The musings of a physician who served the community for over six decades
367 Topics
Downtown A discussion about downtown area in Philadelphia and connections from today with its historical past.
West of Broad A collection of articles about the area west of Broad Street, Philadelphia, Pennsylvania.
Delaware (State of) Originally the "lower counties" of Pennsylvania, and thus one of three Quaker colonies founded by William Penn, Delaware has developed its own set of traditions and history.
Religious Philadelphia William Penn wanted a colony with religious freedom. A considerable number, if not the majority, of American religious denominations were founded in this city. The main misconception about religious Philadelphia is that it is Quaker-dominated. But the broader misconception is that it is not Quaker-dominated.
Particular Sights to See:Center City Taxi drivers tell tourists that Center City is a "shining city on a hill". During the Industrial Era, the city almost urbanized out to the county line, and then retreated. Right now, the urban center is surrounded by a semi-deserted ring of former factories.
Philadelphia's Middle Urban Ring Philadelphia grew rapidly for seventy years after the Civil War, then gradually lost population. Skyscrapers drain population upwards, suburbs beckon outwards. The result: a ring around center city, mixed prosperous and dilapidated. Future in doubt.
Historical Motor Excursion North of Philadelphia The narrow waist of New Jersey was the upper border of William Penn's vast land holdings, and the outer edge of Quaker influence. In 1776-77, Lord Howe made this strip the main highway of his attempt to subjugate the Colonies.
Land Tour Around Delaware Bay Start in Philadelphia, take two days to tour around Delaware Bay. Down the New Jersey side to Cape May, ferry over to Lewes, tour up to Dover and New Castle, visit Winterthur, Longwood Gardens, Brandywine Battlefield and art museum, then back to Philadelphia. Try it!
Tourist Trips Around Philadelphia and the Quaker Colonies The states of Pennsylvania, Delaware, and southern New Jersey all belonged to William Penn the Quaker. He was the largest private landholder in American history. Using explicit directions, comprehensive touring of the Quaker Colonies takes seven full days. Local residents would need a couple dozen one-day trips to get up to speed.
Touring Philadelphia's Western Regions Philadelpia County had two hundred farms in 1950, but is now thickly settled in all directions. Western regions along the Schuylkill are still spread out somewhat; with many historic estates.
Up the King's High Way New Jersey has a narrow waistline, with New York harbor at one end, and Delaware Bay on the other. Traffic and history travelled the Kings Highway along this path between New York and Philadelphia.
Arch Street: from Sixth to Second When the large meeting house at Fourth and Arch was built, many Quakers moved their houses to the area. At that time, "North of Market" implied the Quaker region of town.
Up Market Street to Sixth and Walnut Millions of eye patients have been asked to read the passage from Franklin's autobiography, "I walked up Market Street, etc." which is commonly printed on eye-test cards. Here's your chance to do it.
Sixth and Walnut over to Broad and Sansom In 1751, the Pennsylvania Hospital at 8th and Spruce was 'way out in the country. Now it is in the center of a city, but the area still remains dominated by medical institutions.
Montgomery and Bucks Counties The Philadelphia metropolitan region has five Pennsylvania counties, four New Jersey counties, one northern county in the state of Delaware. Here are the four Pennsylvania suburban ones.
Northern Overland Escape Path of the Philadelphia Tories 1 of 1 (16) Grievances provoking the American Revolutionary War left many Philadelphians unprovoked. Loyalists often fled to Canada, especially Kingston, Ontario. Decades later the flow of dissidents reversed, Canadian anti-royalists taking refuge south of the border.
City Hall to Chestnut Hill There are lots of ways to go from City Hall to Chestnut Hill, including the train from Suburban Station, or from 11th and Market. This tour imagines your driving your car out the Ben Franklin Parkway to Kelly Drive, and then up the Wissahickon.
Philadelphia Reflections is a history of the area around Philadelphia, PA
... William Penn's Quaker Colonies
plus medicine, economics and politics ... nearly 4,000 articles in all
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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.
Warning: Crowd-Out. When Health insurance was still a novelty, sickness and health seemed like a lottery. With time, it became apparent that about half of healthcare costs were routine, particularly if you view the cost of being born and the cost of that dreadful last year of life as 100% certain for everybody. In this book, we gradually evolved a system which is about half insurance, half pre-payment. Bear with a little repetition: medical costs are crowded near the end of life, concentrated in people who are no longer working. That is an advantage when you imagine a method of saving in advance because a considerable cost reduction will result from investment and compound interest coming early, while heavier expenses come late. By instituting a "pay as you go" system at the beginning of a huge scientific reduction in disease, "pay as you go" managed to survive for fifty years. Meanwhile, the pre-paid system we have conjectured would have done much better, because increased longevity compounds investments for a longer period of time. Health pre-funding seems to be the better approach, no matter what happens to the science of medicine. That may not be true if non-medical forces dominate the next century of the environment of health care, but at least this point seems settled.
