Because September is the one-year anniversary of the worldwide financial meltdown, there were many good articles in the various newspapers and magazines over the last few weeks.

One particularly insightful article appeared in the September 14, 2009, issue of  The New Yorker, entitled “Eight Days” by James Stewart. It highlighted three root causes that ended up building destructively on one another:

• Excessively high debt leverage among many players in the financial services system;
• Rapid asset sales driven either by panic or sophisticated profit-driven short selling; and
• Provisions in credit agreements that triggered defaults based on accounting-driven asset valuations.

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In the September 7, 2009, issue of the New York Times, reporter Michael Lud wrote an article entitled “Out of Work and Too Down to Search On,” which essentially made the point that the economic environment is so bad that many people stop looking for work.

Unemployment is psychologically devastating.  I know: I was unemployed for several months in early 1979, when I left my law firm and was trying to secure another legal position.  I was asked to look for another job because I was told I would not be made a partner.  My stay on the unemployment rolls was brief, but terrifying.  As a result, I empathize with anyone who has lost his or her job.

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Many people sought my reaction to President Obama’s health care speech.  I had a mixed reaction.  It was reassuring to see him take a decisive position in staking out the case for reform, his priorities, and the common-sense proposals on which there appears already to be agreement.  I also think that he was more eloquent than I have ever seen him on any issue, and I felt inspired by his leadership skills, and his obviously sincere and deep moral values that drive his passion on health care.

While I believe that we should attack the health crisis first, then the health care delivery crisis, and then attack health insurance, rather than his obvious prioritization of health insurance, his decisiveness and strong leadership has value independent of how he prioritized the issues.

There are two fundamental problems with his plan:

• The proposed public option is a flawed solution to the problems he outlines; and
• The proposed methods for paying for expanding care to tens of millions of additional Americans are highly unlikely to yield the revenues he has projected for them.

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Every so often, I go back and reread a book I liked a lot.  Recently, I re-read a book by Bill Russell, my favorite all-time athlete, entitled Russell Rules.  To me, Bill Russell is the greatest team sport athlete of all time, simply because his teams won the most championships. As a college player at the University of San Francisco, he was the star of two successive NCAA championship teams.  He was a star on the 1956 Gold Medal Olympic team.  As a Boston Celtic, he played for 13 seasons, and the Celtics were champions 11 of those years, including 8 in a row between 1959 and 1966.  In the two years the Celtics did not win, he was injured in the championship series against the St. Louis Hawks in 1958, and lost to one of the great teams of all time, the 1966-1967 Philadelphia 76ers led by Wilt Chamberlain.  Michael Jordan may or may not have had better talent as a basketball player, but even his record was not as exceptional in terms of helping his team win championships.

The reason I think Bill Russell is sometimes not rated as highly as Michael Jordan, Wilt Chamberlain, Kareem Abdul-Jabbar, Magic Johnson, or  even Shaquille O’Neill by many experts is the way he went about winning.  In chapter 5 of Russell Rules, he refers to the value of “invisibility.”  The way he characterizes it,

“Invisibility opens doors, creates opportunity, where none seemed to exist before.  When we are unseen, we have an enormous advantage in moving in, doing things we wish or need to do, and in the process, to change the very dynamic of existing, seemingly closed, patterns.”

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One of the most complex medical challenges policymakers face is when and how much to pay for treatments and screenings for cancers.  Screenings and treatments are extremely expensive, and, while they allow for earlier detection and potential treatment of cancers, they are also very costly and have a high degree of unreliability.

As non-medical professionals, we tend to believe that diagnostic tests like mammograms and biopsies are clear and definitive.  The reality is much complex:

• Biopsies indicate the presence or absence of cancer cells in the tissue samples taken.  Whether there are cancer cells in tissues not subject to sampling is unknowable unless there are other ways to detect their presence.  Moreover, biopsies only indicate that cancer cells are present, and like a snapshot taken at a point in time.  They do not indicate whether the cancer is growing.
• Mammograms also have reliability issues.  To some degree, radiologists miss indicators of cancer cells, and also, sometimes,  have the problem of “false positives,” that is, a mistake is made in diagnosing someone with cancer when they have no cancer cells present.  Similar to biopsies, mammograms can only tell doctors and patients whether cancer cells, not whether those cells will grow over time.

In a newsletter entitled “Medicine for People” published by the Monroe Street Medical Clinic, the authors correctly point out that there are many non-aggressive breast cancers with which women can live for decades.  As they point out, “the most common form of cancer detected by mammography is ductal carcinoma in situ (DCIS). This is a cancer confined within a milk duct within the breast.”

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