Street where he practiced for sixty years. He also consulted regularly for the employees of Strawbridge and Clothier as well as the Hospital for the Mentally Retarded at Stockley, Delaware. He was beloved by his patients, his guiding philosophy being the adage, “Listen to your patient – he’s telling you his diagnosis.” His patients also told him their stories which gave him an education in all things Philadelphia, the city he passionately loved and which he went on to chronicle in this online blog. Many of these blogs were adapted into a history-oriented tour book, Philadelphia Revelations: Twenty Tours of the Delaware Valley.
He was a true Renaissance Man, interested in everything and everyone, remembering everything he read or heard in complete detail, and endowed with a penetrating intellect which cut to the heart of whatever was being discussed, whether it be medicine, history, literature, economics, investments, politics, science or even lawn care for his home in Haddonfield, NJ where he and his wife raised their four children. He was an “early adopter.” Memories of his children from the 1960s include being taken to visit his colleagues working on the UNIVAC computer at Penn; the air-mail version of the London Economist on the dining room table; and his work on developing a proprietary medical office software using Fortran. His dedication to patients and to his profession extended to his many years representing Pennsylvania to the American Medical Association.
After retiring from his practice in 2003, he started his pioneering “just-in-time” Ross & Perry publishing company, which printed more than 300 new and reprint titles, ranging from Flight Manual for the SR-71 Blackbird Spy Plane (his best seller!) to Terse Verse, a collection of a hundred mostly humorous haikus. He authored four books. In 2013 at age 88, he ran as a Republican for New Jersey Assemblyman for the 6th district (he lost).
A gregarious extrovert, he loved meeting his fellow Philadelphians well into his nineties at the Shakespeare Society, the Global Interdependence Center, the College of Physicians, the Right Angle Club, the Union League, the Haddonfield 65 Club, and the Franklin Inn. He faithfully attended Quaker Meeting in Haddonfield NJ for over 60 years. Later in life he was fortunate to be joined in his life, travels, and adventures by his dear friend Dr. Janice Gordon.
He passed away peacefully, held in the Light and surrounded by his family as they sang to him and read aloud the love letters that he and his wife penned throughout their courtship. In addition to his children – George, Miriam, Margaret, and Stuart – he leaves his three children-in-law, eight grandchildren, three great-grandchildren, and his younger brother, John.
A memorial service, followed by a reception, will be held at the Friends Meeting in Haddonfield New Jersey on April 1 at one in the afternoon. Memorial contributions may be sent to Haddonfield Friends Meeting, 47 Friends Avenue, Haddonfield, NJ 08033.
In 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 remains dominated by medical institutions.
Dr. Fisher
As you emerge from the Curtis Building, it is worth a half-block detour to 7th and Samson to glance at Jeweler's Row, a curious concentration of diamond merchants who have clustered there since before the Civil War. However for this leg of the tour, turn about to Washington Square, now a quiet manicured residential square but once the site of the Walnut Street prison, the location of the first balloon ascension, the potters field of colonial days, and the home of the unknown soldier of the Revolutionary War. There are accounts of people catching abundant fish in a brook once running through the square, well into the Nineteenth Century. Because of the brook, there were tanneries in the region; tanneries always smell bad. Accordingly, the deed from the Penn family for the Pennsylvania Hospital nearby is revocable if anyone ever decides to build another tannery on its grounds.
Athenaeum of Philadelphia
On Sixth Street, a few feet south of Walnut, is the splendid brownstone Italianate structure of the Athenaeum, established just after the Revolution as a private lending library, and continuing to today. It's well worth a brief visit to grasp why Lafayette joined it, and so many other members have contributed Nineteenth Century, mostly French, sculpture and paintings. Next door is the former home of then-Mayor Richardson Dilworth. It looks vaguely Georgian in style but was actually built forty years ago as Dilworth's personal statement that Society Hill needed to be revived as a fine place to live. Although Charles Peterson is credited with the idea of starting Society Hill by restoring Stephen Girard's house at Third and Spruce, Peterson bought it for $1800 and eventually sold it for millions. By contrast, Dilworth spent millions for his house, and it later sold for much less. Although they served the same cause, the two men of entirely different social class were always rather reserved with each other.
