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THE FIFTIES
I much enjoyed the photographs of the Fifties ("Shots of 'The Good Life,'" March-April, page 36). It was a good time for this Fifties boy, who was fortunate enough to have two parents who worked their rear ends off so their children could go to college. If curator Barbara Norfleet, Ph.D. '51, wants to speak to the problems of today, she should look elsewhere than the Fifties. Her attempt to trash a working generation that struggled throughout the Depression, fought World War II, and lived the American ideals of family, community, and country, just doesn't wash.
William H. Dailey, LL.B. '63
Moline, Ill.
"Shots of 'The Good Life'" depicts the values of the middle class in the Fifties as naive and materialistic, on which we can look back with disdain and smugness. How are future generations going to look at the Nineties? We now consume many times more of our resources than we did then. We drive ever-larger four-wheel-drive vehicles that rarely leave the city limits. We still have hate crimes. There is ever-increasing disparity between the rich and poor, with the rich setting the standard for poor taste and ostentation. I would say that our intellectual life has not improved. The interests of the middle class show much less concern for philosophical and social matters than for worship of wealth and the famous.
Frank Green
Annandale, Va.
HEALTH CARE: OPPOSING VIEWS
The roundtable on health care wasn't round enough ("The Future of Health Care," March-April, page 42). It failed to include practicing physicians and their patients. Tepid expressions of "concern" by the moderator and "embarrassment" by Aetna CEO Richard L. Huber won't overcome the catastrophe of 43 million uninsured Americans, whose numbers grow by a million a year--one in five working Americans under 65 with no medical insurance. Concern and embarrassment must turn to outrage that we, the richest by far of the industrial nations, stand alone in failing to consider health care a societal obligation.
For the shrinking number of Americans with adequate and affordable health insurance, our current system is sick and getting worse. Managed care has been a failure. It undermines trust in the doctor-patient relationship as physicians are paid more for giving less care and penalized for giving "too much." It restricts patients' choice of doctor and hospital, frequently provides inadequate care, leaves treatment decisions to nonprofessionals, has not controlled costs, and ignores the working uninsured. The fatal flaw in this sick system is that the final responsibility of corporate insurers is to shareholders and profits, not to patients. Since the system can't be fixed, it must be abandoned.
Arguments that Medicare for all or a Canadian-style system are unworkable are unsupported assertions. Even with its defects, Medicare has been a 35-year success story, protecting the physical and financial well-being of older Americans. While managed-care insurers spend only 70 to 75 percent of their premium on benefits, with the rest on administration, advertising, huge executive salaries, and profit, Medicare and the Canadian system each spend more than 97 percent on benefits. Moreover, the nonpartisan Congressional Budget Office has found that reducing the number of payers from 1,500 to one would save $100 billion a year in administrative costs.
The Canadian system, despite severe financial pressure, remains wildly popular; according to polls, most Canadians deem it the crown jewel of their society. Though Canadians wait longer than we for nonurgent services, studies repeatedly show that their outcomes for serious illnesses such as heart attacks and chronic kidney failure are at least as good as ours, and access to high-tech procedures such as open-heart surgery and organ transplants is comparable to ours. Federal and state governments already pay 50 percent of our $1 trillion-a-year health-care bill: the challenge is crafting the best way for government to assume the other 50 percent.
As managed care becomes more insupportable, the public demand for universal coverage will pass the tipping point and, at last, cut out the unnecessary profit-taking middleman between doctor and patient. Harvard should be facilitating this long-indicated surgical procedure.
James S. Bernstein '49, M.D. '52
Rockville Centre, N.Y.
How interesting yet predictable that your panel of experts arrives at the conclusion that a major restructuring of the health-care system isn't in the offing and that the best hope for the future of health care lies in tinkering with the current managed-care system.
They just don't get it. Richard Huber, Aetna mogul, tells us that we should expect to give up the old-fashioned notion of the doctor-patient relationship, but he shows no signs of giving up the old-fashioned notion that health insurance is a cozy contract between the insurance corporation and the employer, and that the people whose health is at issue should just shut up.
My vision might be limited, given that I'm standing in the trenches, but it appears to me that the natural forces at work are moving toward the democratization of health care. The public doesn't own its health-care system now; it doesn't have the privilege of deciding how much health care it wants to purchase, or the responsibility of paying for it directly. Of course health-care costs have risen; there's more good health care out there to buy. We are told that we spend more than we should on health care, but how do we know that the people don't want to devote this much of their resources to their health? We don't.
