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Mr. Alan Greenspan
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When there is inflation, the value of money goes down, so you might expect interest rates -- the rental cost of money -- to go down, too. However, people anticipate higher prices, so lenders build a premium into the interest rate structure to compensate for the value of the money to be lower when it is repaid. That raises interest rates, and the Federal Reserve will generally raise them even higher to put a stop to inflation. So, buying and selling bonds is a zero-sum game, far riskier than it sounds. Consequently, there is a flight toward common stock, thus raising its price. Meanwhile, inflation usually hurts business, tending to lower the stock prices. As a consequence of all these moving parts, long-term investors are urged to buy at a "fair" price and never sell, no matter what. Even that strategy fails for any given stock because somehow corporations seldom thrive for more than seventy-five years. So, the advice is to diversify into a basket of stocks, and the cheapest way to get that basket is to buy an index fund. In a sense, you can forget about the stock market and let someone else manage the index, for about 7 "basis points", that is, seven-hundredths of a percent. All of this explains the choice suggested for Health Savings Accounts of buying total market index funds. Limiting the universe to American stocks is based on a political hunch that it reduces the chances of harmful Congressional protectionism. Having said that, a Health Savings Account must raise cash from time to time, and to guard against forced selling in a down market, some average amount of U.S. Treasury bonds will have to be maintained. Ideally, the number of Treasuries would be small for young people, and grow as they get older, and therefore more likely to get sick. Pregnancy is the one universal cost risk for younger people, and they know better than anyone what the chances of that would be in their own case.
This approach is greatly strengthened by reference to the modern theory of a "natural" interest rate, to which the whole system has a tendency to revert, if only we knew what the natural rate is. It is not entirely constant, but over time it seems to be something like 2%. If we knew for certain what it was, we could set a goal for perpetuities like the Health Savings Account to be "2% plus inflation". Since inflation is targeted by the Federal Reserve as 2%, that would amount to an investment goal of 4%. If you can buy an American total market index fund consistently gaining at 4.007 % per year, you should buy and hold. If it rains less than that, it is either run by incompetents, or it is a bargain which will eventually revert to 4.007% and pay a bonus. If, on the other hand, it gains more than that, there exists a risk it will revert to the mean. That it is being run by a genius is sales hype to be ignored. We suggest buying into it in twenty yearly installments, which should balance out the ups and downs, so then you can forget about even this issue.
But don't count the same issue twice. In order to assure a 2% real return, it is necessary to obtain 4% in the real world of 2% inflation, and the compounded income of 4% accounts for both in equal measure. A compound income of 6%, however, is two-thirds inflation / one third "real", so artificially raising interest rates to control inflation can progressively overstate the requirement, and hence overdo the deflationary intent. Conversely, when the Federal Reserve fails to raise interest rates as Mr. Greenspan did, the result can be an inflationary bubble. The central flaw in adjusting prevailing rates to current natural rates is that we do not know precisely what the natural rate is. To go a step further for immediate purposes, we are also uncertain how much deviation there is between medical inflation and general inflation. As a result, the best we can expect is to make as much income on the deposits as we safely can, and continuously monitor whether the premium contributions to Health Savings Accounts might need to be adjusted. And the safest way to do that is to have two insurance systems side-by-side, one of them a pay-as-you-go conventional policy for basic needs during the working years, and a second one whose entire purpose is to over-fund the heavy expenses at the end of life and the retirement years, permitting any surpluses to be spent for non-medical purposes. With luck, the beneficiary might retain a choice between increased premiums, and increased (or decreased) benefits.
If these calculations are even approximately close, the financial savings would be several percents of GDP, a windfall so large that mid-course adjustments could be tolerated.
My wife once remarked that having children was like making pancakes; just throw the first two away. But she only had four children, her grandmother had ten. Her daughters had two. Increased education makes childhood longer, while improved health lengthens retirement. The working period, age 25-65, however, has already extended its borders, pretty much to the limit. Ben Franklin's crusade to use healthcare to put sick people back to work, has been superseded for lack of orphans and invalids. In the past fifty years, miscarriage changed from passing nuisance into a devastating disaster because waiting to have the first child is largely an athletic event. In the future, population unbalancing will mostly depend on more retirees. There's a big economic effect. Neither children nor retirees earn very much, so the wealth of the country comes from ages 25-65, which must support everybody else. Countermovements seem remarkably feeble. The pressure to retire later in life is voiced but not much acted upon while starting work younger must contend with the publicity that more education increases lifetime income. It is too early to know how realistic it would be to shorten school vacations or to pack more education into shorter time at school, with electronic teaching.
