KELSI READS

Once upon a time, I thought I might be addicted to sugar (inner Kelsi nods her head emphatically). I also thought my regular diet may not be great by most standards or adequate to meet my needs BUT I also didn’t think it was that bad. Enter Whole30. 

I’d seen the posts about it and was admittedly curious. Greg has eaten Keto on and off and alongside him, I’d had my fair share of Keto and Keto-ish meals. I proposed doing Whole30 as a fleeting whim to Greg, who, unsurprisingly, enthusiastically agreed to do it with me before I’d even committed to doing it. 

We started (before I could think twice) on Friday, January 12th. I optimistically looked at the criteria and came to the conclusion that it wouldn’t be that tough, albeit maybe a bit boring. The ‘rules’ themselves really aren’t that restrictive; you can have meat, veggies, fruit, nuts, and oils mostly to your hearts content. But as a walking Yelp for the local bakeries, I knew I might be in for a bigger challenge than I estimated. 

The Rules

Do eat:

Moderate portions of meat, seafood (not for me because ew), and eggs; lots of vegetables; some fruit; plenty of natural fats; and herbs, spices, and seasonings

Don’t eat:

Added sugar, real or artificial. 

Alcohol

Grains

Legumes, including soy.

Dairy, except ghee or clarified butter. 

Additives like carrageenan, MSG, or sulfites. 

This last category is more ambiguous: baked goods, junk foods, or treats with “approved” ingredient.

Let me be clear, Whole30 is not intended as a ‘diet’ but rather as a metabolic reset. Hence, why it perhaps ranks so low in diet rankings. You don’t eat certain foods for a while, see how you feel, then slowly add them back in and again, see how you feel. 

We hit day 11 today, which according to the Timeline, is supposed to be one of THE hardest days of the 30. 11 days into it, I figured now was as good a time as any to share some quick thoughts on what I think and how I’ve felt. I’ll be the first to say: your experience may vary. You can trust though that nothing I say is BS - I went into this with my BS radar UP and truly didn’t think I was going to feel/learn much. I can honestly say that I’ve been surprised. And with no further ado, let’s get to the spiel:

Hair - TMI but I used to use a ton of hair in the shower/post-shower combing things out, and I’ve noticed substantially less hair loss since starting. 

Skin - I’ve been lucky in that I’ve always had pretty clear skin. I haven’t noticed a demonstrable difference here. 

Energy - excluding the last 3 or so days when I’ve admittedly been kinda zonked (note extenuating circumstances, aka I didn’t sleep well nor did I eat enough), I’ve had definitively more energy in the afternoon/evenings and dare I say mornings. I attribute this energy change almost certainly to the quality of the food I eat (and I notice when I don’t uphold my end of the bargain). I used to come home post-work, starving and flop on the bed with a book or tv. Now, not so much. 

While you’re on Whole30 you’re not supposed to weigh yourself, but I am definitely less puffy and more than likely slimmer than when I began. 

Mood - I alternate between “I don’t want to eat/do anything, I just want to sleep. Shut it Greg” and “I have so much more energy!”. I don’t really see this as having a huge impact other than the energy piece and that it’s frustrating I can’t eat a damn cupcake when I want to. Greg might have different thoughts though... :p

Dreams - I haven’t really noticed any crazy dreams associated with the diet. Pre-Whole30 I dreamt regularly on often remembered dreams; this has pretty much held true albeit one dream I had where we were people made out of sweet potatoes and our skin kept peeling and the stuffing came out. 

Food Realizations

Coffee - I don’t need sugar in my coffee anymore. Thank god. I plan to keep this one post-Whole30. Almond milk here on out. 

Water - I drink more now and I should probably keep doing that. Just maybe. 

Breakfasts - might be a good idea to eat these once in a while. Especially if I want that energy I mentioned up there. More importantly, I feel like a gd superhero (or well at least I’m not dying at my desk while reading Medicaid waivers) with protein and veggies in the AM. Breakfast is probably my most challenging meal though. I find it really difficult to get those aforementioned veggies in and GOD am I bored by eggs (I don’t even really like them that much).

Protein and veggies - they’re the name of the game. Pre-Whole30 I did pretty well with dinners but not so well when it came to lunches... I wasn’t eating enough and I wasn’t eating the right stuff. I get it, okay. I need more protein and more plants to keep my energy up. 

Snacks - I don’t need ‘em! When I eat what I’m supposed to I am satiated for longer and don’t feel as compelled to snack. 

Hunger - overall I’m way less hungry. In fact, I err on the side of not eating enough more often than not (I’m working on it, don’t get worried or anything). 

I think that mostly covers it - for now anyways. We’re only just a third through the program so who knows what will set in later. So far, it’s not really been hard. I’ve definitely gotten frustrated or bored but I can’t say that I’ve found it all that difficult to eat compliantly. I moan about it regularly and talk often about the things I wish I could have, but I also felt comfortable passing on homemade ice cream while babysitting. It probably helps that I’m stubborn as mud and once I commit to something I stick to it hard, as anyone in my family or Greg can attest. I’d give him hell if he deviated and feel even worse myself if I cheated. Granted, I’m also taking a slightly more flexible approach than he is... for example, when I ate out I didn’t ask whether my kebab was cooked in canola oil and I definitely used some mustard that had a tiny bit of white wine in the ingredients. You can only take this thing so far (and spend so much money on compliant replacements). 