Your panel's discussion would have been more productive had it acknowledged that the central issue is whether and how we are going to ration health care. There are no simple answers, but it doesn't help to pretend that this is not the question. The process can move forward only when we dissolve the accidental marriage between access to health care and place of employment. That arrangement has served only to mollycoddle the public into believing that health care is an entitlement bestowed upon us by the rich and powerful. It has led to a situation in which health-care rationing is being practiced by special interests (including your panel of experts and including myself); as they come to appreciate this fact, the people find that they don't trust the special interests, nor should they. Health care is not just another commodity; it is a vital and cherished part of any society's social and moral fabric, and our society will remain stuck until we find a way for the public to ration its own health care. To paraphrase Jefferson, the right to ration derives from the consent of the rationed.
Jonathan L. Weker '76, M.D.
Montpelier, Vt.
Universal health care was alluded to only a few times and reluctantly. On the other hand, the outrageously self-serving remarks of Richard Huber of Aetna were tolerated without challenge.
There is no basis for his statement that "country after country tries to shed its non-functioning national health-care system." The same can be said about "We [Aetna] have yet to go into Western Europe because we're waiting until the system bankrupts, which will not be long," and the canard that Canadians "jump in the family car and drive south" the minute they get sick. Where is the evidence to justify such sweeping statements?
In fact, while Canada and Western European nations are tinkering with their universal national health systems, no serious political party advocates abandonment of universal health care. To do so would be political suicide, given their systems' popularity and evident ability to improve population health. Citizens in Canada and other nations with universal health care live longer, express more satisfaction with their health care, have greater choice of physician, and spend far less for health care than we do in the U.S.
Thanks to the insurance industry and for-profit HMOs, we have an unpopular, fragmented, profit-driven, non-system of health care. Despite the promises that market competition would provide good care and contain costs, it has instead produced new problems, such as a decline in consumer choice and widespread denials of care to insured patients with expensive illnesses. Perhaps Harvard Magazine should offer equal time to the proponents of universal national health insurance.
Stephanie Woolhandler, M.D., M.P.H.
Associate professor of medicine
Harvard Medical School
John W. Littlefield '46, M.D. '47, M.H.S.
Professor emeritus of pediatrics
Johns Hopkins University School of Medicine
Baltimore
Huber's comment regarding the patient "...with an ingrown toenail who wants to have an MRI" was preposterous. What he alludes to is the ongoing struggle physicians and patients have with HMOs regarding treatments denied by the HMO. The more valuable discussion would center on those treatments which the doctor feels are indicated and the HMO clerk denies. By choosing such an unrealistic example, Huber glosses over the very important issue of uneducated, nonmedical personnel making decisions regarding the necessity of medical treatments.
Furthermore, Huber's comments regarding the congressional mandates for "...another series of things that have to be included in health insurance" were not fully addressed. Government-mandated health-care coverage is a necessary evil. Yes, this prevents insurance corporations from offering a completely barebones package to employers seeking coverage for their employees. However, it also protects those persons in our society who are not represented in the groups making decisions regarding health-care coverage. A male manager arranging for a health-insurance package for his female factory workers, for instance, could easily decide to include coverage for Viagra and exclude coverage for oral contraceptives.
Finally, one glaring omission from the discussion of health-care economics must be mentioned. The cost of a medical education has skyrocketed. The average amount of debt a physician has acquired by the end of this lengthy education has variously been quoted to range from $50,000 to $100,000. Yet physician salaries continue to decline. This places quite a strain on even the most idealistic of doctors.
Elise Luna, M.D.
Washington, D.C.
As a health reporter and former contributor to Harvard Magazine, I was amazed at the lack of diversity in your roundtable. All of the participants were white men. I find it difficult to believe that you could not find any women or people of color with Harvard connections to participate. You wasted a chance to hear from people who don't regularly appear on the media circuit, and may have different perspectives to offer because of who they are.
Susan G. Parker, M.T.S. '98
Greenbelt, Md.
The roundtable fails to touch on the most serious problem facing patients and health-care professionals--the disappearance of secrecy and confidentiality as our computerized records become increasingly available to anybody who wants to snoop.
Stephen Fleck, M.D. '40
Professor of psychiatry emeritus,
School of Medicine, Yale University
New Haven
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Had a practicing physician been included, the roundtable would have been much less congenial.
A practicing physician would have taken Huber to task for the hours spent on the phone "on hold" by physicians and their office staff trying to obtain approval not for MRI scans for ingrown toenails, but for the most trivial medical and diagnostic procedures. A practicing physician also would have commented about the inconveniences to patients (many of them elderly) caused by insurance companies' demands for grossly shortened hospital stays, or some of the dangers posed to patients because carriers will pay for emergency care only in specified hospitals.