In a simpler age, parents supported their children and their aging parents. It was unusual for women to earn very much, so marriage contracts enforced a support requirement. While the employment of women broadened the base of earnings, weakening the marriage institution threatened the retirement security of unmarried women. The political reaction to these changes has been a tendency to substitute government support and retirement programs for the family-based support system. Our national commitment to equal justice has had a tendency to make the new government system more expensive than the old family one. It once seemed just and natural for the wife of an impoverished man to be impoverished, but now the standard has moved to equality of treatment. In all classes of life, there is a tendency for discordance between males and females. The poor single woman gets more money, the poor single male probably gets less. The prosperous single woman gets less that she has been accustomed to, the prosperous single male is probably better off. It is too early to know how the new legislative climate will affect homosexuals. There is little doubt these changes will affect political attitudes of almost all demographic groups, but great uncertainty about the degree and direction.
Nothing makes it likely there can be much change in the dependence of the whole system on financial transfers from working groups to non-working ones. However, the system of collecting in the form of taxes and disbursing in the form of subsidies is both inefficient and disagreeable. A particularly inefficient way to accomplish this response to a weakened family structure is found in health insurance, now representing close to 18% of Gross Domestic Product (GDP). If we are to take money from younger people and transfer it to older ones, we should be collecting investment income on the decades-long interval. This is a continuous process, not a one-off transfer, and the amounts involved are seriously large. While the issue is the same for Social Security as it is for Medicare, it is easier to see how it came about in Medicare. In any new program, there is usually a transition problem to be financed, quite often by phasing it in. In the case of Medicare, the choice was made to facilitate passage of the legislation by employing "Pay as you go". In this system, the early recipients receive full benefits without paying anything toward them and are paid by the contributions of the new younger beneficiaries who will not need benefits for many decades. In other words, the system functions on the cash flow of the system instead of on funded reserves. Its great danger lies in the possibility that some generation (in this case the Baby Boomers) will eventually create a beneficiary class too large to be supported by smaller later generations. This pitfall has received much attention, but unfortunately, very little attention has been given to the problem mentioned earlier: no interest or investment income is derived from funded reserves, as is quite common in whole-life life insurance.
Nor should it happen, if the price to be paid is to have the Federal Government become the largest owner of common stock control of the private sector. That would be a very large step in the direction of government ownership of the means of production, otherwise known as Communism. With present artificially suppressed interest rates, the investment return available to governments is so small it could well be counter-productive. Borrowing from yourself is a useless exercise, and if confined to government bonds, puts the nation in a vulnerable position with potentially hostile foreign nations, or even supra-national organizations like the UN, who could one day have an agenda we consider hostile, under the control of a unicameral body dominated by one-state, one-vote system. No matter how it is arranged, it involves a loss of sovereignty for an unacceptably large part of our economy, eventually leading to a total loss of sovereignty. This transfer of funds from young to old must remain in private hands, with individual voters retaining control of it. Unfortunately, a great many intended beneficiaries are incapable of managing their own affairs, so there is a significant agency risk. That's a nice way of saying that a great many people have been cheated by friends and relatives they unwisely trusted, and there is every reason to look an offended politician straight in the eye and say, "I'm sorry, but I don't trust you." Unfortunately, this commonly results in the ones you can trust, charging an exorbitant fee for the simple role of being trustworthy. This is not a new problem. The only solution is to have at least two systems at the same time: a Prudential group of experts with themselves much to lose from being exposed as less than perfect, giving oversight to at least five competitive funds. How you chose the funds, and how you choose the expert overseers, are crucial.
In conclusion, let me set boundaries for whatever hopes this book might arouse. In the first place, HSAs are tax-exempt. The hidden significance is the government will tend to oppose expanding its concepts to other purposes since Treasury will want to retain as much as it can in the taxable category. This tax exemption is limited to health costs, just as Senator Roth's other qualified retirement programs were limited to paying for retirements. That exposes it to accusations of being a tax dodge perhaps, but it's intentionally limited to health and retirement. Moreover, the added "escrow feature" additionally restrains the individual himself from diverting the tax exemption to unintended purposes. So it's constrained, in two directions. I think that's a good thing, keeping too many people from climbing aboard the lifeboat, and sinking it.
Secondly, no amount of tinkering is likely to make HRSAs cover all health and all retirement costs. One or the other perhaps, but not both. The mathematics of health care and its consequence, extended longevity, simply will not stretch that far. By ignoring all the internal steps, forgetting about transition costs and all the rest, the total cost is more than the total revenue. After applying some strategies, the shortfall has been concentrated into retirement. The conclusion is health costs can be covered, maybe, but retirement costs can't. Adding Social Security, a constrained retirement might be possible, but this is the point where any shortfall was designed to emerge. If your retirement plans revolve around HRSAs, you had better plan to supplement them with other sources. And if you then must plan to mix sources, you are always going to need a common fund, and therefore the individual fund must continue as a place to derive funds for a common purpose and possibly extended tax relief for funds of differing size, rather than a communal paradise. Everybody better keep on planning to work longer, to pinch pennies, and earn some outside income. It isn't going to result in everyone living the life of a character in a Jane Austen novel. That's not to say it's nothing to pay for all of the health care and some of the retirement. It would actually be a great achievement. But even that only becomes possible if everything works exactly as planned. And if it won't, don't count on paradise, work toward it.
