Category: Links

Have any inspiring/funny/interesting links? Leave a comment or send me an email, and if I choose to feature it in my next link post I’ll link back to you.

Necklace

July 6th, 2010
Design, Links, Products I Love, Style, What I Wore
6 Comments

July 4th was the 13th anniversary of the day I met my husband. To celebrate he gave me this AMAZING necklace:

I had seen one of his former classmates wearing it at his college reunion at the end of May, and commented about how much I loved it.
My husband, being the awesome guy he is, asked the woman where she got it, and she told him it was by Melissa Borrell.

Not only is it a beautiful necklace, but the concept was really cool- it comes as a disk, and you literally push the pieces out. It also comes in a cute tin.

You can buy this necklace (it comes in other colors too) and Melissa’s other amazing pieces here.

Amazing Chocolate Cupcakes

When we were at The Woodstock Farm Animal Sanctuary, I bought a couple of cookbooks including Vegan Cupcakes Take Over The World. (See link in sidebar.) Willa woke up yesterday and said “Let’s make cupcakes!” and so we did.

We decided to make the basic chocolate cupcake recipe. I started to gather all of the ingredients, and I realized I only had whole-wheat flour instead of all-purpose flour. Now, being a former pastry chef I realized that if I used whole wheat flour it might make the cupcakes dry, so I started to think about what I could use (instead of more oil) to help make them moist. Then I remembered reading this recipe that used avocado. And that’s how I came up with the recipe below.

Makes about a dozen cupcakes

I cup of soy milk
1 tsp apple cider vinegar
1/2 avocado
3/4 cup sugar
1/3 cup canola oil
1 1/2 tsp of vanilla
1 cup whole-wheat flour
1/3 cup cocoa powder
3/4 tsp baking soda
1/2 tsp baking powder
1/4 teaspoon salt

Preheat oven to 350. Whisk together soy milk and vinegar and set aside (it will curdle). In a separate bowl sift the flour, cocoa powder, BS, BP, and salt. In a food processor or blender puree avocado with a little bit of the soy milk mixture until smooth.
Add sugar, vanilla, and oil to the rest of the soy milk mixture and beat until foamy (I used the paddle attachment on my kitchen aid, you can also use hand beaters- you could also probably just whisk it by hand). Add the avocado mixture and mix until combined. Add dry ingredients in two batches, and mix until combined. Fill cupcake liners about 2/3 to 3/4 of the way.
Bake 18-22 minutes depending on your oven. Make sure you transfer them out of the pan about 10 minutes after you take them out of the oven so they don’t get soggy.

I also made a vegan ganache. This recipe made more than enough for a dozen cupcakes. I’ll guess I’ll have to eat the leftover ganche with a spoon, or make more cupcakes!

Heat a half cup of full fat coconut milk in a saucepan just until it simmers. Remove from heat and stir in a 1/2 teaspoon of vanilla, and about 5 oz. of chocolate (I used vegan semi-sweet chocolate chips). Whisk until smooth. Put in a glass container in the fridge until it gets firm (a few hours). You can also keep it out of the fridge, and use it as a glaze- just turn the cupcakes upside down and dip them in. Spread, dip, or pipe on cupcakes (when they have cooled completely) and enjoy! I don’t mean to toot my own horn, but these were honestly the best cupcakes I’ve ever had.

If you have any question or you try the recipe please let me know!

Life List #5 and #28 DONE.

A couple of weeks ago we finally went to The Woodstock Farm Animal Sanctuary. They were having a Jamboree, so we thought it would be the perfect opportunity to pay them a visit. I don’t really know how to talk about it without sounding dramatic or cheesy- it was an amazing, life-changing experience.

To see all of these animals, who were rescued from being killed, was so touching. I felt so at peace there. I felt like my heart was going to burst out of my chest.

To see my child interacting with the animals, and playing with other veggie children brought me such joy.

And to be surrounded by other people who shared the same morals as me, when I usually feel so lost and alone- well, I had a really hard time leaving.

We snuggled with a 450 pound pig, we watched as a cow came happily running across a field when his name was called, and we learned that turkeys are really friendly and social, they have very warm soft heads, and they like music.