Clinicians also might have had some thoughts about what insurance companies really mean when they buy medical care "wholesale." This translates into driving reimbursements down to the lowest possible level in a system in which the insurance companies can virtually dictate rates because they are immune from antitrust legislation, and yet physicians are unable to negotiate in groups without the threat of an antitrust suit. This situation is even more outrageous when one realizes the money thus saved goes to pay for inflated salaries for insurance-company executives.
One also hopes that when standards and performance measurements are applied to the industry, they will include performance standards for reimbursement of health-care providers. Many carriers, most particularly Aetna, are months behind in reimbursing physicians for services rendered. Attempts to negotiate these and other problems with carriers are often met with indifference or arrogance on the part of insurance companies, and have led to lawsuits or withdrawal from managed-care contracts by physicians.
Finally, I was disappointed that relatively little was said about the most serious threat of managed care, namely the effect it will have on medical education, research, and the future professionalism of physicians, caused by the enormous transfer of wealth from physicians and teaching hospitals. This is the real danger from managed care, and we will not see its pernicious effects for another 20 years.
Russell W. Hardy Jr., M.D. '65
Cleveland
Dean Joseph Martin outlines a 14-hour day in the life of a primary-care physician and then points out that such a professional will be paid between $80,000 and $100,000 per year, which he characterizes as not being "big bucks."
To more than half of the American people, that kind of money is big bucks, more than they can ever hope to earn. It is roughly three times the median yearly American family income. Many of the clients of my law practice work 14-hour days, at one or two minimum-wage jobs, and then have to go home and clean house and help their children with homework--but they would view $80,000 as unimaginably lavish compensation for a schedule twice as rigorous. This perception is not necessarily a function of education or intelligence--a Harvard alumna myself, I would be extremely surprised if I ever earn that kind of money. Which suggests that one of the major problems in the American health-care system is the wide gulf between the medical profession and the patient population, a gulf the former evidently does not even see; it is a gulf which has a lot to do with "patient noncompliance" with treatment regimens, a major worry of primary-care physicians.
Panelist Daniel Callahan is undoubtedly right--most Americans want more and better medical care than we/they can afford. But one of the reasons such care is so costly is the presence at the top of the system of a large layer of people who do not consider $100,000 per year "big bucks."
Marian Henriquez Neudel '63, Div. '67
Chicago
BILL BACKWARDS
I was amused by the letters about the photograph of "Vita" subject H.B. Bigelow with his cap on backwards (March-April, page 9). I'm afraid my classmate John Spofford's questions must be answered in the negative. Seafaring men didn't always turn their caps around, because caps with bills didn't come into favor at sea until the nineteenth century. But if you're going to make frequent use of binoculars, as the squinting Bigelow probably did, reversing the cap gets the bill out of the way.
The photo of Bigelow also dates from a time when images of daring aviators and dashing movie directors typically showed them with caps reversed. That made it easier to pull goggles down over the eyes, or to look into the eyepiece of a camera.
For the genesis of "today's fashion of wearing baseball caps bill-backwards," however, we must look elsewhere. The reversed baseball cap is part of a jailhouse couture, along with baggy and beltless pants and laceless shoes. If you wish to talk through the bars of your cell, the visor can be a hindrance, so you turn your cap around. The street fashion originated with the homeboys of Southern California and Texas in the 1980s, and, as we all know, has since spread throughout the youth culture.
While functionality certainly sanctioned the practice for seamen, aviators, directors and cameramen, and convicts--and of course baseball catchers--it's safe to say that the millions of high-schoolers and collegians who wear caps à rebours don't have a clue about the provenance of the fad.
John T. Bethell '54
Manchester, Mass.
Editor's note: Contributing editor Bethell did not do time in the course of his research.
Starting in about the sixties, students wore caps to class and, having nowhere to put them, reversed them, perhaps to make themselves less conspicuous. With no one telling them that wearing hats indoors is rude, it became a fad.
Robin Higham '50, Ph.D. '57
Manhattan, Kan.
ANIMAL RIGHTS
Edwin Locke's letter regarding animal "rights" (March-April, page 4) is--forgive me--imbecilic. John Lauerman's "Animal Research" (January-February, page 48) argues persuasively for formulating some middle ground in the rambunctious controversy, sending Locke all to pieces.
The ability to feel pain may be one source of rights; surely there are others more or less weighty. By Locke's twisted, self-serving logic, since animals cannot reason, they "do not have rights." This is ludicrous, and at logical end justifies even the most heinous torture or abuse of animals. Since Locke's pet dog cannot reason, I do harm only to its owner if I set a steel-jaw trap and the dog chews her leg off trying to unsnare herself. What sadist believes this hooey? Whether the dog's rights derive from her reasoning or from ours, in the end, is immaterial to whether she has them.