Bill Roth of Delaware and Bill Archer of Texas made HRSA politically possible, and John Bogle of Pennsylvania made it financially conceivable with passive investing. Dale Yamamoto the actuary devised the system for measuring medical costs at different ages, and my son George then established the probable feasibility of a lifetime financing. My family, including Miriam, Margaret, Stuart, and Janice, applied the "No prophet in your own valley" approach and picked every nit. John McClaughry lurked in Vermont, fearful to see how I would make a mess of his one-liners. God bless you, every one.
In closing, let's restate the argument:
1. Where does the extra money come from? From investing rather than borrowing the healthcare money. That doubles the effective result.
2. Where did the seed money come from? Initially, from HSA tax exemption, and reduced healthcare expenses. Subsequently, from reduced investment costs, and the fact that both lifetime health costs and compound interest follow J-shaped curves, allowing unused early deposits to accumulate until needed later in life, accelerating toward the time they are used. In recent years, the public discovery that unused funds turn into an IRA at age 65, has led to extra depositing within legal limits. (I propose the same incentive system for Medicare.)
3. Isn't this too complex for the average person? Not since the introduction of low-cost "passive" investing.
4. Aren't interest rates too low to accomplish much? Yes, so this increases the attractiveness of a long-term, low-cost, total market, index-fund investing.
5. Aren't fees too high? Often, they are. Stick to funds with a trillion or more invested, and cost of less than a tenth of a percent.
6. I'm afraid to be a pioneer. You aren't a pioneer. Nearly twenty million people have HSAs already. You need to worry about waiting too long to start because you are dealing with J-shaped curves. If you never get sick, you can spend the enhanced money on retirement living.
7. Is that all? By no means. If you want to bedazzle yourself, consider using leads and lags on a. First and Last-year of Life re-insurance, and b. Grandchildren Inheritance Transfers. There's also c. the possibility that science will eliminate some Medicare costs, so the money can then be transferred to retirement. I propose an automatic transfer of Medicare surplus to Social Security, as an incentive. These are all new ways to cope with transitions and to enhance investment income by prolonging its investment periods, but they probably require legislative confirmation.
It would appear both healthcare and compound interest follow J-shaped curves of slightly different shapes over time, sufficiently to encourage the idea that a little manipulation could make achievable, passive investment pay for all legitimate healthcare as we now know it. For example, a single fairy-godmother deposit at birth would rather easily cover the costs of first-year and last-year of life insurance, if interest rates return to a normal 6.5%. That could also be accomplished by saving $5-10 dollars per paycheck from Medicare
withholding tax from age 25 to 65, provided the savings were continuously invested at 6.5%. Some might argue such estimated investment return is too high, while others might question whether future generations would be sufficiently frugal to continue the process. But most people would say the amounts estimated are small enough to adjust to such questions. Paying for all of the retirement costs, however, is another order of magnitude.
Just as a lot of people warm to the idea of giving newborns an equal financial start, there is a lingering hope that at retirement, everyone might enjoy a more-or-less similar life of leisure. However, a little calculation of the two shows it would be far more difficult to achieve in the case of retirement. If we can agree on a hypothetical number, perhaps it would be debatable whether a hypothetical $20,000 a year might satisfy most ideas of an adequate pension, particularly when reminded this would amount to $40,000 a year for a retired couple. But then just look at what it would cost.
To achieve this goal, savings of $250,000 would be required at age 65. And to achieve that, several of our favorite strategies look a little marginal. We could transfer an increased Medicare withholding tax of $150 a month for forty years and invest it at 6.5%, at the conclusion of which we would have about $250,000. But the newspapers seem certain fifty percent of the population aged 50, have no liquid savings at all. Daunting though it may be, those might be accurate figures. They may well be rough estimates, but do not augur well for asking new hires at age 25 to put away $150 a month, and keep doing it for forty years. Nor does the fairy godmother approach sound like an easy approach. If we imagine an inheritance or a federal subsidy, it would require a lump-sum deposit of $3500 per person at birth to achieve an individual goal of $250,000 at age 65. Or a deposit of $18,000 at age 25, coming from similarly undefined sources. We might look for ways to stretch out the investment period since it would look as though compound interest has a chance of growing faster than the cost of living. If that approach is tapped, it would require a transfer of $700 to a newborn, assuming a 90-year investment time could be manipulated out of thin air. Or $300 for 104 years, the present definition of perpetuity (one lifetime of 84, plus 21 years). Or $150 for 111 years, hoping life expectancy to increase to 90 years looking one lifespan ahead. The trouble with such projections is not so much the dollar amount, which some would say could be inflated away, but the extended time period. All such extensions exceed the human lifetime, depend on someone else to keep them up for someone, who has himself been dead for decades. It is possible to predict great advances in medicine, in computers, and in transportation. But I would not be willing to predict such advances in human nature.