That's one way of looking at health costs, but it is also possible to see them as part of a huge transfer system between generations, which will endure under any set of circumstances. The really sick people are often unable to pay for themselves out of current earnings; that's the old retired generation. Working people in a younger generation are better able to pay, but they mostly aren't sick. Since there is essentially no one else left, working people must simply face up to paying for sick people, under any system it is possible to devise. To acknowledge those facts isn't a sign of being compassionate, it's a sign of common sense.
And there is one more fact of the matter: most people simply don't trust an implicit promise of repayment "when their turn comes", fifty or more years later. Governments develop more urgent priorities, like national defense, which for thousands of years repeatedly diverted loose cash to new projects. Regardless of motives or promises, experience teaches that governments are unreliable custodians of private wealth. Experience, therefore, suggests it might be best to exclude routine medical costs from a government-run system, thereby enhancing public protectiveness for what is left. If circumstances force routine costs to be included, the long-run strategy should endure: try to transfer such costs back to the private sector, and if possible back to individual responsibility whenever that does become feasible. Don't let government get off cheap when you must ask for its help.
The Medicare Annual Deficit. The present predicament of Medicare offers a particularly vivid example. Medicare is popular with everyone, so popular indeed that many wish to convert the whole medical system to "single payer", which is to say: put everyone on Medicare. Unfortunately, the reason it is so popular is exactly the reason we can't continue it; it's at least fifty percent subsidized, and the government is running out of borrowing power to cover it. In 2011, Medicare spent $550 billion, but its total revenue was $530 billion. That leaves the impression that Medicare debt only increased by $19 billion. Unfortunately, $223 billion of its "revenues" were "transfers from general revenue", which is to say: deficits ten times bigger were made up from general tax revenue. The government borrowed this money, incidentally depleting the so-called trust funds of $19 billion, for a total program deficit of $242 billion. Distributed over the 48 million Medicare beneficiaries, that's an average yearly deficit of over $5000 apiece. The average Medicare subscriber meanwhile shares in Medicare expenditures amounting to about $10,000 a year apiece. (Medicare expenses $10,000 a year per subscriber, program revenue only $5000.) No wonder it is popular. Indeed, since the Department of HHS reports that hospitals across the country routinely surcharge their audited costs by 400% in their claims charges (and patient bills), the public is easily under the illusion that it gets $50,000 of services at a cost to themselves of only $5,000. But the ratio of charges to costs is another matter entirely, taken up later. The point here is that there is a $5,000 subsidy, per Medicare subscriber per year, and there are about 50 million subscribers. These are 2011 statistics; the subsidy is constantly growing, is now the largest domestic contributor to the national deficit, and Obamacare may or may not make it worse.
In 1965 it was possible to look at these matters with more tolerance. In the first place, America had enjoyed a favorable balance of trade with the rest of the world for twenty years since World War II, and could not be expected to realize this balance was about to turn negative, apparently forever. Medicare was then new and untested, and the employer-based insurance community argued strongly and effectively that it had done its fair share without government subsidy. So, it seemed fair for the government to act as payor of last resort for the unpredictable costs of starting the system with a large cohort of elderly -- who immediately had Medicare costs but no prior opportunity to pay any Medicare payroll withholding taxes, the main source of new funds for the program. There had to be a way to pay for the indigent elderly, and the startup costs; and to get it through Congress. Presumably, it was planned to make adjustments and creep up on the deficit, but it never happened. So the designation of "transfers from general revenue" as a revenue source instead of a liability was not an accounting accident or illegal; it was just the complicated new system making optimistic guesses about the future, and guessing wrong. From the beginning, a well-intentioned design generated unsustainable deficits, and no one had the heart to say so. Now that we begin to see we must give up something else to be able to afford to continue on this path, we hear other things are being crowded out. The alternative to facing facts will lead to an unsustainable debt burden, adding force to a recession's artificially suppressed interest rates, potentially leading to a weakened international dollar, eventually raising the unthinkable specter of the dollar losing its status as a reserve currency. It is not necessary to understand monetary policy to understand that an implacable limit to the nation's borrowing -- is beginning to arrive.
