January 2011

As any faithful reader of the old gossip columns knows, great wealth too easily acquired can be a very mixed blessing indeed. Many of the very rich whose names appeared endlessly in the columns—the Duke and Duchess of Windsor, for instance—simply frittered life away in an endless round of public pleasure-seeking. If they seldom seemed actually to be having a very good time, perhaps their friend Noel Coward put his finger on the reason when he reportedly noted that “work is so much more fun than fun.”

For others of the very rich, however—Barbara Hutton and Huntington Hartford come to mind—their lives as they were played out in the columns seemed sad almost to the point of tragedy. And the cause of their unhappiness was precisely that they inherited huge fortunes at an early age and lacked the personal strength to carry the burden of them.

Even paranoids have enemies, the old joke runs. And according to Driven Patriot, the elegantly crafted new biography of James V. Forrestal by Townsend Hoopes and Douglas Brinkley, when America’s first Secretary of Defense committed suicide in 1949, the enemies he had come to see everywhere were by no means all phantoms.

Forrestal was born in the Hudson River township of Fishkill, New York, in 1892, the youngest of three sons of a hard-drinking Irish-born builder who inculcated in him the virtue of work. “Whatever you got for nothing should be regarded with deep suspicion,” the elder Forrestal taught his son, “because somewhere along the line one lost either independence, self-respect or honor.” Work would one day literally consume James Forrestal, and he was finally driven to the window ledge by savage attacks on his self-respect and honor.

Truth and fiction

Historical novels may be a lucrative genre for publishers of popular fiction—but are they of any use at all to people seriously interested in history? An important special section in the October issue examines what turns out to be a complex and intriguing question.

What Can You Learn from a Historical Novel? Daniel Aaron explores the strengths and weaknesses of historical fiction versus “real” history.

Raising Nat Turner . Twenty-five years ago next month William Styron published one of the most controversial and influential historical novels ever. Now the author of The Confessions of Nat Turner discusses what he was attempting to do and surveys the stillseething turmoil he ignited.

Twice during my tenure as President Reagan’s White House physician, I accompanied him to performances at Ford’s Theatre. Each time I found myself looking up at the flag-draped box where Booth shot Lincoln and wondering what I would have done had I been one of the doctors who rushed to the President’s aid. Could the medical techniques that had saved Reagan’s life after he was shot in 1981 have helped Lincoln? What about Garfield, McKinley, or Kennedy? Nothing, I have concluded, could have saved Lincoln or Kennedy; Garfield and McKinley are another story.

John Steele Gordon replies: I confess I didn’t realize what a large percentage of companies now self-insure, as mentioned by Mr. Hunt. Still, whether a company self-insures or uses an insurance company makes no difference to the employees if the benefits are the same. What’s important is the consumer’s indifference to medical costs, not the exact means by which this indifference is fostered.

As for governments mandating toupees as a health cost and otherwise meddling for political advantage, I suspect that will always be a cost of doing business (whatever business) in this country. After all, bald people vote too.

I failed to mention HMOs and other health-care plans (such as the Canadian) only for lack of space. What I wanted to get across was that as long as the consumer of health care is not the purchaser, so long will health-care costs run riot or be contained only by rationing. The plans I did mention make that connection most directly. But by all means, as Chairman Mao said, let a hundred flowers bloom.

Mr. Gordon’s review of how the United States fell into a health system with intractable cost problems was masterly. It takes a historical viewpoint to understand the situation, which many economists persist in treating as a problem in tax theory or regulation.

Two aspects of health care have to change, not one. If payment reform is to succeed, then delivery reform should precede or parallel it, or people could find themselves covered, but with no services available. Or, we could pass insurance-access bills, and simply inflate the health system further, if there were no checks and balances on hospital and physician resource decisions.

Planning public-policy interventions in health care has logic on one side w and the weight of history on the othj? er. What we still do not understand how to do is gain support for an improved system from those who would inevitably have to change—and that includes most of us.

Thank you for a very well-crafted overview of health care’s evolutionary life cycle to this point.

The first non-children’s book I ever read was Philip Van Doren Stern’s novel The Man Who Killed Lincoln. How it fell into my hands, I cannot say. I retain a clear memory of going to my mother to inquire about what appeared on page 16: “A big buck Negro, whose black skin glistened with sweat, held in his arms a young mulatto girl who was hysterical with desire.” Very baffling. What could it mean?

My mother studied the passage. There was a long silence. My mother wore rimless spectacles. It would be unthinkable for her to depart our New York City apartment in anything but a dress or skirt and high heels. She finally made a reply to my request for an explanation: “ I…don’t…know .”

We tend to identify the first American public display of art with the post-Civil War surge of wealth called the Gilded Age. Conventional wisdom also assumes that our first art museums were born in Boston, New York, and Philadelphia, all of which were eager to assert their cultural hegemony.