So I would urge everyone to be satisfied with these suggestions for healthcare, looking elsewhere for help with luxury retirement.
Although we intimated retirement funding vastly exceeds the rest of health funding as a problem, everyone in America is also aware that paying for health costs is a tangled, expensive mess. Far from simplifying matters, computers have forced us to stop to justify every step of the process. For a simple example, it would be a great comfort to know someone has seriously studied the details and can assure us the cost of examining claims generates more savings than its cost of doing it. No one doubts more cheating would occur if we paid claims without looking at them, but are we really confident the savings justify such a cost?
After all, the cheating is encouraged by passing it through a third-party, which makes it appear to be cost-free. Meanwhile, the Health Savings Account essentially pays claims with a debit card, relying on the depositor to howl when the charge seems unwarranted. Most managers of HSA would rebel at imposing extra claims processing costs onto a system which keeps customers quiet with a 30% reduction in overall costs. The vast majority of personal expenditures are paid directly by a two-party transaction. Are we really so concerned about chiseling we wish to impose a third-party system on the whole retail economy? Put it another way. Is there something so especially evil about healthcare costs which forces us to single its transactions out for the undeniable costs of claims processing? The problem, dearest friends, is not whether claims processing costs so much. The real problem is why in the world do we use a third-party system to pay for them.
The Health Savings Account asked that question three decades ago and lets the customer be his own policeman with his own money, so long as the amount is less than the deductible. It really is necessary to have insurance to spread the risk of health catastrophes, and so catastrophic health insurance is the cheapest form of it. It happens a reasonably high deductible and the minimum cost of a hospital admission are pretty much the same, so third-party reimbursement is pretty much a hospital problem. There's not much difference in cost between one breakfast and another, so I would interject the comment the hospital problem boils down to the accounting fiction of indirect overhead. Every single hospital expenditure must be assigned to reimbursement, so by calling it indirect overhead it gets paid for by someone, no matter who, and "costs" go up, employees get raises, equipment gets purchased. Just call in ten CPAs drawn from the phone book, and ask them to establish a justification system for any item to be included as indirect overhead. If that doesn't solve your problem, you don't have a problem and might as well stop complaining about it.
So to return to the whole-life model, it seems reasonable to include the Health Savings Account as a model for expenditures. It might be reasonable to impose some standards for catastrophic high-deductible insurance compliance, with the indirect overhead approach as a default option in cases of dubious performance. Otherwise, cost overruns can be restrained by dropping insurance company participation where suspicions are warranted.
Design of the insurance approach is thus fairly simple, leaving energy left over for designing incentives and efficiencies, which we would hope would collectively generate another one percent investment return or its equivalent. Together with the one percent picked up with revenue efficiency, the additional 2% return on investment income might be going far enough. As I see it, we still haven't got to the crux of the matter, however. It's to generate sufficient profit and reserves to carry the system several decades through the transition to full implementation. Unfortunately, everybody wasn't born on the same day, and won't have the same personal reserves. Either we implement this system in stages, or we find some massive funding mechanism to carry it through the rough spots. It isn't adequate to dump the transition problem on the Congressional staff and go on to unrelated matters; this is the make or break issue. Even at the best, it will take several decades to be fully implemented, satisfactorily running, and solvent. So even if we do it this way, it will displease many people, unless--. Unless the scientists soon find an inexpensive cure for two or three major diseases.
So let's look at several pieces of the financing puzzle which might be included within the main structure, or they might remain independent. The choice must save money, however, or it won't serve the purpose.
Superstitions about Health and Medicine
By: Stuart B. Blakely, M.D.
Superstition" is defined by the dictionary as "a notion maintained in spite of evidence to the contrary." This might be paraphrased as "an obstinate belief in something that is probably not so." It is quite impossible to define the words "health" and medicine" in any compact compass, but I think that we can reasonably well understand each other in their use. Please keep in mind though all my talk that definition of superstition "a notion maintained in spite of evidence to the contrary," I hope that you will not carry away with you the idea that I am a sadistic iconoclast, that I delight in destruction for the sake of destroying. I have great respect for ancient faiths and popular beliefs, for they often contain a golden kernel of precious truth. I could give you many examples.
I saw a most interesting one in a textbook on obstetrics published about one hundred years ago. In a footnote about the care of the navel in the newborn, the writer says-- "some midwives believe that if the sheers used to cut the cord is first heated before the fire, and if the cord is then covered with a piece of scorched linen, it (the cord) will heal kindlier. He then adds, "I can see no reason for such belief." We know now that the doctor was wrong, and the midwives right, for by these procedures the sheers and dressing were partially sterilized. They had properly observed cause an effect but had not thought the matter through. I once witnessed an amusing and potentially tragic survival of this ancient practice. I saw an old lady scorch a piece of linen and start to place it on an unhealed cord. When I called her attention to the fact that she had dropped the cloth on the floor and then picked it up again on the way from the kitchen to the nursery, she could not understand what difference that made for had she not followed the formula was it not linen and was it not scorched?
