Casa Rosada

On my way to San Telmo, I noticed that people were walking right inside Casa Rosada. What?! Ok me too. A free tour? Yes please! It was awesome!  There is a beautiful art room, the room celebrating the Women of Argentina in which the President gives important speeches. There is the Salon de Eva Peron.  The tour even includes the President's office! No photos allowed in there, but man, Christina has a LARGE pile of books on her desk, and very sweet photos in her office. Could you imagine visiting the Oval Office?! Apparently no one comes to work on the weekend, and the President lives elsewhere. I was so pleased with stumbling across this experience!

Evita's desk

Abuelas de Plaza de Mayo

This cartoon runs on the children's channel of the Argentine Ministry of Education, explains the reasons and history behind the "Rights of Identity" and exactly what the Abuelas are still working for.

I'm sorry it's only in Spanish...

"91 degrees, feels like 110"

That was the weather report for this afternoon. Oh boy it's been a hot one today! And I take a long walk to Museo Evita. Haven't felt this close to passing out before.

Some photos of the day...

My fresh pasta with pesto and baguette with brie

Unnamed sculpture nearby Recoleta Mall

The best of the US

Museo Evita, the building previously housed one of Eva's shelters for Women and Children

Evita Peron

A collection of Evita's stylish outfits

BA street art

Why I Support the Affordable Care Act

     

Watching another instant classic Jimmy Kimmel clip made me realize that we supporters of the ACA have been failing. Jimmy Kimmel went to talk with people on the street about whether they supported the Affordable Care Act versus Obamacare. The joke was that everyone supported the ACA and no one liked Obamacare, highlighting the fact that most people failed to realize they were the same thing. I want to make sure you know why I support "Obamacare", aka the Affordable Care Act. 

     At a recent town hall meeting with CA Secretary of Health and Human Services Diana Dooley, she highlighted that the Affordable Care Act has three legs to it. The “Affordable” part, aka the delivery and finance reform, the "Prevention and Wellness" leg, and the "Coverage Expansion" leg. This third leg, the expansion of coverage starts this week. Each state runs its own health insurance exchange, ours is “Covered California”, which is basically an online marketplace for health insurance. You can visit the website at https://www.coveredca.com/. From my work with creating websites in the past, I have to give major credit to Secretary Dooley and her office for the user interface and ease of use. Check it out yourself, in one of the 14 languages it's been translated into. Starting now, you can “enroll” in health insurance that will go into effect on January 1st 2014. All insurance providers who enter the exchange are required to cover 10 Essential Benefits. 

      To give you some examples of the coverage rates. If you are single, and make $27,000 a year, your health insurance will cost $175 per month, thanks to a $2460 subsidy by the federal government. Or lets say you are a nurse with a family of 4, earning $88,800 per year, your monthly health insurance will cost $700. Compared to the old individual market, where a family of 4 could cost $2k-3k a month, these are very affordable plans. The rates vary depending on the particulars of the plans you choose of course. 

    As for the other two legs of the ACA, I’ll be brief, you need to know that with the “Affordable” leg the ACA bans discrimination based on pre-existing conditions and bans insurance caps. For us healthy folks, this doesn’t mean a whole lot, but it is a really big deal. The number one cause of bankruptcy in the US is health care costs. Now, because of the ACA, less people will go bankrupt due to hitting their insurance limits while on chemotherapy treatments or living with cystic fibrosis. With regards to the “Prevention” leg, your routine health screenings, vaccines, and birth control will be free. Many of these perks have started to kick-in already. Check out https://www.healthcare.gov/prevention/ for more. 

     Is the ACA really such a big deal? A resounding yes. The insurance reform, focus on prevention, and extension of coverage, are exactly what we need in the health care sector. The ACA will make us healthier as people, communities and as a nation. There will be bumps in the road, the ACA is not perfect (has any legislation been perfect ever?), but it is definitely a big step forward. As Congresswoman Anna Eshoo recently remarked about us Americans, “we love our history once it’s been made, but we seldom embrace the fact that we are making it. As someone who was in the Senate chambers on March 23rd 2010, watching the Senators vote for the passage of the ACA like a Giants fan in game 7 of the World Series,  I knew that I was part of something historic. I will consider it an privilege to serve my country as a doctor under the Affordable Care Act. 

I hope you’ll join me in my support and spread the word yourself. 