Towards the end of our visit my husband turned to me and said “I want to be vegan” and I said “So do I”, and that was that. We are now vegan. Is it easy? Not always- I can’t just grab a slice of pound cake or a cookie when I’m in a hurry. We were already mostly vegan at home, so it’s just more of a challenge when we’re eating out or traveling. It’s forcing me to eat healthier, which I love. Most of the time, doing the right thing also means doing the hardest thing, but we’re really happy with our decision.

To see the rest of my Life List click here.

Master Bedroom

Still have a lot to work to do unpacking and decorating the new house, but I thought I’d show you where we’re at in the master bedroom.

The color scheme is blues, grey, and a touch of red.

I was inspired by this painting that used to be my grandmother’s:

The paint color is Still Moment from Freshaire Choice. The mattress is a Select Comfort, so if you look closely, you can see the line down the middle. (My sleep number is between 30-40 and the husband’s is between 80-90.) The sheets are organic cotton from West Elm. The Blanket is Nautica . The blue pillow with red squiggles is actually an outdoor pillow from Crate and Barrel. The lamps are Barometer from Ikea. The nightstands are hand me downs- I’m thinking of getting new hardware for them. We’ve had the bed frame for YEARS- we got it from Boston Interiors when we lived in Boston.

Here’s another angle where you can see our carpet- Flor Tiles- Feeling Groovy in Titanium. It’s actually a little darker than I wanted, but it still works.

We still have to hang some pictures and curtains, but so far I’m really pleased with it.

Skinny Dipping

I just read my friend Rachel’s post about potty training her daughter. It got me thinking about how insanely uptight this country is about nudity. I feel like most of us spend the majority of our lives not happy with our bodies. I make a point of never saying anything negative about my body in front of Willa. I love how happy she is with her body, and how comfortable she is naked.

Late last summer, we were visiting my mom in the Pocono Mountains and we let Willa skinny dip in a stream. I took several of what I think are the best photos I’ve ever taken, and then I was afraid to post them. Not because I was worried about perverts looking at my kid, but because I was worried about what the internet trolls would say. Today I realized that I didn’t care anymore what the trolls had to say. I’m proud of these pictures, and I think they are perfectly appropriate, and that’s all that matters.

Throwing his hat in the ring

My husband and I have spent a lot of time talking about healthcare lately, so I encouraged him to write an article about it.

I want to preface this by saying a few things:

I felt like my husband was the perfect person to talk about this- he might be liberal, and vote mostly Democrat, but he is also a well educated doctor, so he understand that it’s not as simple as “Free healthcare for everyone!” He sees the healthcare system in action every day. He also, has a wife who has had numerous medical problems, and has been denied medical treatments by her insurance company, so he gets the personal side of it too.

I have seen a lot of doctors who the minute they graduate from medical school, stop learning. My husband is not one of those people- he’s constantly reading various journals and articles, trying to educate himself further.

This is not typical of this new blog, but I felt like this was important, so I’m posting it. Healthy debate is encouraged- disrespectful or hateful comments will be deleted.

I’ve been doing a lot of thinking about healthcare reform lately. In fact, I’ve been meaning to write something down for a number of months now, but I tend to function at a weird crossroads of “really busy” and “procrastinates a lot.” Therefore, I’m only getting to it now. So at the risk of trying to shut the barn door after the horse has run away, I’m going to give this a shot. As my brain has a large capacity for random information, you might want to settle in and grab a drink. I love to talk, and writing a lot is no major stretch. As a disclaimer: I’m not a healthcare economist. I’m not a public health policy wonk. I’m a physician, with a few years of experience. But I have a few ideas about things.
First, some definitions that I think have been missing from the healthcare debate. Everyone says that we need more “access to healthcare.” In other words, more people covered by insurance, and more ability to pay for it. However, access also depends on having physicians available who can take care of you, and many areas of the country don’t have enough. Plus, patients with Medicaid coverage, which pays physicians very little for visits and procedures, often cannot find a doctor who will treat them. The other component here is that “access to healthcare” is not the same as “health;” we need to make sure that our interventions are effective and efficient, otherwise, more healthcare (to the exclusion of other things) could actually result in WORSE health. As an example, there may be studies indicating that each of twenty drugs is helpful for different major health conditions. That doesn’t mean that placing a patient on all twenty drugs will be helpful; it is likely, in fact, to be harmful as side effects and interactions pile up. More is not always better.
Another key misunderstanding is the difference between “spending” and “costs.” There is lots of rhetoric in the current debate about reducing healthcare spending, but that’s just a temporary fix. To make our healthcare system less expensive, we have to decrease how much health care costs to provide. For instance, insurance companies, Medicare, and Medicaid have gradually decreased how much they pay for a typical doctor’s visit. This maneuver, however, has not reduced costs: physicians now see more patients per day, and more and more are moving into specialties that perform procedures, since those are better reimbursed. On the other hand, if we reduced overhead by making doctors’ offices more efficient, the doctors wouldn’t have as much of a need to make money and could charge less per visit. The system is flexible, so we can’t address the actual cost of healthcare without making care itself more efficient and less expensive.