I am not going far afield today. I shall speak of superstitions remember the definition that is more or less current in any community and more or less familiar to you all. Some have their origin in the dim and pagan past. In general, however, they are examples of and result from three curious ways of false and sloppy thinking.
The "post hoe ergo proper home" type of reasoning. The Latin may be translated "after this, therefore because of this." Since B follows A, B is caused by A. For example, I am sick, I take a pill, I get well; therefore, the pill cured me. Not necessarily true at all. Closely linked with this is.
The drawing of conclusions from insufficiencies endorse a very common error. The same crude example of illness may be elaborated to illustrate this also. Ten persons with the same disease take a given pill and get well. Such a report is of little or no worth. If out of a hundred persons with the disease and given the same pill, ninety get well, we begin to have some evidence of the value of that pill in a given condition. I out of a thousand such cases so treated 900 recovers, the evidence is much stronger than the medicine had something to do with their cure provided that the recovery rate of a like number of controls was much lower. In all the cases we are assuming the presence of only one factor must be considered, the drawing of a correct conclusion may be a terribly complicated and difficult problem.
Blind acceptance of statements, hallowed by age or authority, without critical examination and analysis.
No one is immune to the contagion of these three methods of reasoning, for they are the easiest way. Herd, consecutive, antically, constructive thought is one of the hardest tasks that anyone can undertake. Dr. Vincent used to say that when most of us fondly imagine that we are thinking, we are only rearranging our prejudices.
Let us now examine a number of superstitions about health and medicine that are right among us believe by an astonishing number of people who should know better and whose ignorance can be laid directly at the door of our faulty educational system.
It is entirely true that one man's food is another man's poison, but a mass of superstition has grown up about articles of food and drink. This r that food is frequently said to be "especially good" or especially bad" for us; careful examination seldom addresses evidence to support such statements. Milk is certainly not perfect food at least for adults because it is over 90% water. Coffee is claimed to be bad children and cocoa good for then, but both have about the same content of similarly acting drugs. Of course, as usually prepared, cocoa contains more nourishment. In spite of advertising, cereals are not rich in body-building proteins and are not in general "all around" foods. There is no such thing as skin food, and it is not true that fish is brain food. There is no essential difference in food value, digestibility or other quality between light and dark meats. It is very easy to say that something is "hard to digest," but to prove that and to make clear just what is meant is quite difficult. Broths have practically no food value. I have never heard a completely satisfactory explanation of why oysters should be eaten only in those months that contain the letter "R".
Probably one of the most commonly held ideas, even by physicians, is that meat is "bead for", even if not a cause of, high blood pressure and kidney trouble. There is no good evidence that this is true. Vegetarians may suffer from high blood pressure as well as anybody else, and surely Eskimos, who eat meat exclusively, do not all die of kidney trouble. This story is told of Stephenson, the famous Arctic explorer. He was telling some skeptical friends of the harmlessness of a meat diet. His friends said that it might be all right in the frozen north but could not be done with impunity in this climate. Stephenson wagered that h and a companion could and would live exclusively on meat end its products in this country for two years. This they did remain well and in good health and medical examination of them at the end of that period revealed nothing abnormal. The greatest objections to a total meat diet are the bulk required and the cost.
The study of religious food taboos is of great interest, but there is no time. There is no reason why only those fruits should be eaten that grow in the climate of the consumer. An apple a day keeps the doctor away no better than many another wholesome fruit. Incidentally, there is no reason to believe that eating green apples causes colic. Fruit juices make the body less acid, NOT more acid. The advertisement that advises you to "get over on the alkaline side" is rarely scientific. Many advertisements play upon and up to the reader's superstitions. How often have you not known diabetic to reject a small amount of sugar while eating starchy foods in my quantities desired, and gorging on rye, gluten or bran bread which does not differ much from white bread in their carbohydrates content? Americans drink more water than any other people and European think us crazy in this respect. We claim that it is "good for us, but I never have seen it proved. A lot of nonsense has been written and believe about the effect of alcohol on health. Not for one moment do I belittle or underestimate the bad social and economic effects of drinking, but there exists no proof that alcohol in moderation causes any disease. Dr. Osler used to say that bad teeth and oral sepsis have caused more harm to the human race than alcohol. Many alcoholics develop curious ideas and defense mechanisms about their drinking habits. Many still believe that whiskey is an antidote for snake bits.