Cross the grassy Washington Square, turning left on Seventh Street. Until 1980, this area was the home of publishing, mainly medical publishing, but now publishing's loft buildings have been converted to condominium apartments. The penthouses on the top of these buildings are invisible from the street, but are truly spectacular.
Spruce Street itself is a sort of architectural museum, with houses on the Delaware dating to 1700, getting progressively more recent as you go West. At the level of Seventh Street, the houses date from around 1810, eventually reaching Broad Street around 1890. Midway up the block of Spruce Street from 7th to 8th on the North Side (the South Side is nothing but a facade, covering hospital buildings) is the house --really two houses run together -- of Nicholas Biddle. He had more backyard than most houses in the suburbs now do, even once keeping a baby elephant there. The house was made famous for dinner parties conspiring against Andrew Jackson, and later its social glamour was described admiringly by that gossip diarist of the time, Sydney George Fisher.
Pennsylvania Hospital
At Eighth and Spruce, one half of a city block is occupied by the most modern of hospitals, now tending 440 patients after the manner of a medical Swiss watch. The remaining half of the block is a museum of American Medical History, polished and manicured by professional museologists. There are, however, many people still alive who remember when it containing 160 desperately sick poor people, tended to by unpaid nursing students and resident physicians. It is frequently said that the history of American Medicine is the history of the Pennsylvania Hospital
.
At Ninth and Spruce, Joseph Bonaparte the Emperor's brother once lived, subsisting on a steamer trunk of gold coins he brought along. Continuing north to Locust Street, Thomas Jefferson University begins and stretches for several blocks in all directions. Before turning west, however, glance down to the southwest corner of 8th and Locust, the original Musical Fund Hall. The music moved west to Broad Street, but the Musical Fund Building was long the largest auditorium in town, housing entertainments, and graduations. Abe Lincoln was nominated for his second term, there. Turning about to view Jefferson, it is easy to believe it is now the largest employer in Center City, and furthermore owns most of the major hospitals in the Pennsylvania suburbs.
Now proceed west on Walnut (although if hungry you might instead wish to take a short detour to the Reading Terminal Farmers' Market), going past the little alley between 12th and 13th Streets called Camac Street, a street of little clubs the most notable of which is the Franklin Inn. Note that Camac Street is paved with wooden blocks, to deaden the clip-clop of horses' hooves. At the corner of 13th and Walnut is the Philadelphia Club, the oldest and toniest men's club in town with a membership limited to 300. As you reach Broad Street, you can see the brownstone gingerbread of the Union League, now by far the largest and most successful club in town.
Philadelphia City Hall
Further north on Broad Street looms City Hall, designed to be the tallest building in the world but superseded by the Eiffel Tower made of tinker toys while the Philadelphians struggled to build with solid stone. Short of the Maginot Line, it is hard to imagine any building more solid than this one. No expense was spared, and it is really worth a tour. That little statue of William Penn on top is 37 feet tall. Just across the street to the north of it is the Masonic Temple, an equally spectacular series of architectural flourishes. If you visit (the public is quite welcome), you will never forget seeing this place. The Masonic Temple is not an imitation of City Hall; it was built there first.
So that's the end of our one-day historic walking tour of historic central Philadelphia. No doubt you are tired and want to go home. We've left you right by Suburban Station (17th and Arch) if you are going to the suburbs. If you are going to New Jersey, take the high-speed line at Broad and Locust (there's an entrance downstairs on the two eastern corners).