Those things said, the primary question, as I see it, is: Why is American health care so expensive while providing care that’s not much better, and sometimes worse, than care in countries that spend less? There are a lot of reasons for this, some related to our national culture and some related to the actual health care system. First of all, we are not very healthy as a nation. We have the highest obesity rate in the world (up to 40-50% in some areas) and similarly high rates of diabetes, high blood pressure, heart disease, breast and colon cancer, and other major health problems. Our nutrition is generally terrible- lots of fast and processed food, hydrogenated oils, corn syrup, meat, salt, and other things we should know better than to eat. The thing is, we don’t. The average American has a pretty poor level of insight about their diet, and no one (aside from maybe Jamie Oliver) is trying to fix that. The government subsidizes production of corn, wheat, and cattle, and gets lots of money from their respective lobbies, so the nutrition guidelines the government provides are geared towards supporting those industries. Just read Marion Nestle’s Food Politics for all the gory details. Likewise, while we watch plenty of nutritionally-positive TV shows like “The Biggest Loser,” most TV commercials are trying to get us to eat more, consume more, and choose items that are unhealthy but tasty. Advertising and the “food-industrial complex” plays a major role here, and they have plenty of political and financial capital to support this mission. So why don’t doctors reverse this trend? Well, first off, most of us know very little about nutrition. I went to a great medical school, and my education in nutrition and preventative medicine was two hours a week for one semester- and most of that was learning about things like vitamin deficiencies. So I can diagnose and treat beriberi, scurvy, and kwashiorkor, but didn’t learn what the glycemic index was. And even if we’ve educated ourselves about nutrition, we don’t really have time to discuss it in detail, when the average primary-care patient visit is something like fifteen minutes. So we’re not going to be the White Knights on this issue.
Nutrition isn’t the only problem doctors can’t fix- we’re also a seriously sedentary culture. Most Americans don’t exercise regularly, and the rise of the computer and improved communication technology (along with better entertainment technology) means that we also don’t get much physical activity during our everyday life. This is, again, a big product of our culture and history- lots of parts of this country were settled and laid out based on the automobile. Very few were laid out accounting for walking and public transportation. As a people, we don’t take much time for ourselves and our health. While Americans work more and more hours every year, with stagnating wages that often mean working more than one job, we rarely have time to go to the gym, run, bike, or do other healthy activities. When we do, it’s frequently as a short-term resolution, not a permanent lifestyle change. Sleep is also not a priority, and numerous studies have linked lack of sleep with weight gain, heart disease, and diabetes. I, like most doctors I know, am as guilty as anyone of these infractions- I work about 60 hours a week, commute two hours a day, and when I get home, I just want to play with my kid and watch some TV. Most physicians don’t take time to care for themselves, so we’re lousy at advising others on doing it.
The bottom line of all this? Obesity is one of the main things that differentiates American health care from systems in other developed countries. About 9% of our health-care spending is related to obesity, an amount that has been estimated at $147 billion per year. That’s not the majority of our budget, but it’s significant. $147 billion spent elsewhere would buy a lot of health care.
Our national psyche is a big part of all these problems. Americans are, by and large, not good at deferring gratification for long-term benefits. We want to have our cake and eat it, too- literally. And then we want someone to fix the problem created by eating the cake. There’s no emphasis on preventative medicine, and again, I’m implicating the government, industry, and the medical establishment on this one. (Although I think the current administration and most physicians would honestly like to see that change.) One of the unspoken (but just barely) messages of medical companies is that you can do whatever you want and modern technology will fix the resulting mess. Eat too many burgers? We’ve got Lipitor. Arthritis from obesity? Knee replacement. Sleep apnea? Positive-pressure mask to help you sleep. Drank too much booze? Liver transplant. Smoked like a chimney and got lung cancer? Surgery and targeted (read: expensive) chemo. There’s a solution to everything- we just don’t focus on the cheapest solution, which is averting the problem in the first place. To paraphrase a U2 album, the best way to defuse an atomic bomb is to not build one. And Americans love new, shiny things, including medical therapies and devices. Just because something’s new doesn’t mean that it’s better, usually just more expensive. But drug and device companies love to play on this dynamic to sell more products and make more money. And doctors love playing with new toys, so they’re not the best gatekeepers for using new technology.
We are an activist nation, physicians and patients alike. It is very hard to tell someone that we have no more options, no “hail-Mary” to throw, to treat their condition, even if that is the appropriate answer. Modern medicine has gotten very good at fighting disease, to the point where admitting defeat is often a crushing blow. Our expectations are way off-balance, and physicians do a lousy job of correcting those expectations because they are part of our personalities as well. Many people like to point to how end-of-life care differs in European countries, citing the way physicians limit the care of elderly patients. But that’s only half the story; those elderly patients and their families don’t expect aggressive care in their last days, and they don’t demand it of their physicians. Again, the problem is not with doctors or patients alone, but their interaction and the culture to which they belong.