There are many fads in foods and diets. The strict vegetarian is in error, for the human intestinal tract is geared for a mixed diet. Many fears to eat lobster and milk at the same meal. A short time ago a popular fad was not to mix certain foods, for example, acids and starches. I know nothing to support such fancies. Reducing diets are frequently quite indefensible. The value of fresh against stale foods is large, if not entirely, esthetic. The advertisers of raisins used to ask, "Have you had your iron today?" At present, molasse is highly praised for its iron content. It is true that it is comparatively rich in that metal but not more so than oatmeal. If you need considerable iron and unless you are crazy about molasses, an iron pill is easier to take and cheaper. Vitamins are of real importance. Much is known about them, but a great deal yet remains to be discovered. They are of great interest in many ways one is that we can watch superstitions about them in the making.
It is fallacy that savage man is noteworthily healthy. I doubt that it can be proved that good health protects against diseases, or that exercise is conducive to health. It is not true that the Chinese pay their physicians only while they remain well. The early church was responsible for a hideous superstition when it taught that the human body was sinful and low, something to be scourged and mortified. That idea has permeated our whole life and thought; its eradication her just began, a slow and painful process. All sorts of things are introduced into school curricula, but rarely anything really valuable about a personal, community or general hygiene, using the word "hygiene" in the broadest sense. A man's body is his most precious material possession, the temple of his mind and soul, but he is practically never taught anything true and worth-while about its structure, functions, and care. In this respect, at least our educational system is appallingly stupid.
Germs come in for their share of superstitions. They are usually pictured in many bizarre shapes; actually, their forms are usually extremely simple. A citizen will object most strenuously to the establishment of a contagious hospital in his neighborhood, although the chance of contracting diseases from its presence is exceedingly small in comparison with the danger from common eating and drinking utensils, or from our sputum strewn streets. Fumigation was once held in high esteem but, as you know, has been practically abandoned, for as usually carried out, is without value. Bore acid and peroxide are very feeble antiseptics, and the efficiency of iodine far exceeds that of ordinary mercurochrome. A thing is sterile or not sterile there really is no middle ground, and the briefest and slightest touch of something else spoils its sterility. The possible value of external applications is rarely due to the absorbing power of the skin which is very slight. An iceberg over a threatened appendicitis is no better and no worse than a hot water bag, neither are of probably much value and may be the cause of fatal delay. A rusty nail is dangerous not because it is rusty, but its rust is evidence that it may have been whore tetanus germs abound. All say that frostbite should be rubbed with snow, but probably both friction and cold are bad advice in this condition. Normal blood pressure is NOT one hundred plus your age. A person cannot get warts by taking oil. Night air used to be "bad" when malaria-carrying mosquitos because active with nightfall. The word malaria comes from the Italian "malaria" which means bed air, and chat is its origin. The advice contained in the adage "Feeds a cold and starve a fever" should best be reversed. "Colds" are catching and are usually gotten from someone who has a cold like any other contagious disease.
Intestinal conditions rarely cause fever in adults, and laxatives do not reduce the temperature. Acute indigestion, if there is such an entity, is not associated with severe pain, and is never a cause of death. Grinding of teeth by children in their sleep is not a sign of worms. Worms do not come from candy or other food, but from a person or animal or meat that is infected with or harbors the parasite. Colic, teething, and worms are dangerous diagnoses to make in children, for they are rarely the cause of acute illness. Mothers feel obligated to take their babies out for the sun and air. They could save themselves much effort for their infants could get just as much air if wrapped up and placed in a room with opened windows; as ordinarily wheeled about, the amount, the amount of sun they get is legible with only their faces exposed and these often covered with a veil. While bad orders are objectionable, they do not cause disease. Grape seeds do not cause appendicitis, mad dogs do not cause it to grow thicker, and there are no such things as "growing pains".
Of all the fields of medicine, obstetrics offers the most outstanding example of superstition. The reason for this is a long story. You are probably familiar with some of them that it is dangerous to have the teeth pulled during pregnancy; that a seven months baby is more apt to live than one of eight months; that a raisin is good to put on the cord stump; that it is unwise to out the hair or fingernails of the newborn. Very possibly your attitude toward them is like that of a famous Englishman who said that he did not believe in ghosts but was scared to death of them. It is unnecessary to dwell on the darker of these beliefs. Probably no person here believes that a cat can kill an infant by sucking its breath. Today few believe in possibly some in this room have never even heard of the evil eye. But the old Irish lady who, after praising a baby, says "God bless him", unwittingly adds a saving formula to ward off the influences of evil that ever menace, especially the newborn. The ritual of the christening gives, among other advantages, the child the protection of a name. Probably one of the commonest superstitions is that a mother can, some experience or activity, affect her unborn child, in other words, "mark her baby". The origins of this belief, widespread through the world in all ages and cultures, is obscure but very interesting. Probably the best guess is that it contains the idea of the scapegoat. In savagery true today in our civilization through superfine sensitivity refuses to recognize it a deformed baby was a definite liability, and its mother was a natural scapegoat. In self. protection and as an alibi the idea of "marking" was evolved, by which the mother absolved herself from responsibility for such a birth. But someone will ask, "if that is not the case, how do you explain it?" This, of course, propounds a new question, and inability to answer it does not in the slightest prove the truth of the first. If I could answer all the question, and inability to answer it does not in the slightest prove the truth of the first. If I could answer all the questions that might be asked me about the human body and its working I should be God. If I could tell you exactly what happens in my brain and body when I thus crook my finger, my niche in the Hall of Fame would be assured. There exists no proof that any women have ever "marked" her baby. The cause of the deformities has never been explained.