Weekly Goods

A good book...
Hilary Rodham Clinton's Living History
Finally finished it. My favorite part of the book was learning more about her younger days, at Wellesly College especially. It was also interesting to hear her opinions on the contrast between her image as First Lady when she tried to take on legislative roles vs advocate for women's rights internationally. Her China speech as Women's Rights being Human Rights is historic, a must watch, and an excellent call to arms. "If there is one message that echoes forth from this conference, let it be that human rights are women’s rights and women’s rights are human rights once and for all". I know that in the development world so many people are advocating for women's rights as a path towards development, and I think Hilary was the one who really set that agenda in action. I'd be proud to support her in 2016 if and when she decides to run. I couldn't think of a better candidate.

A good song...
Let Her Go
By Passenger, this is a beautiful song. I want to learn the guitar so I can play it myself.

A good film...
Miss Representation
A few facts I learned from this film... Cuba, Iraq, China, and Afghanistan have more women in politics than the U.S.... Did you know domestic abuse was acceptable denial of insurance as a "pre-existing condition?" (Thank goodness for Obamacare)...I also didn't know that the US is the only industrialized nation without paid family leave. Jennifer Newsom did a great job.

A good talk...
Stanford Population Health Symposium 
I attended Stanford's kick off conference debuting the new department of Population Health.  The best part was my lunch table conversation with Dr. Jack Rowe, former CEO of Aetna, and Dr. Mads Melbye, head of the Danish National BioBank -to say it was an interesting conversation is an understatement.

A good youtube..
Hitting the Wall
Paula Newby Frasier, one of the epic ironman triathletes in 1995 pushed herself beyond her limits. This is a heartbreaking and inspiring video illustrating her limits. "Totally surreal". It shows how dangerous athletics can be when we are strong enough to push ourselves beyond our limits. You get knocked down, but you get up again. That's the best 4th place finish I've ever seen.

Another good week in the books.

Weekly Goods

Attempting to get back in the blogging groove, here are a few highlights of last week.

A good movie...
La Misma Luna
A wonderful movie directed by Patricia Riggen about a boy and his mother.  An enticing summary can be found here. Spanish with english subtitles, so a great movie for improving your spanish language skills as well. It's also called Under the Same Sun. Watch the movie trailer for yourself.

A good song...
Pure Imagination
A hauntingly beautiful song remade by Fiona Apple. This is the song behind Chipotle's latest advertisement, The Scarecrow.

A good book...
The Thoughtful Dresser
A novel by Linda Grant taking a closer, and more serious look into our love of fashion. She intertwines many wonderful bits of fashion history, from Chanel to Christian Dior's New Look, while telling moving stories of the power of fashion and style in the face of of atrocities against humanity. Makes me like fashion even more then I did before. Quick and easy read, if you like fashion at all, this book is for you.

A good eat...
Boulevard
After making a reservation 3 weeks ago, we finally had dinner at Boulevard. If you are up for a gourmet meal, wonderful ambience and the best halibut I've ever tasted, Boulevard is where you should eat. Chef Nancy Oakes lives up to expectations, now I want to check out her other restaurant in town, Prospect.

A good talk...
ACA Town Hall Meeting 
I attended Stanford's Affordable Care Act Town Hall Meeting today. The guest speakers were Congresswoman Anna Eshoo, California Secretary of Health & Human Services Diana Dooley, and Stanford Pediatrician Paul Wise. Enrollment in "Covered California", our health insurance exchange begins next week. Thus why House Republicans are all in a fit this week. Diana Dooley did an excellent job breaking down the 3 legs of the ACA, the delivery and finance reform, prevention and wellness aspects, and expansion of coverage. My favorite quote from the event was via Anna Eshoo, "We love our history once it's been made, but we seldom embrace the fact that we're making it". Let's hope that with the bans on lifetime insurance caps and discrimination based on pre-existing conditions that health care stops being the number one cause of bankruptcy in the US.