It’s not just the healthcare consumers or their physicians- the structure of the medical system bears a lot of responsibility for high expenses. For one, the way care is paid for is perverted by the third-party-payer system: physicians are paid for care provided, not quality or results. Therefore, we have a huge incentive to do MORE, not necessarily to do the right things for a patient. This has been shown to be a huge factor in costs: in most areas of the country, the amount of healthcare spending per patient is primarily determined by utilization. In other words, the most important factor in how much your care costs is not the price of care, but how many procedures and doctors’ visits are recommended for you. And as Atul Gawande indicated in a recent article, a major determinant of how many procedures and tests physicians recommend is how much profit they stand to make from those interventions. So physicians’ self-interest drives costs up, but that’s just human nature- economic theory clearly dictates that logical individuals will act in their own best interests. The problem isn’t greedy doctors, but the system that pays based on volume of interventions and not quality.
Defensive medicine is another reason physicians order so many tests. We are afraid of missing some obscure diagnosis, which might result in a lawsuit, as well as loss of professional pride and a patient’s trust (and business). The solution many have proposed to this is tort reform, meaning laws governing whether a patient can sue their physician and how much money they can stand to make from the case. This has apparently helped lower costs in some areas, notably Texas. However, this step is not really fair: multiple surveys have revealed that while malpractice premiums are driven up by a small number of big verdicts, some of which are unfounded, many more instances of true malpractice are never followed by any lawsuit. So some sort of malpractice mediation system might be helpful, but capping verdicts is unlikely to lead to a just result. Also, defensive medicine is not just to defend against malpractice, but also to prevent being faulted by our peers and ourselves. In a country where we expect excellence and perfection of physicians, physicians are unable to admit when they don’t have an answer to a question, or when, indeed, finding an answer is not helpful.
One of the greatest problems in the third-party-payer system is its inefficiency. Large amounts of money, time, and resources are squandered on the mechanisms of payment, not on actual medical care. Any physician in private practice will admit that a large proportion of their time is devoted to insurance paperwork, and many (if not most) physicians need to hire independent billing companies to manage their bills so that they have time to see enough patients to keep their doors open. In addition, the fragmented medical system we have leads to unnecessary and redundant testing, as well as plenty of missed communication. While certain innovations like improved online charts and health information systems like those in the Veterans’ Administration and the Mayo Clinic can help reduce redundancy, the main problem is that we have no financial incentive to improve our communication- the system rewards complexity and volume of care, not efficiency. If you need to spend more time wading through a patient’s thick chart full of notes and test results, well, you can bill more for that extra time, or you can require them to come back for another visit later.
It seems to me that one of the central problems of healthcare is that of incentives. The healthcare system does not incentivize the things we want from it: quality care, efficiency, and low cost. A big part of this is the fact that most patients do not pay for their care out of pocket- in a normal market, the force that keeps prices low is the unwillingness of consumers to pay more, resulting in competition between merchants to lower prices. The third-party-payer system disrupts this process, because most healthcare consumers pay a very small portion of their healthcare bills, and fixed deductibles mean that this effect is magnified as care becomes more expensive. So again, while insurance companies can try to reduce spending and modify incentives, their attempts to do so are largely ineffective, backfiring by causing more negative publicity and consumer sentiment than they gain in savings. But that doesn’t mean that physicians can negotiate prices with patients; the fees for various services are set by insurance companies and the government. In fact, if you want to pay out of your own pocket for medical care, many physicians will refuse to negotiate a lower rate, because they are afraid of committing Medicare fraud. While the law does not explicitly ban negotiating prices on an individual basis, it sets limits on how low those prices can be, especially for physicians who take insurance and Medicare/Medicaid. The beauty of a system where patients pay for healthcare directly is that they have freedom to shop around, make their own choices about what care is necessary, and negotiate prices directly; the current system essentially takes these abilities away from healthcare consumers and puts them in the hands of the insurance companies or government bureaucrats. Therefore, no one is really able to control prices, yet no one feels like they actually get what they want. Plus, if a patient actually has to pay for their own care, they will have a better incentive to stay healthy.