When creditors sense they may not be repaid, they raise interest rates, so it gets even harder to "service" the debt. Other valuable parts of the economy cannot pay higher interest rates, so they get "crowded out" of the debt market, or else something they must buy gets crowded out. That's the first sign of serious trouble, and should be taken seriously, because people getting crowded out lose their willingness to help others.
Since Benjamin Franklin's time and before, there has been little dispute that saving for a rainy day is a generally good thing. The big problem has always been that to save more, you must spend less. True, spending more and saving more is hard to imagine, but quirks in health insurance might indeed make it possible to save more while spending about the same. The lucky circumstance that major health costs cluster toward the end of life provides a long preliminary period when compound interest could be at work. It should also be possible to persuade even the revenue-hungry Congress that allowing health benefits to be tax exemptions and allowing their internal interest income to be tax-sheltered, represent no greater revenue cost than is now accorded the pay-as-you-go system. Taking before-tax income and compounding it, tax-exempt, for a long period of time can generate astonishing sums of money.
But you must start with some seed money. The heart proposal for a relatively painless transition to funded health insurance is to abandon the insurance mechanism for small medical costs. Health insurance would not pay anything until a person's health costs totaled, say, $500. In insurance jargon, we would abandon "first-dollar" coverage and impose a subtab=ntial "front-end deductible". Please don't get hysterical; just listen how money gets taken from one pocket and placed in another in this way. Quite obviously, the premium for $500-deductible insurance is smaller (by about 25%) than for first-dollar coverage. Equally obviously, the subscriber then has to pay out of pocket for some medical costs which formerly seemed free. However, if the employer contributed the same amount the employee hasn't lost money, just undergone forced saving. Since some medical care then has less illusion of being a free lunch, there will be some "utilization" saving. (see Table A) That's one true saving which contributes to the seed capital we're trying to build up.
A second real saving generated by high deductible insurance comes from the way the employee makes interest-free loans to the system. Whenever he digs into his pocket and pays medical expenses which do not total up to the annual deductible, an equivalent sum (which first-dollar insurance would have paid out) continues to earn interest within his funded insurance. His employer is paying for the medical expense, but the payments get locked into the investment fund. The double payment might otherwise have increased personal savings, or it might have been "squandered on drink"). If the money would have been saved, it earns a greater return in a tax-sheltered account. If the money would have gone for luxuries, it is no matter. However, if it actually deprives a marginal income producer of true necessities, some readjustment must be made and the ultimate result will probably be increased cost to the employer. Since at most we are talking about $5 a week, this obstacle does not seem as serious as the problem we are trying to solve. Excluded from all this discussion, of course, are those truly poor people whose medical care is destined to come from private or public charity. A funded system will reduce the number of charity cases, but it does not pretend to address their medical payments directly.
The third source of cost saving, hence seed capital for investment, comes from eliminating the rather horrendous costs of processing insurance forms and checks for millions of little medical expenses which aggregate to less than $500 a year per individual. The fourth section of this book ("Tangles") deals at length with the complexities going on inside those big insurance company buildings. Suffice it here to say the national cost of insurance administration and processing is at least $xxxx billion, a sum equal to 1/xxx of the federal deficit or 1/xxx of the loss in the international balance of trade. It makes no sense use insurance to pay a five-dollar claim with a bank check, because it costs at least $1.50 to produce, send, credit, deposit and reconcile the check. It makes no sense to require a claim form to be filled out, mailed, received, opened, verified, and processed because it costs from two to six dollars to do it. To go through all this processing for a five-dollar charge essentially doubles it into a ten-dollar cost. This sort of thing happens every single day in my office, and it must happen millions of times a day nationally. The cost in extra mail bags alone must be appreciable. So, a large front-end deductible health insurance policy is definitely less costly to society than a first-dollar policy which pays for exactly the same medical care at the same prices. The savings would become part of the nest-egg saved up in the funded insurance.
Proposals For Reform of Health Care Financing: AMA Resolution, No loss/No Gain Clauses in Group Health Insurance
WHEREAS a "no loss / no gain" clause in a group health insurance contract assures employees that an employer who transfers the group to a new insurance carrier will not create "pre-existing illness" exclusions or loss of benefits under an ongoing claim under the old carrier.
AND WHEREAS some states (Arizona, California, Connecticut, Florida, Georgia, Minnesota, New Hampshire, New Jersey, North Dakota, New Mexico, Rhode Island, South Carolina, Texas, and Wisconsin) require the inclusion of "no loss/no gain" clauses, state do not.