A good run...
Palo Alto Moonlight Run
Stanford Med came out in full force, fundraising over $6k for our free clinics in honor of former Dean Phil Pizzo, aka Marathon Man and one of my idols. I entered the 5k race, and wasn't going to push myself, because I strained my calf earlier in the week (yes injuries still mar my existence). But, when the gun went off, I couldn't help myself and I went for it. The sheer joy of racing was felt in every ounce of my being. I was grinning from ear to ear for at least the first half of the run (don't worry shortly after I started to feel like I was going to die from lactic acid). Seriously though, such a joy to be out there with everyone. Racing is a spectacular feeling! Even though I was about 200 people back and took a solid 5 minutes before we were going faster than 10 min/mile pace, I somehow managed to win my age division? I didn't even know this until my advisor emailed me saying she picked up my medal for me. Sure enough, I am now in possession of a blue ribbon medal! A surprising highlight. I think I can run a pretty good 5k in the upcoming year. So here goes nothing...

Ok, first post in two months, have to start somewhere. This was certainly a good week, hopefully I"ll have something worthy of posting soon. Pass along any "goods" from your week.

Who won tonight?

Women.

We voted an unprecedented number of women into the Senate (19 and counting).

We voted for all female representation in New Hampshire.

We voted for equal pay.

We voted for women's health to remain between women and doctors, not mandated by predominantly male legislators.

Most importantly, we moved one step closer to the tipping point.  Generally it's noted that 30% representation is the threshold at which women's issues (ie democratic issues like education, income equality, health care) to become front and center and truly championed and implemented. 19 is better than 17, but still short of 30...

In case you needed more convincing...

(Just a couple of) the Obama Administration's accomplishments:  taken from Obama for America... 1. The first bill President Obama signed was the Lilly Ledbetter Fair Pay Act, to help women fight back when they don't get equal pay for equal work. 2. His Recovery Act supported millions of jobs and helped to stave off a second Great Depression. 3. He pushed for and won middle-class tax cuts that benefitted every American worker, and saved the typical family $3,600 in taxes over the last four years. 4. President Obama rescued the auto industry, and now GM and Chrysler are healthier than they've ever been. The American auto industry has added nearly a quarter of a million jobs since June 2009 -- and they most likely wouldn't exist right now without President Obama's leadership. 5. He doubled funding for Pell Grants, helping to make college more affordable for nearly 10 million families. 6. His student loan reform ended billions in subsidies to banks serving as middlemen and reinvested those savings directly into students. 7. The President established the American Opportunity Tax Credit, worth up to $10,000 over four years of college. 8. His Race to the Top Initiative helped spur nearly every state to raise academic standards. 9. His tax cuts, social-welfare programs, and economic policies lifted nearly 7 million Americans above the federal poverty line in 2010.  10. President Obama has signed 18 tax cuts for small businesses since taking office. 11. We've seen 5.2 million new private-sector jobs over the last 31 months. 12. The unemployment rate is at the lowest level since President Obama took office. 13. Health care reform -- passed after decades of failed attempts by every previous President -- provides affordable health coverage to every American and will lower premiums by an average of $2,000 per family by 2019. 14. Obamacare expanded access to lifesaving preventive care such as cancer screenings and immunizations with no out-of-pocket costs for 54 million Americans. 15. Obamacare ends insurance discrimination against the 129 million Americans with pre-existing conditions.  16. Because of Obamacare, over 3 million more young adults have health insurance today than would if the new law hadn't passed. 17. The parents of over 17 million children with pre-existing conditions no longer have to worry that their children will be denied coverage. 18. President Obama has ordered the overhaul of federal government regulations to make them smarter, practical, and more efficient. Just a fraction of these commonsense initiatives will help save businesses $10 billion in the next five years alone. 19. His historic investments in clean energy have helped more than double the amount of electricity we obtain from wind and solar sources and helped increase biofuel production to its highest level in history. 20. President Obama is doubling fuel efficiency standards, which will save drivers more than $8,000 at the gas pump, not to mention lessen the impact of automobiles on our environment. 21. President Obama has taken unprecedented action to address climate change, reaching historic international agreements to curb carbon emissions, and taking action here at home to reduce carbon pollution from our vehicles and promote clean energy production. 22. He has taken historic action to protect our environment -- signing one of the largest expansions of protected wilderness in a generation and putting in place standards to reduce toxic air pollution that will save thousands of lives. 23. President Obama fought for and won landmark Wall Street reform that reins in the abuses that led to the financial crisis and ends the era of taxpayer bailouts and "too big to fail." 24. Wall Street reform created the Consumer Financial Protection Bureau, the nation's first federal agency focused solely on consumer financial protection -- and the Bureau is already protecting families from unfair and abusive financial practices from Wall Street banks and shadowy corners of the financial industry. 25. As part of President Obama's commitment to transparency, the White House has posted its visitor records online for the first time ever. 26. President Obama's all-of-the-above approach to energy has helped cut the United States' dependence on foreign oil to its lowest level in 20 years. 27. President Obama responsibly ended the war in Iraq. 28. He announced a plan to end the war in Afghanistan and transition security responsibility to the Afghan people. 29. President Obama sent the largest security assistance package to Israel in history and funded the Iron Dome system, which is protecting Israeli homes and schools from rocket attacks. 30. President Obama rallied the international community to implement the toughest sanctions on Iran in history. 31. Through the President's historic increases in Veterans Affairs funding, he has expanded and improved healthcare and job training access for our returning veterans. 32. President Obama negotiated the New START Treaty with Russia to reduce the number of nuclear weapons in both countries. At the same time, he also secured commitments from dozens of other countries to lock down nuclear materials. 33. His administration naturalized 11,146 military service members as U.S. citizens in 2010; more than in any year since 1955. 34. President Obama set a bold new plan for the future of NASA space exploration, using the skill and ability of the private sector for short trips to the International Space Station, while building a new vehicle for exploration of distant space, and doing everything in his power to support the economy on Florida's Space Coast. 35. President Obama recognizes that tourism is one of America's largest economic engines; he's worked to encourage international visitors to come here, maintaining our security while keeping millions of Americans in good, paying jobs. 36. He has affirmed his personal support of marriage equality, directed the Justice Department to stop defending DOMA in federal courts, and took the practical and compassionate step of extending hospital visitation rights to same-sex partners. 37. He fought for and won the repeal of Don't Ask, Don't Tell, allowing gay and lesbian members of the military to serve openly for the first time in history. 38. When Congress failed to fix our broken immigration system, his administration did everything in its power to improve it, streamlining the legal immigration process and announcing a policy that lifts the shadow of deportation from hard working young immigrants brought to the U.S. as children. 39. Oh, and he gave the order to send troops in after Osama Bin Laden -- and has decimated al-Qaeda's senior leadership. View the list here.