EVOLVING scholarship now suggests the ideas and driving vigor behind the Constitution were mainly Washington's, with young Madison mainly his leg man. Young Alexander Hamilton was a second devoted agent of Washington, easily recruited after his earlier relationship as the General's chief aide and assistant during the Revolution. These three made things happen. Madison seems to have begun the relationship absorbed with advancing his place in the Virginia dream of the Potomac River: future gateway to the West and main highway of the nation. Hamilton was ambitious as well, perceiving early where the Industrial Revolution was likely to take America. He was not landed gentry. He had aristocratic ambitions, but they grew out of an orphaned boyhood spent in a Caribbean counting-house; above all, Hamilton was a risk taker and a climber. As we now know the different paths they eventually took, we see they were very different. But at the beginnings of the Constitution, they were both Washington's boys, following Washington's orders, advancing his vision.
The Potomac vision was just between Madison and the General until Hamilton eventually put it into a deal, traded for the location of the national capital, at a famous dinner party in New York hosted by Tomas Jefferson. In the meantime, the two younger men advanced Washington's long-range goals in different areas and different parts of the country. Throughout the early years, Washington maintained his natural aloof dignity. A better idea of what he was seeking emerges from how he acted. Start with his being aroused from plantation retirement by Shay's Rebellion.
Daniel Shay
Daniel Shay was a leader of 1200 rebellious farmers in central Massachusetts who in 1786 stirred up concern about chaotic government by making it worse, surrounding the debtor's courthouse in Springfield Mass. and threatening to raid the local armory to overthrow the Massachusetts government. Shay's rebellion was eventually put down but only after two years of fighting which thoroughly frightened local citizens. The rest of the country had some sympathy with a former captain in the Revolutionary War who lost his property because of currency shortages very similar to the ones that started the Revolution. Regardless of earlier rights and wrongs, the public now demanded a government which could maintain law and order. Washington was particularly upset by Shay's Rebellion because of its resemblance to the earlier revolt of the Pennsylvania Line. He continued to be blistered by the Continental Congress' inability to raise troops and pay them, inflicting hardships on the patriots Congress had once begged to protect them. Washington wrote dozens of letters around the country protesting the sorry situation and privately set about to recruit people like Madison and Hamilton to help. Madison's initial task was to recruit the Virginia Legislature and the Virginia congressional delegation to devise necessary legal provisions that would make this country a fit place to live. Washington's position in public opinion could not be resisted; he almost invariably got what he wanted. But if he could have read a letter written by Thomas Jefferson at the time, he would have had a warning that important people disagreed with him. Said Jefferson:
"A little rebellion now and then is a good thing . . . .It is a medicine necessary for the sound health of government... God forbid we should ever be twenty years without such a rebellion. The people cannot be all, and always, well informed. The part which is wrong will be discontented, in proportion to the importance of the facts they misconceive. If they remain quiet under such misconceptions, it is lethargy, the forerunner of death to the public liberty . . . . and what country can preserve its liberties, if its rulers are not warned, from time to time, that this person preserves the spirit of resistance? Let them take arms. The remedy is to set them right as to the facts, pardon and pacify them. What signify a few lives lost in a century or two? The tree of liberty must be refreshed, from time to time, with the blood of patriots and tyrants. It is its natural manure."
Thomas Jefferson, 1787
Let's jump ahead. Washington is now our first president, confronted with our ships and sailors under attack by the Barbary Pirates."Would to Heaven we had a navy to reform those enemies to mankind or crush them into non-existence," Gen. Washington wrote in 1786. The nation built that navy largely because the pirates' hostage-taking and escalating ransom demands became politically unbearable. The ships were built in time, and in one of history's great ironies, it was President Jefferson who gets credit for subduing the pirates on the Shores of Tripoli.