A common superstition is that the suppression of menstruation will "throw" (just how, is quite obscure) women into tuberculosis. There are many erroneous ideas prevalent about the dangerous effects of cold and water on the menses. Some mothers will not allow their daughters. to even put their hands into cold water during their periods, and the number of women who fear to take a bath during that time is legion. False beliefs about the menopause or change of life are far too common and have led many women to their death. Really very few symptoms are directly attributable to a change of life itself, though almost everything is ascribed to it. It is unfortunate that bleeding is associated with a normal female function for about thirty years of every women's life. Abnormal bleeding from any other body cavity would drive her to seek the doctor early. Be it enough to say that in a normal change of life the bleeding is always less in amount, shorter in duration and farther apart. Anything else is ALWAYS abnormal, it matters not any statement by any person to the contrary, notwithstanding.
Superstitions about "Tumors"
Incorrect medical terminology "tumors" means swelling whether caused by inflammation, blood clot, collection of fluid, new growth or what not. When your wife hits you on the head with the rolling pin and thereby produces a lump, that lump s, strictly speaking, a tumor. When the average women speak of a "tumor", she usually means either a fibroid of the womb or a cyst of the ovary. The proper word of all such as neoplasm or new growth. To new growths disappear spontaneously? Warts certainly do, and many persons have charms to get rid of them if they are not wart charmers themselves? Occasionally, smell cysts of the ovary do. At times, multiple small cystic tumors of the breast. PLEASE note carefully, I said MULTIPLE, not SINGLE tumors of the breast. To the best of my knowledge and for immensely practical and all safe purpose no other new growths ever do. There are two prevalent beliefs about cancer that are false. One, that cancer is always painful; the truth is that pain is never a sign of cancer except in the late and hopeless stage. The other, that cancer cannot be cured; the truth is that many cancers have been and can be cured by early discovery and proper treatment. We know little or nothing about the world the real cause of any tumor will have a place among the immortals of all time.
Superstitions about Healers and Schools of Healing.
Dr. Locke of Canada is a good and recent example of such healers. He has had and still has, many sincere advocates, and he may believe wholeheartedly in himself, his mission and his ability, it has always been thus. But no doctor who has seen his action could by the greatest stretch of charitable imagination understand how the manipulations he performs can have the slightest permanent effort on crippled joints. With his enormous material, he has added nothing to our knowledge about orthopedics. Homeopathy has almost run its course. Some of you have probably been helped by spinal adjustments, and some may even be followers of Mrs. Mary Parker Eddy. It would be foolish to deny that some sufferers have been helped by such men and such methods. It would be strange it if were not so. Most of these schools of healing have taken one small, often neglected, item or branch of the great domain of medicines, and tried, sometimes in well-intentioned ignorance end sometimes in the spirit of pure charlatanism, to build it up into an independent science, though science is not the word. They exceedingly rarely contribute anything that is new or valuable. One of the best answers to all this lunatic fringe of medicine is that it will be a long dark day when trainloads of chiropractors will be rushed to a railroad wreck or the battlefield, or shiploads of Christian Scientists to stamp out a scholar's epidemic. The history of medicine abounds in such individuals and such movements'. They will continue to appear, to have their day, and pass into oblivion. Wishful thinking is no pleasant. It is much easier to say and believe that a thing is so than to prove its worth. Scientific medicine will still march on.
Superstitions about Regaining Lost Health.
Energy, once expended, can never be restored. Once gone, it is gone forever; nothing can ever bring it back. Nature always exacts her penalty for folly. Man has always been willing to suffer agonies and torture, to do anything, to pay any price to recover lost health. We break or disregard the laws of health which are usually so plain that he who runs may read. Then we hopefully, frantically, often too late, strive to undo the evil by the magic of some cure: the waters of some reputedly healing spring; the restoring power of some system of mental therapy (remember the errant nonsense of Dr. Coue's "every day in every way I am getting better and better"); penance or prayerful petition to some anthropomorphic god; the exhibition of some holy relic, or a visit to some sacred shrine; the administration of some medicine of magic potency. Many patent medicines illustrate the last-named superstition and are still sold in large quantities. Someone has said that all patent medicines contain a bitter, an aromatic, a laxative and alcohol. Incidentally, many people are seen to judge the strength of medicine by its nauseating or near strangling power. The fountain of youth ever beckons us on. The elixir of life has yet to be found. We still believe in magic.