Happy Earth Day

In an attempt to enjoy the outdoors on earth day, I drove to the beach. It's 80 degrees, picture perfect at Stanford today, but once arrived at said beach, it was cold, howling winds, no sun in sight. That's northern california beaches for you. I'll never be fooled again!

A quote from John Muir, the consummate naturalist, to honor Earth Day 2012:

"God has cared for these trees, saved them from drought, disease, avalanches and a thousand tempests and floods. But he cannot save them from fools"

Affordable Care Act

Quite a few folks have asked my opinion on the Affordable Care Act. My bottom line on health care: providing health care for citizens is a fundamental component of a fair and just society. On a daily basis I am horrified at the disparities in care and outcomes I witness.

The details of how we provide universal health care for citizens of the United States are just that, details.  I agree 100% with Ted Kennedy's philosophy:

"...Quality care shouldn’t depend on your financial resources, or the type of job you have, or the medical condition you face. Every American should be able to get the same treatment that U.S. senators are entitled to." 

Ted Kennedy

Horrifying: State announces closure of 70 parks to save money

Portola Redwoods, Castle Rock, Henry Coe... Some of the best. This is a travesty for all Californians!!!!!

A story from AP Mobile:
State announces closure of 70 parks to save money

My favorite color is blue

Thank goodness the good state of California agrees with me, a clean sweep! I'm such a California girl at heart. We can get back on track now.

Yes on CA Prop 21

We all pay taxes so we can partake in public goods and services. CA Proposition 21, the State Parks Initiative would remove all entrance fees to California state parks (fees recently increased from $6 to $10 last spring). Prop 21 would add an $18 surcharge on obtaining a vehicle license, and in doing so make our state parks more accessible to all Californians. I strongly support this Proposition and hope that in November you vote yes on Prop 21with me.

NEJM Letter on Arizon Immigration Law

Thought it necessary to share this brief letter to the editor...While I was reading it, I was struck by the fact that the Arizona law has such similarity to the Fugitive Slave Law of 1850 that made it illegal for people in the Northern states to "conceal, harbor or shield" a slave and effectively turned police officers into "slave catchers". This is wrong. If I ever am subjected to such inhumane laws, I will choose to nonviolently protest and disobey.