THEREFORE BE IT RESOLVED that the AMA review the experience in states which require "no Loss / no gain" . clauses in group health contracts, with recommendations as to whether AMA activities to promote that concept or some alternative, might be appropriate.
Typical language for no loss/no gain:
Benefits are payable for pre-existing conditions if you or your dependents were insured for all of the benefits under the old plan on the date it ended. Benefits will be the lesser of the benefits payable under the new plan as if there were no pre-existing conditions section; or the benefits that would have been payable under the old plan.
It's not big news that Medicare could run out of funds by the early 1990s. And government solutions are no revelation, either. They go from price-fixing capping payments at the hospital bed or at the stethoscope to making users pay more through higher deductibles or larger copayments. The only tired old scheme that hasn't been trotted out yet is to raise payroll tax beyond the increases scheduled.
There is talk, however, about one new and sensible solution: return a great potion of retirement medical insurance to the private sector. This majestic idea comes from a team gathered by the National Center for Policy Analysis, a Dallas-based think tank. Its benefits are many, its costs slight, and its chances not as bad as might be imagined.
Under the current system, Medicare is funded by a payroll tax equally divided between employer and employee. The Tax now totals 2.6%, with workers paying 1.3% on income up to $37,800. Rates are scheduled to rise to 2.9% of payroll in 1986, with another bump up to 5.08% by 1995.
That's a considerable tax bite revenues this year are estimated at $51.3 billion and it's not nearly enough. The problem, along with overgenerous benefits and the waste and inefficiency engendered by the payments system, is that Medicare funding borders on check-kiting.
The tax revenues go into a trust fund, sure, but most of the money goes right back out again to pay the bills for current beneficiaries. This pay-as-you-go arrangement makes for a peculiar kind of trust fund: The money doesn't stay put long enough to earn investment returns. What's more, since individuals don't accumulate their own discrete piles, they can't pass anything to their heirs if they die before "their" contributions are used up.
The National Center for Policy Analysis goes to the heart of that funding problem. The scheme, brainchild of economists John Goodman, Richard Rahn, George Musgrave, and Peter Ferrara, calls for the establishment of individual retirement accounts to cover medical expenses. In short, medical IRAs. Each year workers could contribute up to $500 tax-free. Workers with no taxable income could receive a refundable tax credit. The money would constitute an actual trust fund, thus throwing off investment returns that would, in turn, accumulate tax-free. And, of course, those who die without exhausting their funds could assign the money to their heirs.
Under the NCPA plan, people would have two options upon retirement: use their funds to purchase insurance from a private company or withdraw the money to pay for medical expenses as they arise. How much would a typical worker have on retirement? The NCPA team calculates that a worker entering the labor force at age 20 would have just under half a million at age 65 and over $500,00 by age 67. That's assuming an initial contribution of $464.10, with contributions thereafter (see chart, p. 72) rising apace with wages at 5% a year (the postwar historical rate) and 9% investment returns. The initial contribution of $464.10 is what workers now pay to Medicare on average.
The NCPA plan does leave room for the government to play a role, however, a most important one. A payroll tax would be retained to do what it should do now and doesn't provide coverage for catastrophic, or high costs illness. The government also would provide vouchers on retirement for workers electing to remain in the Medicare system. Even with this government role, the NCPA figures that Medicare expenditures would decrease and that the payroll tax could be lowered gradually.
There is, of course, a cost to this scheme. According to Peter Ferrara, if medical IRAs were used at twice the rate of regular IRAs, the tax revenue loss would be $12.5 billion in 1985. But that revenue drain, Ferrara says, would be gradually offset by lower Medicare bills as workers relied less on the Medicare system.
Now for the benefits. Privatization of retirement health insurance would create powerful incentives to hold down costs. Currently, a third party the government pays most of the bills. Thus, users have little reason to scrutinize, let alone constrain, their bills. Moreover, absent patients paying attention to costs, doctors and hospitals have no check on how many services they provide, or even on how necessary those services are. With both users and providers spending other people's money, waste and inefficiency are practically guaranteed.
Now consider the two options people would have on retirement with the NCPA's medical IRA plan. Under the self-insurance option, the incentives to avoid unnecessary surgery and seek low-cost treatment are straightforward. The money comes out of one's own pocket. Says NCPA President John Goodman: "This is a wild guess, but if people had the option of operation, you would see the number of medical procedures cut in half".
Under the purchased insurance option people would surely search for the insurance company offering the best deal. Since the best deals can be offered only by companies that are cost-effective, you can bet that insurance companies would be policing the providers of health care.
There are also more intangible benefits to the medical IRA idea. People would have control over their money. They could tailor their insurance coverage to fit their insurance needs. Substituting IRA funding for Medicare funding for also would boost savings.