Superstitions about State Medicine
Health is not something that can be bought, bestowed, given away or insured. In all the drive and propaganda for socialized medicine formerly called "health insurance" and as seam but now dropped as an impossible concept, not a word is said about the MEANS of health, and nothing about individual instruction in and for health. Health is largely an educational and individual thing. The government fosters and attempts to foist upon the people of this country some miserable superstitions that illness is the greatest cause of poverty; that organized medicine has failed, and medical men are remiss and lack social consciousness; that socialized medicine can and will solve all the unsolved problems; that we shall, almost overnight and at relatively small cost, banish illness, disease, almost death itself. They are all cruel untruths.
In no please where socialized medicine has been put into effect has the incidence of illness been lessened, disease been prevented or the death rate lowered, the only honest criteria by which its efficiency can be judged. Mass production, assembly line tactics and political control do not work well in the domain of medicine. This country has the lowest disease and death rate in the whole world, and the finest hospital system in existence. The medical profession has made it so. No one knows better or is more genuinely interested in the medical needs and shortcomings of this country than the doctors. The medical profession takes strenuous exception to the false assumption that socialized medicine is the only method capable of solving the health and medical problems of the United States. The superstition of the benevolence, all-wisdom, and all-powerfulness of government is freighted with tragic disappointment for us all.
Superstitions about Doctors.
In some mysterious way the physician has been credited with possessing the powers of life and death. Such a mystery has always been feared; such power must be curbed. Accordingly, society has always wished to make the medical man either a slave or a god and still does. In many ways, it is unfortunate that the old family physician has been idealized into a see-all, know-all type of being because it is not a true picture. He is usually represented as follows he came, took the patient's temperature, counted the pulse, asked a few questions, mumbled a bit and doled out some medicine. If the patient recovered, the doctor got the credit, frequently deserved; if he died, it was God's will to be bowed to in resignation.
The attitude toward the physician has profoundly changed in recent time. There are several reasons for this. ONE the physician no longer lays claim to the omniscience which was freely ascribed to the stereotyped old practitioner,TWO the laity, I.e. the non-medical part of the population knows more about doctors and medicine, even though they know so many things that are (speaking ungrammatically) "just isn't so." THREE the present generation is impatient and wants things done in a hurry, a procedure that is rarely compatible with good modern practice. FOUR this generation is also unwilling to bow to God's or anybody's will. The reason that illness and death ought to be prevented, which all grant is desirable but by no means always possible. Since they are not prevented, they further reason that someone is to blame, which is some is to blame, which is sometimes true. However, they Seldom blame themselves, their own acts or their own ignorance, or the failure or shortcomings of the social order; nor are they over willing as the negro aid, to cooperate with the inevitable. They have been taught to shrink from the stark realities of life. They do not like to hear that we all must die. Instead, they frequently turn upon the doctor who is conveniently and helplessly near from birth through life to death. I have heard a person state to a group that Dr. So and so "killed Mrs. Jones, or Smith or Brown," a statement for which she had little evidence to any nothing about proof, and against which the doctor is powerless to defend himself.
Many harsh things have been said about my profession. I think it was Voltaire who said that doctors our medicine of which they know little into bodies of which they know less for diseases of which they know nothing at all. at the other end of the scale is Robert Louis Stevenson's Tribute to the Physicians. Doctors are sometimes foolish, sometimes ignorant, sometimes dishonest, occasionally knives. They make mistakes, which because of nature their work is sometimes tragic in their results. In other words, they are frail human beings like yourselves. There is no superior, all-wise being who chooses and decides who shall become your physicians. The modern doctor is better trained in his profession than in any period of the past. In general, he is the best-educated man in the community, as to being almost always has been. He is deeply religious, general impression to the contrary notwithstanding. he is humble for he deals with the intricate complexity of living things and is in content daily and intimately with the great mystery of life. The human body has been compared with an automobile. The comparison would be more valid if the automobile could repair itself with materials of its own production. While the physicians today possess a real specific cure for many diseased conditions, he still recognized the limitations of even modern medicine. He sincerely subscribes to the great truth in that sentence of Ambroise Pere, a famous harbor surgeon o the 16th century who said, "I treated him and God cured him." Individually and in groups he contributes a great deal to his community, and none deserves better at the hands of his fellow citizens. He exemplifies that "greater love hath no man this, that a man lay down his life for his friend."
I have reviewed (this afternoon) a few superstitions about health and medicine. I hope that I have interested you and have given you something to think about. If I have cleared away some of the notions that you have held about these things in spite of evidence to the contrary, I am satisfied. It has been a great pleasure for me.
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.