General Sullivan
Throughout Washington's long career it became evident that whenever America developed conflicts in the neighborhood, the enemy's uniform response was to stir up the backwoods Indians to assassinate the settlers. Andrew Jackson is the President who is most famous for responding by confronting whole regions of Indians with the choice of extermination or eviction to lands further west, but Washington was well aware of the realities of the frontier. In response to British-inspired Indian massacres, while he was at Valley Forge, Washington dispatched General Sullivan to march against the Iroquois and exterminate them. There is legitimate doubt the settlers around Wilkes Barre in the Wyoming Valley had any right to be there, but Washington knew that above all else, a leader of a country is expected to protect it.
The most dramatic illustration of Washington's idea of a central government came in the case of the Whiskey Rebellion. When Hamilton persuaded him to impose a tax on whiskey, the corn growing frontiersmen around Pittsburgh started a rebellion against the tax. The old General's reaction was prompt and violent. Riding his horse at the head of 1500 militia, Washington marched across Pennsylvania to put an abrupt end to such ideas of defiance against his new system of proper government. He made a great show of pardoning the intimidated farmers, but he left them with no mistaking that George Washington meant business. And still, there was a warning if he could only see it. Albert Gallatin, who was to be Jefferson's future Secretary of the Treasury and thought the leader in everything economic, was one of the leaders of the Whiskey Rebellion. To see the hand of Jefferson or Madison in this affair is not alarmist.
Washington wanted a strong central government. One that would pay its troops and keep its promises, collect its taxes and defend the coasts. The rest of this mechanical formula called the Constitution was left for Madison to work out. Hamilton persuaded him that a country had to be rich and strong to be able to protect its citizens, so Washington went along with the Bank, and the Report on Manufactures. He agreed with anything Madison proposed in the way of process and balances of power. What Washington wanted of a country were law and order. When Madison eventually started talking like Jefferson, Washington never spoke to him again.
Let me put some emphasis on what I consider the most revolutionary change of a current lifetime. Nothing to do with Hitler, Stalin or Mao; or jet planes, television, and computers. Or even the rise of the impoverished underdeveloped world. To me, the most revolutionary change of the past century has been the extension of the average life span, by thirty or forty extra years, depending on where you happen to live. I'm proud to be a member of the profession at the center of it.
The Great Depression
Right in the middle of this revolution, the Great Depression of the Thirties convinced a great many people there were not enough jobs to go around. The Union movement, as we say, or the Socialist movement as they come right out and call it in Europe, adopted a general thesis that a limited number of jobs should be shared equally so everyone could have a chance at them. Child labor should be condemned, and those occupying "decent" jobs should retire early. A number of lesser agitations of the Thirties have the same sound to them: piecework was a bad thing because it encouraged women to work at home, depressing prevailing wages. Home offices are condemned by the IRS for similar reasons. Automation and efficiency generally were resisted. Since I persist in the notion that efficiency is almost always a very good thing, these anti-efficiency campaigns sound like more hidden agendas to spread the supposedly limited amount of available work. But all of this is a left-over idea from the great 19th Century migration from the farm to the industrial city, where job creation generally requires a manager, some risk capital, and an atmosphere of creative destruction -- all of which can seem threatening, except for the seemingly obvious evidence of their usefulness. If you have grown up hating managers and investors, it's painful to be told your only alternative is to spend a lifetime working as their subordinates.
While some people understandably oppose the forward march of efficiency, few want to live shorter lives. Even victims of self-inflicted conditions generally drawback when the consequences become fully visible. Mistaking a lifetime of paychecks for a lifetime of work, they wish to extend one without extending the other. That's called inflation, it seldom creates wealth, usually destroys it. It's vaguely possible that alcoholism, unsafe sex, and recreational drug consumption are efforts to end it all, but let's be charitable. More likely those confused souls are just that, confused.
And that's where matters seemed to rest until recently. People didn't specifically ask for this extra longevity, and while often willing to risk it, are seldom willing to lose it. My own elderly generation can start to see signs that a protracted retirement can eventually lead to running out of money, so there is plenty of need for an open mind, experimentation, and innovation about making retirement a more productive period of life.