Arizona Immigration Law and Medical Practice

To the Editor: The new Arizona state immigration bill (SB-1070) signed into law on April 23 will seriously obstruct, if not undermine, the practice of medicine in the state of Arizona. It specifies that those who "conceal, harbor or shield or attempt to conceal, harbor or shield" a foreign person who came to the United States illicitly "are guilty of a class 1 misdemeanor" punishable by a fine of at least $1,000 (Sec. 5, Section 13-2929).¹ It can be argued that health care providers who neglect to report illegal immigrants under their care will violate the law and be considered criminals. The bill provides physicians with no guidance as to what constitutes "reasonable grounds" to suspect that somebody is in the country illegally, leaving the particulars of such scrutiny to anyone's imagination (although the fact that Arizona shares a border with Mexico rather than a European country suggests that whites will not be "reasonable" suspects). One interpretation is that health care providers in Arizona will need to ask for a passport before seeing certain patients (and providers themselves will need to carry their own passports at all times, depending on their physical appearance or accent). Arizona practitioners, hospitals, and medical associations need to ponder the extent of their liability under the new law and draft clear institutional policies to defend their patients and employees from potential harassment. Asking patients to produce immigration documents violates the trust that physicians, nurses, and other health care workers endeavor to earn from them.
This bill threatens one of the oldest traditions of medicine: physicians shall protect patients regardless of nationality or race.² This legislation, if unchallenged, will force health care providers to choose between the dignity of their profession and the indignity of violating the law.

Lucas Restrepo, M.D.
Barrow Neurological Institute
Phoenix, AZ

Change-Congress.org

5 Steps to Understanding our Financial Crisis

1. Listen to this podcast, by This American Life: The Giant Pool of Money: What does the housing crisis have to do with the turmoil on Wall Street? Why did banks make half-million dollar loans to people without jobs or income? And why is everyone talking so much about the 1930s?

2. Listen to this podcast by This American Life: Bad Bank: The collapse of the banking system explained, in just 59 minutes. (also downloadable via itunes)

3. Read this blog post at the Baseline Scenario (co-written by Simon Johnson former chief of the IMF)

4. Explain it to a friend (like me!)

5. Repeat Steps 1-4, seek more information as necessary

Also of note, this graph does more than any commentator or newspaper in explaining the heart of the problem:


It's a graph of the ratio of Consumer debt compared to GDP. As of 2007 it was the first time since the Great Depression that this ratio hit 100%, meaning that as a whole we have $13 trillion in consumer debt and $13 trillion in GDP. Guess when this ratio really started climbing? 2002-2007. Thanks W. Thanks OC, manicures, tanning salons, Hummers, ipods, big houses, hair highlights and everything else for getting us into this mess. As much as we want to blame the banks, its lack of government regulation and lack of self-restraint that got us in the mess. Go burn your credit card. NOW.

The Obameter

The St. Petersburg Times is keeping up an Obameter and is tracking Obama on over 500 promises that he made during the campaign...

Here's an example:

No. 458: Invest in all types of alternative energy

The Promise:

"We'll invest in research in every form of alternative energy - solar, wind, biofuels."

Update February 20th, 2009:

Stimulus provides money for alternative energy research

Obama Sushi

I wish I could take credit for this or even finding this, but I can't (Thanks Tiff!)

Stimulus Bill

You can read the full bill that recently signed into law here

I prefer primary sources over pundits.

8 Ways the Stimulus Bill Will Improve America's Health

From Division A, Title IX

• $600 million for the training of nurses, primary care physicians and dentists and to boost funding for the Health Service Corps
• $1 billion to renovate and rebuild health centers and health IT
• $1.5 billion to the NIH specifically for funding more scientific and clinical research
• $700 million to fund comparative effectiveness and evidence-based research (Ie the beginnings of a Federal Health Board made up of physicians in federal agencies that will examine current clinical patterns vs. the evidence-base and will create an annual report to the president and congress
• $2.1 billion to expand the Head Start program
• $2.5 billion for immunization and disease prevention programs

From Division B, Title III

• Extending COBRA benefits for those left unemployed

Division B, Title IV: Health Information Technology (HITECH Act)

• Policy and Requirements for national health IT standards and implementation

You can read the whole bill for yourself here