Ambivalence toward animal research is real, but opposition to outright animal abuse is as close to an absolute and universal ethical standard as thinking people can come. Locke's conclusion, that "the deepest motive of the animal-rights advocates is hatred for man," utterly defies reason. Animal-rights activists can certainly be impressionable, but I've never met one hateful of his or her fellow humans. I wonder how many Locke himself has ever known, and whence he finds fodder for his loony ideas about them.
Peter Braverman, Ed.M. '90
Bethesda, Md.
Why did Lauerman avoid mentioning all the animals that are killed by other animals, or for sport, or for food? Surely humans benefit more from research on animals than from at least the first two methods of reducing animal population.
Elliott Doane '51
Oklahoma City
MUTED COLLEGE PRESIDENTS
I agree with James O. Freedman's reasons for the relative absence of presidents speaking out ("The Bully Lectern," January-February, page 36). The time pressures are crucial. There are many meetings where my presence is necessary. (I attend many events where a cardboard cutout of me would do about as well.)
However, I want to add to Freedman's list one other reason for presidents' relative silence. I think many people do not want to hear us on general issues. There is a different sense, today, of the legitimacy of using the "bully lectern."
People in Chicago like to hear me talk about Northwestern. They like to hear me speak on my pre-presidential areas of expertise: foreign policy and development. And I do so when I can. Occasionally, I chair meetings at the Chicago Council on Foreign Relations and attend foundation-sponsored meetings on Africa, and I have talked on U.S.-Russia relations. I think people are interested to hear me speak on Title IX or affirmative action. But I have no sense that people would give privilege to my views on welfare or American morals. And I have no sense that I should speak out publicly on those issues. Being president of a great American university does not give me legitimacy to go public on any and all issues.
I am not sure that is a bad thing.
Henry S. Bienen
President, Northwestern University
Evanston, Ill.
LAWRENCE MUNGIN'S STORY
After reading Randall Kennedy's review of Paul M. Barrett's The Good Black ("The Browser," January-February, page 27), I was led to read, not the book, but the decision in his case of the U.S. court of appeals for the District of Columbia. The overwhelming impression from these two sources was not one of whether Lawrence Mungin was discriminated against, or whether he was effectively discharged from the firm, as it was of how brutishly difficult it is for an outside party--the Equal Employment Opportunity Commission or the courts--to intervene in a situation laden with personal, technical, and professional considerations beyond their expertise.
John P. Powelson '41, Ph.D. '50
Boulder, Colo.
TORTURED VAN GOGH
As a longterm (32 years) sufferer of severe tinnitus (constant, high-pitched ringing in the ears), I was surprised to read in "Van Gogh's Malady" (January-February, page 23) that the artist was afflicted with Geschwind's syndrome. It was my understanding that van Gogh's strange behavior was due to Menière's disease, of which tinnitus is one of a group of symptoms that also includes loss of hearing, dizziness, and the sensation of fullness or pressure within the ears, symptoms that are described in the artist's writings. Could it be that the brilliant painter was simultaneously afflicted with the set of five epileptically induced traits identified by Shahram Khoshbin, and thus doubly tortured by complex maladies?
Victor H. Mair, Ph.D. '76
Princeton, N.J.
THINK POSITIVELY, RADCLIFFE
Why are Linda Wilson and a few others trying to deny me and other women our Harvard educations? Radcliffe does not and never did have any faculty. Radcliffe was created so that women could receive a Harvard education. Since nineteenth-century New Englanders thought it best to segregate women and men (unlike colleges elsewhere, which admitted women directly), originally Harvard faculty gave lectures to the men, then crossed the Common and gave the same lectures to the women. This nonsense ended with World War II, when the faculty lectured once, to both sexes. Radcliffe continued to provide separate housing for women until practical Mary Bunting urged complete integration, nearly 30 years ago.
Now, suddenly, recent literature sent to me seems designed to suggest that Radcliffe College is a full-fledged, separate educational institution, while the current issue of the Radcliffe Quarterly touts a highly political message supporting the agenda of what I believe is a small group of segregationists. To suggest today that Radcliffe is a separate college for women is not merely nonfactual, it is confusing. The outsider must wonder, since there are Harvard women students, who then are these Radcliffe women?
For me, "Radcliffe" has been more of a stigma than support, since I must continually assure people that I did actually study at Harvard, taking the same classes, in the same classrooms, with the same exams, and meeting the same academic requirements as the men. Surprisingly many people think Radcliffe is a small two-year girls' finishing school in upstate New York. If I went to Harvard, why don't I say so, they wonder.