Great Depression of the Thirties
I heard some college kids talking; kids do talk a lot. The proposition argued was essential as follows: Instead of adding a few years to your retirement, when you are feeble and useless, why not deliberately offer kids an extended period of loafing, when health is good, love-making is vigorous, and the ability to endure the debilitating effects of recreation is still strong? A grungy lifestyle is more tolerable for someone who is thirty than for the same person at seventy-seven so it could be an overall cheaper lifetime. An additional five years of pizza for breakfast; sounds heavenly.
Boys and girls react to this proposal in biologically different ways, of course. Boys don't have the same biological clock, telling them they better start their families while they still can. Raising little children is strenuous, particularly during time shared with continuing education, starting a career, or finding a husband. Getting a divorce is also a surprisingly debilitating distraction, seldom recommended by those who have experienced it. The males have an easier time loafing; so why not return to the customs of a century ago, when girls planned to get married during the same summer they graduated from college. Because a big part of that tradition was "Don't get married until your ship comes in," it tended to define an eligible male as someone thirty years old. Unfortunately, that interferes with another new trend, the buddy system.
Most girls now expect to go to college, and colleges have mostly become coeducational to accommodate the expanded market. Hand in hand kids stroll the lawns of academe, more like siblings than lovers. The faculty marvels at this phenomenon, which to them seems like an unfamiliar mixture of incest and promiscuity, but it does not quite follow the rules of either entertainment. Since the buddy system is probably connected to the increasing divorce rate, universally condemned as a bad thing, it may further evolve into something else. It's been suggested men should get over their traditional reluctance to raise someone else's children. Now that's an idea which is going to take some time getting used to.
So, all in all, let's swallow our generational pride and seriously consider whether we just ought to do what our grandparents did. Men should wait until thirty to get married, while women should marry at twenty; simple. It forces feminists to admit that in one sense they are inferior to men, so declare victory and ascribe it to an innate superiority of women. It also calls the pseudo-sibling pairings of school children into question, which is essentially the only thing new in this whole business. It's probably a lot of fun, but it exacts too high a social price.
Sixteen years after the Clinton Health Proposal was withdrawn from Congress in 1994, its sponsors can thank their lucky stars they withdrew it. While high-minded or even nobly intended, The Clinton Plan's operational feature was an elaborated system of Managed Care, usually called HMO (Health Management Organizations.) Leaders of large business, hoping to streamline the risk-adjusted health insurance they provided to their employees, had originally cooperated with the Clinton administration, but were dismayed by the habits of micro-management they encountered, and pulled out. In their view, politics would soon cripple a complex idea which needed good management more than it needed legal sanction or a legal monopoly. The Clinton Administration decided to yield to the wishes of Big Business, and let them go their own way. So, major businesses undertook the job themselves but burned their fingers badly when they discovered the HMO concept was fundamentally doomed to failure. The public, even their own employees, bitterly resented the intrusiveness and loss of personal freedom for patients which characterize HMO systems. HMO is now the butt of every joke, so while Democrats escaped the stigma of its flaws by failing to get it passed, Democratic politicians did get some benefit. But somehow they never grasped the real message the public was sending.
New blog 2013-12-10 22:51:24 description
So in 2013, while political grievances from this earlier failed experiment may partly explain unfocused public dissatisfaction, much deeper issues still need to be debated. In the resurrected Obama version, which actually passed Congress to be implemented January 1, 2014, Obamacare is no longer a theory, but a program in operation, fixed in place and required to stand examination as written. Millions of people were legitimately worried about how they could afford to get sick and certainly were not prepared to see costs forced upwards. The deeply indebted Medicare program was also doomed to bankruptcy by demographics unless something was done about rising healthcare costs. We might even find we analyzed health finance exactly backward; the bigger problem may soon become, not the cost of dying too soon, but the cost of living too long. Perhaps we now have gained some better idea of how to look at our problem, and how to fix it. Both political parties in the 2008 election promised to revise healthcare financing and delivery. When Democrat Barack Obama won the election, his concrete proposal was eagerly awaited and now will be remorselessly examined. In order to receive an essentially free hand, the elements of Obamacare were not concisely stated; in America, that may have been his biggest misjudgment. After enactment, they can no longer escape systematic examination for what they are, and what they omit.
