Philadelphia Reflections

The musings of a physician who has served the community for over six decades

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Front and Back Flaps


Foldback, Front Cover

This book further expands the hidden advantages of Health Savings Accounts (HSA), which the author had a hand in creating in 1981, along with John McClaughry of Vermont when John was Senior Policy Advisor in the Reagan White House. Temporarily skipping a confrontation with the Affordable Care Act (ACA) for lack of certainty about where it stands, we expand the horizon to lifetime health insurance and discover that Medicare poses the most important obstacle. HSAs had more advantages than we had realized, but Medicare poses more issues.

By turning HSAs into healthcare-plus-retirement funds, they are unchanged except for adding retirement as a new incentive to save. By simplifying reimbursement, they expose the ineffectiveness of third-party policing, and instead, gather money to be multiplied by investment. They offer a potential vehicle for subsidies to the poor, a Christmas savings fund for the frugal, and interstate mobility for the rich. For retirement, Social Security is an overlap, while Medicare is a direct competitor, beginning simultaneously with retirement and dominating the same funds.

Finally, the idea dawns, the simplicity of HSAs provides excellent avenues for a gradual transition to new programs, plus an easy escape hatch if they fail. Beads on a string, as it were, with a common healthcare-and-retirement fund, as a unified incentive for savings in both programs. It might take fifty years to implement every step proposed. But then, it took fifty years to get into this situation, except now we must start with the biggest expense first -- Medicare.


Foldback, Back Cover

George Ross Fisher III M.D.

George Ross Fisher, MD, the author of this book, graduated from the Lawrenceville School in 1942, from Yale University in 1945, and from Columbia University, College of Physicians and Surgeons in 1948. After postgraduate training at Pennsylvania Hospital, Thomas Jefferson University, and the National Institutes of Health, he spent 60 years practicing medicine in Philadelphia and consulting in New Jersey and Delaware. During that time, he spent 25 years as a delegate to the American Medical Association, and as a trustee of a number of medical organizations.

Following retirement, he formed a publishing company, Ross and Perry, Inc, which has published several hundred books, mostly reprints. He is personally the author of eleven books about Philadelphia history, from William Penn to Grace Kelly. He is the author of the following three books about medical economics:

The Hospital That Ate Chicago; Health Savings Accounts: Planning for Prosperity; Surmounting Health Costs to Retire: Health (and Retirement) Savings Accounts and Beads on a String: Further Extending Health (and Retirement) Savings Accounts


Book cover back page, possibly in conjunction with above box and introduction, possibly omitted:

Health savings account

From Wikipedia, the free encyclopedia

This article is about medical savings accounts in the United States and their connection to Medicare. For international uses, see medical savings account. Health care in the United States

It's also about the Centrality of Medicare in any major healthcare reform, for whatever age.


Originally published: Tuesday, November 22, 2016; most-recently modified: Monday, May 20, 2019