So what do I think about the current healthcare reform package? On the one hand, it addresses many of the unevenness of the third-party-payor system. Insurance companies will not be as able to “cherry-pick” healthy patients while leaving sick people out in the cold. In addition, there is the promise of much broader insurance coverage (especially with government subsidies) and better coverage for prescription drugs. And there are some nice provisions to help reverse the tide of medical trainees abandoning primary care for higher-paying specialties. However, what worries me about this reform is what isn’t included: a real way to cut costs. The bills do not provide for any fundamental change in the incentive structure of our system, and they don’t make any great steps towards improving our national health. Looking at the current plan, the main way it seems to limit health care expenditures is by creating health insurance exchanges, which will allow more competition between insurance plans. To return to a previous point, though, this will not reduce the cost of healthcare itself- only how much the consumer pays for it. The only way this plan will reduce costs is if covering more individuals allows for more preventative care, and that consequently improves our overall health as a nation.
So here’s the worst-case scenario: as we cover more individuals, and require insurance companies to take on patients who have much higher expenses, insurance companies begin increasing premiums (this is already happening) and decreasing payments. Medicare and Medicaid may follow suit as more consumers are unable to afford private insurance. As a response to decreased reimbursement, many private physicians will stop accepting insurance or government plans, going entirely to a “fee-for-service” structure. Eventually, the government will have to force physicians to accept certain plans, and this will likely drive many physicians into early retirement or other career paths. The end result to maintain access to care will have to be a national healthcare program like the U.K. or Canada. That isn’t necessarily a bad thing, but enacting fundamental change as a last resort to prevent the system from collapsing is not the best way to go.
The best-case scenario: the government follows up its bill by enacting measures that will improve our national health, including broad interventions to improve our nutrition, encourage physical activity and sleep, and bolster screening for preventable diseases. The purported long-term savings from increased competition and better technologies are farmed back into our system and used to defray the cost of insurance subsidies. New projects towards reforming the tort system and maximizing quality of care (hinted at in the current bills) take root and improve efficiency. And physicians, bureaucrats, and patients alike come to a shared consensus on making health-care work in a more effective and sustainable way.
Sound like a pipe dream? I agree. I’m not necessarily a pessimist, but I’m a realist. On the other hand, I have a lot faith in our president, and I deeply respect someone finally having the guts to address an issue that has been simmering for too long. Do I think everyone should have access to some level of healthcare? Yes. Do I think that the current reforms will fix the healthcare problem in a definitive way? Nope. Do I hope I am proved wrong? Absolutely.