Political strategists calculated that sweeping changes had the best chance of approval immediately after a new president takes office. That may have been true but miscalculated; such short timing gave interest groups responsible for Obama's election undue influence over the proposal, arising out of an undue sense of mandate from the election. The resulting proposal, the Affordable Care Act, is heavily slanted toward rewarding the base, Organized Labor, blacks, and Hispanics, without openly saying so, while displaying no great willingness to accommodate features the rest of the nation objects to. As Lyndon Johnson once said, the majority of Americans are non-black and non-poor. The political misjudgment is increasingly called Obamacare.
Thousands of pages of uncoordinated proposals soon emerged from four congressional committees, intentionally confusing the public about what the basic proposal was, but making it uncomfortably obvious that the congressmen themselves had neither written nor properly considered it. It was announced to general satisfaction as a proposal to expand coverage to the whole population and to save the resulting cost by eliminating waste and overutilization in medical care. That's indeed what the public wanted. But without more explanation about how these goals would be made achievable, the public could not see how to program expansion and cost reduction were compatible, or how these two thousand pages made them so. Furthermore, the public could not see what urgency justified delivering a stack of paper to congressional authorizing committees in the morning and demanding an affirmative vote in the afternoon of the same day. Consequently, the conviction took hold that what was proposed might end up being a massive cut in Medicare benefits to pay for it. Soon after the voluminous bills were released, the Congressional Budget Office (CBO) further undermined trust in the proposal by announcing the assessment it would add a trillion dollars to health costs in ten years, but still would only extend insurance to about half of the uninsured population. That didn't sound like universal coverage at no added cost. Furthermore, the CBO had credibility, in fact, was the only credible agency that had actually studied this massive legislation. Since the President immediately appeared on television, endlessly repeating the promise that the extra cost would not add one dime to the public debt, fear of large impending Medicare cuts was entirely plausible if you believed anything the man said. The public uproar about an implausible idea thus became general before members of Congress had time to read it or devise soothing explanations; this floundering appearance upset the public even more.
To rescue the deteriorating situation, the President attempted to go directly to the public with weeks of daily speeches, and on one Sunday appeared personally on five television talk shows. Naturally many speeches were ghost-written, containing misstatements or exaggerations, with the result that the harried President next resorted to heated oratory that would have been excessive even on the campaign trail. He was criticized as using rabble-rousing undignified for a sitting President. Failing in a "trust me" approach, he was left with the difficult choice of withdrawing the proposal or being seen to ram it through Congress on a party-line vote. Party-line enactments of controversial legislation tend to provoke the opposition party to repeal a controversial law just as soon as the opposition returns to power.
With the public bewildered as to what the proposal really was, enacting something certain to be reversed was unappealing. The alternative, a humiliating withdrawal of the proposal, seemed intolerable to its strongest supporters. But reversal did not seem unreasonable to independent voters, who had wondered all along why there was such haste. The nation was fighting two wars, both of them going bad, and was in the deepest economic recession since 1937. What's the hurry with this healthcare thing? It was a reasonable question, and the President did not help himself by reflexly accusing opponents of delaying tactics.
In this analysis, the following three sections address 1) the proposal and its own flaws, particularly a salvage strategy for getting enacted. 2) The growing consequences of flaws in health financing which long pre-existed Obamacare and 3) An improved proposal, not so much radical, as extensive. For a century, conservative proposals of all sorts have been incremental, creating opportunities for mid-course corrections. Often denounced as hesitant and timid, a grand strategy often takes longer than a pitched battle, but usually advances farther and more enduringly.