To segregate Harvard women once again under a separate name is to create a club, a sorority within Harvard College--precisely the self-celebrating separatism that I for one chose to avoid at college.
How would it help women to grow if women students were to give up the enormous resources of Harvard? Male faculty, when I was there, were highly supportive of me in my studies, and that's why I was there, to learn. Sure, Harvard has areas in need of improvement. Today's problems are with administration, and tenure; but why should women run away from helping to solve such problems, as Wilson suggests? The proposals I read in the Quarterly seem limiting, regressive, timid. Instead, let's urge women to expand their position within Harvard.
Since the Radcliffe corporation has money, spend it by supporting Harvard women. Harvard lacks portraits of women? Commission them. Harvard needs more tenured women? Fund some chairs for the most recalcitrant departments, with the obligation that the earliest recipients will be women. And so on.
Think positively. Be proud of your Harvard education. And start the next century in unison.
Joan Mickelson '56
Wellesley, Mass.
WOMEN ON THE FACULTY
As part of Harvard's capital campaign, President Neil L. Rudenstine has called for an increase in the number of faculty hired, in part to increase the ratio of faculty members to undergraduates from the current figure of 1 to 11. Faculty serve as powerful role models to students, influencing their sense of confidence and potential with respect to their own future careers. In the preponderance of tenured male faculty at Harvard in 1998, i.e., 87 percent men to 13 percent women, a message is given to women that future career success is more the prerogative of men than women. Whereas the faculty-student ratio of 1 to 11 refers to all faculty and all undergraduate students, when this figure is broken down by gender the following ratios occur: for male faculty and male students, 1 to 8, and for female faculty and female students, 1 to 20.
Thousands of students have graduated from Harvard without ever having had a course with a female professor. This is hardly adequate preparation for young adults of either sex, about half of whom will be working for female bosses in their first jobs. To perpetuate the current imbalance is to do a disservice to both men and women.
The Committee for the Equality of Women at Harvard is asking President Rudenstine to increase significantly the number of women faculty at Harvard over the next five years.
Cornelia Dimmitt '58
for the Committee for the Equality
of Women at Harvard
Concord, Mass.
Editor's note: see "Gender in the Humanities...and Beyond," page 70, for a relevant report.
REAPER REVISITED
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One of the eight images of nineteenth-century trade cards shown in "Treasure" (March-April, page 100) depicts, of course, a reaper and not a "thresher," as your text might suggest. A reaper--also called a harvester--could cut, bundle, and bind the grain, which was later taken to a stationary threshing machine, probably steam powered, or was threshed manually. When in later years a mowing machine was developed that threshed as well as harvested, it was called a "combine(d) harvester," now known simply as a combine. The old name "harvester" lived on a long time in the name of the International Harvester Company.
Henry Taves '76
Natchitoches, La.
Editor's note: the trade card occasioning Taves's observations shows an "Improved Light Harvester & Twine Binder." The Kress Library at the Harvard Business School preserves 10,000 trade cards, early mass-marketing tools.
AMPLIFICATION
The statement in the March-April issue ("Brevia," page 74) that the new associate vice president for sponsored programs, Norma Allewell, "founded" Wesleyan's molecular biology and biochemistry department is incorrect. The department was formed as the result of the joint efforts of six faculty, including Professor Allewell, and the leadership of the then dean of science, Barry Kiefer.
Lewis N. Lukens '49
Professor, Department of Molecular Biology
and Biochemistry, Wesleyan University
Middletown, Conn.
COCKTAILS WITH
ALAN JAY LERNER
The comment that Lerner was a college chum of J. Paul Austin '37, LL.B. '40, later chairman of Coca Cola, is inaccurate ("Singer and Songsmith," March-April, page 27). Austin had left college and was attending law school when Lerner entered as a freshman.
Paul Austin was a close friend of Dick Lerner, Al's (we always called him that instead of Jay in the old days) older brother. They spent many a summer together cavorting at the Westchester Country Club in New York. Austin lived in Scarsdale while the Lerners had a home not far away in Mount Vernon.
Dick Lerner never went to college; instead he was put to work in the Lerner Stores by his father. When Al was a freshman, I received a letter from Dick asking me to check on Al to make sure he was doing okay. I went by his room in the Yard one evening and found a rather noisy and raucous cocktail party taking place. Al assured me he was doing just great, he had been accepted by the Hasty Pudding Club, and wouldn't I have a drink--one-third lime juice, one-third rum, and one-third Vitalis!
Paul E. Morgan '39
Fort Lauderdale, Fla.