Some useful links:

How American Healthcare Killed My Father- A great article about incentives in the healthcare system

The Cost Conundrum: What a Texas Town Can Teach Us About Health Care- Atul Gawande takes on overuse of healthcare resources

Obesity a Key Link to Soaring Health Tab as Costs Double- An analysis of the costs obesity adds to our healthcare system

New House

When we moved out of Manhattan to the suburbs a little less than two years ago our priorities for a place to live were a little different than they are now. We wanted something CHEAP. And so, the place we’ve been living in has an acoustic tile ceiling with fluorescent lights in the living room (lovely), a blue bathtub and toilet in one bathroom and a painted (Yeah, I don’t know why either) shower in the other bathroom, and wood paneling by the back door. Oh, and the backyard is literally composed of three things- a hill of dirt, a cement patio (fun when we moved here with a kid who had just learned to walk), and, no joke, a pile of rocks.

Our lease was going to be up and my husband was finally making more than slave wages, so we started looking for a new place. Our options were limited because we a needed a place that my husband could walk to the train from.

Well, we found it.

It’s has 3 bedrooms (now we will have a guest room so my mom doesn’t have to sleep on the couch when she comes for a visit), and 2 1/2 baths- all with stone floors, nice tiles, and nice fixtures. The living room/dining room/kitchen is one big open space, so Willa can be eating or playing while I’m doing stuff in the kitchen. There is a big finished basement that will be set up as a playroom so we don’t have toys everywhere like we do now. The garage entrance is right off the living room instead of having to walk through the basement and up a flight of stairs like we do now. The master bedroom has a walk-in closet that is so huge in Manhattan it would be considered another room. The washer and dryer are on the 2nd floor, so I don’t need to drag everything up and down stairs like I do now. And, the backyard? GRASS. What a concept!

Here are some pictures. They are crappy- I took them with my Iphone- but it will give you an idea of what it looks like. When we have access to the house again (April 15th) I’ll take pictures of each room.

This will be the nicest place I’ve ever lived. It makes me misty just thinking about it. I’ve been living in crappy places my whole life. I almost feel weird about living in a decent place. It’s a rental, but I’m going to do everything in my power to make it feel like a home.

The thing that I’m so excited about is decorating the new place. I’m going to take my time and do it right.

We have several pieces of crappy furniture that we will be selling at our garage sale or donating. Most of it is crappy particle board stuff that I bought when I was 19. Which means will will need to get a few new pieces.

We’ve already ordered a new couch for the living room. We got it at Mitchell Gold & Bob Williams which is an eco-friendly company. We even had it upholstered in eco-friendly material. I highly recommend Mitchell Gold & Bob Williams- our salesperson was great and he gave us 20% off!

Our old couch and chair will go in the basement.

I’ve been thinking a lot about what color schemes I’m going to use in each room.

In our bedroom I’m hoping to paint the walls a light gray and get some Flor tiles in a bit of a darker gray. Our bed linens and accessories will be mostly blue with a few touches of red. I got the idea for blue and red from a painting that was my grandmother’s that hangs in our bedroom.

Willa’s room will be similar to what she has now- pale blues, greens, yellows, and if she has her way, some touches of pink.

I’m thinking of painting the basement a pale yellow to brighten it up. I’m also thinking of using green accessories (The couch and the chair are boring beige).

The living/dining/kitchen area is a blank canvas. The fabric we ordered the couch in is a neutral- sort of a nubby sandy color with chocolate flecks. I figured we could bring color into the room with accessories and chairs. I’m thinking of doing a red/orange/yellow color scheme.

One thing we know for sure- any new pieces we bring in will be eco-friendly. I might make an exception for the occasional decorative pillow, but all of the paint, furniture, rugs, linens, etc. will be eco-friendly. I’m willing to buy furniture at a garage sale or antique shop if it’s a good solid piece.

I’ve been doing a lot of research on line looking for eco-friendly products. It seems almost everyone has at least something eco-friendly these days- Crate and Barrel, Pottery Barn, West Elm, etc.

I’ll be taking you guys along for the ride as I decorate the new house. It will probably take a while- I don’t want to run out and buy a bunch of new stuff right away. I want to take our time and find the right pieces.

I’d love to hear from you guys about your design inspiration- what color combinations do you love? Where do you shop for eco-friendly products? Any inspiring design web sites that you recommend?