Three Different Ways of Looking at the American Revolution.
If you are a resident of nearby Boston, the American Revolution began on April 19, 1775, at Lexington and Concord for reasons having to do with smuggling and tea. If you live near Philadelphia, the chances are fairly good you believe the Revolution began on July 4, 1776, because Admiral Howe attacked us. What's this all about?
The colonies had fought the French and Indian War loyally together, with George Washington at Fort Necessity and Ben Franklin supplying wagons to General Braddock with his own money, against the hated French and their Indian allies, English colonists fighting off the enemy, side by side from 1754 to 1763, even back as far as traveling together to the Albany Conference in 1745. Ben Franklin drew the first newspaper cartoon, Join or Die, at that time, and first proposed an alliance of the thirteen English colonies with the homeland. The Quakers would probably still dominate Philadelphia, if they hadn't chosen religious consistency over the dictates of power. And yet a few years later the British were chasing gunpowder stores around the countryside. The British wanted the Americans to help pay the cost of their own defense, but we were all Englishmen, together, and everybody wants something for nothing. New Englanders wanted a negotiated arrangement like Ireland or union like the Scots; these were only technical details.The slogan aimed at representation, not independence. "No taxation without representation" for English-speaking colonists. Eventually, they hoped for parliamentary membership. They were mainly fighting against mercantilism using taxation as a weapon to fend off taxes while they remained English settlers. Franklin wanted a little more, moving the capitol to America because it was biggest, and he nursed this view until King insulted him in person,a few weeks or months before he grudgingly returned to America to help lead the Independence movement.
But this is the story of the forming of the Constitution, and in the fight to remain untaxed, English settlers got left behind and will be left to drift along. Got left behind by the Treaty of Westphalia. Everyone hates to be persuaded of something which hurts his self-interest, and Westphalia said the land became private property if the King had the exclusive right to adjust the borders, and by implication the local religion. That may have been useful in dealing with Indian lands, but in the sixteenth century, people took their religion pretty seriously. That was a serious matter, and it was made worse for Protestants as a consequence of Catholic activity in which Protestants played no role. Even worse, it was accepted by an English King who was German about whom Episcopal Englishmen had some reservations. And still worse was to see German Hessian soldiers about to do most of the fighting arriving in the troop transports, paid for by a German King, enforcing a law most of them didn't understand which had unexpected twists to it which sounded like the fight they ware already fighting about taxation without representation. Remember, Ben Franklin only had a second-grade education, and most of the colonists couldn't read and write. There were only a handful of lawyers in America, and most of them had a conflict of interest about this subject, which was cataclysmic in its sweeping implications.
The logic of the new German law which only a few lawyers could follow sounded like a trap. The lawyers back in England at the Inns of Court might explain it, but the essence was that rebellion was punishable by hanging, while Independence was settled by treaty. The colonists might not understand how they got into this fix, but the new legal situation created a much worse punishment for rebellion than for Independence, and hence a strong incentive to prefer Independence. Admiral Howe was only 90 miles away with dozens of warships and hundreds of troop transports, and the Continental Congress was in Philadelphia with the power to make a choice. The Germans had just experienced a large wave of immigration, more German soldiers were sitting in the transports, anxious to obey the orders of a German King, which started as a law passed by other Germans without a vote by any of the colonists affected, starting fight a war about taxation without representation, which hardly anyone had the education to understand.
It was, so to speak, a perfect storm. We came very close to losing that war, so after three centuries it is still true: Whether it was the League of Nations or the United Nations, or changing the Health System -- you have a hard time convincing the American public that it's a good idea to follow he decisions of non-American leaders. If the idea was foreign, and particularly if control is left in non-American hands it's going to be a hard job persuading Americans to vote for it.
england
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.