Sounds good, but does it sound likely? Well, the American Medical Association, for one, is interested. While it doesn't want to see Medicare phased out entirely why sever the hand that feeds? it looked at the NCPA idea as a "promising long-term alternative." At its December 1984 meeting, the AMA House of Delegates called for a continuing evaluation of the proposal.
Other powerful groups, such as the Conference Board, Business Roundtable and Health Insurance Association of America, have yet to be heard from. But Willis Goldbeck of the Washington Business Group on Health says, "We've supported medical IRS+As privately and publicly, to no avail. Nonetheless, it's an idea that's going to grow."
And that brings us back to Washington. Goodman reports that the members of Congress he has talked with admit the proposal makes sense. But, he says, "The initiative will have to come from outside of Washington. When politicians see this idea mentioned in a publication like FORBES, they'll say, 'My God, it must be important.' Congress does not lead. It follows."
The first obstacle for a lawsuit to jump is the right to use the courts. Although failure to demonstrate injury is one of the commonest ways to clear a court's calendar, insisting that the lawsuit must have some utility has become the very foundation for an impartial body of government to be free to settle disputes between citizens. There are other mechanisms, particularly the Courts of Equity of the young Republic, when there were many occasions when something was obviously wrong, but no statute covered the situation. By the Civil War, the Legislative Branch had more than supplied any deficiency of statute. The State of Delaware now has the only surviving Court of Equity, and "standing" now protects the courts from floods of useless lawsuits. However, that leads to the present Court System sometimes blocking a lawsuit, simply because the cause of the complaint is too broad, and requires special strategies to proceed. At the least, it requires a description of how an entire profession has been barred from its customary role, by an accident within the Judicial System.
History of the Matter. In the District Court of Maricopa County, the State of Arizona successfully sued the Maricopa Medical Society as antitrust for its prohibition from Medical Society Membership, any member who charged an indigent patient substantially greater than a fee published by The Society. This action was described as a per se violation of federal antitrust law, and without any trial of the facts was appealed successively to the U.S. Supreme Court. Two Arizona Justices recused themselves, and again without trial of the original summary judgment, was upheld by a 4-3 decision which still stands as National Law.
Subsequent Consequences. In Medical Circles, the Maricopa case is described as "dethronement of the doctors from control of the medical system" and "their replacement by non-physicians". For example, in 1948 the Nation's First Hospital (The Pennsylvania Hospital in Philadelphia) had two administrators, the Administrator and his secretary. Today, the same building which housed 200 patients in 1948 is entirely filled with puzzled administrators. The transition from physician control to something more legal has required insurance redesign which is still an expensive mess. After fifty years of trying, the pharmacy system is still cumbersome, the nursing schools have been upended, and the greatly enlarged billing system is still undecipherable. Meanwhile, physicians are quitting in their fifties because of the welter of unnecessary paperwork which keeps them from doing what they were trained to do, an occasional old nurse still defiantly wears a nursing cap, while cafeteria workers fumble at new-fangled uniforms. Everything has been unnecessarily changed, concealing the fact that it did not need to be changed. Meanwhile, those who took these supervisions in their stride are retiring early. Doctors used to marry their nurses; you now seldom hear of that. Salaries, which used to be zero, are now in six figures. Everybody complains; no one does what he was trained to do, especially the trustees. It once was the function of trustees to oversee funding requests of the doctors and get the money when needed; nowadays they rubberstamp the plans of administrators. There are simply hundreds of computers; no one reads their output. The disappearance of thirty common diseases (tuberculosis, syphilis, polio, rheumatic fever, etc.) is what keeps the system from collapsing. I received a salary of zero for four years, my grandson makes $53,000 a year of what is surely government money for much less medical work, much more red tape. If you don't believe these tales, I will be happy to call these people as witnesses. No doubt, witnesses for the other side will be happy to testify as well, and you can decide for yourself.
Repairing the damage. It took two thousand years to design the old system, but only fifty years to bring many hospitals to mergers, two medical schools to near collapse in Philadelphia alone. The Rs are fighting with the Ds over God knows what. All this mess cannot be repaired quickly, but it wouldn't hurt to get started. The Health Savings Account would be a better place to begin. Since remanding Maricopa for full trial would only be a beginning without much repair, it's little enough to ask as a beginning. The goal, well beyond my own sunset, would be to put the doctors back in charge and then waiting for fifty years. At least, stop getting in their road, since it is only fifty years since they stopped being the most admired profession on earth.
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.