Lately, I’ve been struggling with the why and what next of Whole30. I’m never going to give up cupcakes or cheese, let’s be real. But I also have some take-always that I can see implementing after the 30 days (e.g., no sugar in coffee, more protein and green-rich meals). 

The Hotel Hacker - it sounds like a thrilling John Grisham novel turned bad Ben Affleck movie. This longform article details the raids of a technological burglar on hotels across the Southwest as he exploited the global vulnerability in hotel key card locks. 

What happens when you take a leading health care policy and health care cost researcher and ask him to price shop for an operation? #strugglebus Even the pros struggle with this. Read it here.

Should white chefs sell burritos? Exploring the complex interactions between race, culture, appropriation, and racism. Still something I’m turning over in my head. 

Rock star status. Check out this 18-year old and her efforts to map abortion clinics across the U.S. 

And finally, An Ode to Bad Family Vacations. This article holds a special place in my heart. Just like that family trip/drive to DC after I first moved here... ;)

On American Identity, the Election, and Family Members Who Support Trump - reflections from an adopted, Asian American woman. A good read in light of the upcoming holiday season. 

Ask Polly - this one hit home a bit. It can be a challenge to be flip and (overbearingly, treacly - my words) positive when at your heart of hearts you feel dark and cynical and want to really talk about the fact that we’re all gonna die and what does that mean and why does it mean anything... and oh. Well you get it. Old friendships, new friendships all are welcome but as the author says, you need ‘people who make more sense to you... people who don’t sometimes stare at you like you crawled out of a hole in the ground.’ 

Body Brokers - fascinating look at the highly unregulated U.S. market for human bodies

This article is why I could never quite get behind my sister’s addiction to HGTV.

The Week My Husband Left and My House Was Burgled I Secured a Grant to Begin the Project That Became BRCA1: A reminder that life goes on. Sometimes the shit hits the fan and you make a life-changing discovery that will affect a large portion of the human race anyways. 

Hi friends, it’s been a while and without further ado, I want to get right back into it and tell you about my recent trip to Copenhagen.

When Amanda told me she was moving to Copenhagen with her family and invited me to visit, I don’t think she planned on me texting her that I booked a trip shortly thereafter. I can’t resist cheap airfare. After hurriedly sending around a chain of texts, Kyu, Greg, and I booked our tickets for a long weekend abroad. 

We flew with Iceland Air from Dulles to Reykjavik and on to Copenhagen in about 9 or so hours total. After arriving on Friday morning, we hopped the train (or was it the metro, I still don’t really know) to meet Amanda and co. At that point, Ava Grace and Casey (Amanda’s oldest and middle child) had already departed for school, but Charlotte (the baby) and Amanda welcomed us with open arms into their beautiful apartment -- and boy do I mean beautiful! It made me think of the elegant family city apartments described in the books about the 1940s I used to read. 

After filling up with fresh coffee, we left the apartment to visit the first of our Copenhagen bakery stops and went onward to a park for Charlotte, whereby we watched small, towheaded Danish toddlers attempt to engage her in play. From there we left to visit Rosenborg Castle (Slot), a renaissance castle built as a country summerhouse for Christian IV. 

By that time, we were hardcore crashing having been up since 7ish AM or so on Thursday all the way up to what was Danish mid-afternoon and U.S. bedtime. We returned to Amanda’s where Greg and I promptly passed out face-down on Amanda’s drawing room carpet. Post-nap, we made it back to our hostel downtown and grabbed a drink at its bar before rejoining Amanda and her family for a homemade dinner. Amanda led us on a night-time constitutional through the streets to Nyhavn (you know that Insta-famous place with the colorful houses set against the harbor?) until we parted to finally return to the hostel and sleep. 

Saturday brought a groggy morning of coffee and yogurt at Cafe No. 11 followed by a walk across town from Indre By (downtown) to the Christianshavn borough. We went directly to the Church of our Saviour to climb their tower and take in some amazing city views. Somehow all my research neglected to inform me of the perilously narrow, sloped path round the very top -- let’s just say I was gripping the wall and there may have been a moment where I about lost it from the looking down and contemplating a fall to my death. But the views though! 

We walked a short way down the road to the Freetown of Christiana, a favorite stop of the entire group I think. Christiana is a self-proclaimed autonomous anarchist district of about 1,000 or so residents, covering roughly 80 or so acres. The town consists of a former military barracks that was taken over by city residents in the 70s and first used as a playground and source of affordable housing. From there it quickly developed into a home for the hippie movement and squatter movement prominent in the 70s. Today many still call it home but it’s also quite a draw for tourists due to the flourishing (illegal, but not prosecuted I think) cannabis trade, street art, and general art/culture/history. They don’t allow pictures for obvious reasons, but I have to say this was a highlight for us and definitely worth visiting. It’s quite interesting to see how the community has woven itself into the existing built environment. If you go, look out for the flag - a red banner with three yellow disks; Greg had one of the local beers and its logo was the flag. 

Next, we stopped by Copenhagen Street Food for some lunch on our way back downtown. The waterside marketplace had ample and varied stalls, enough to please our group (not to mention a post-lunch ice cream on the harbor wall). That evening we made our way to Vesterbro (the old red light district / current hipster district, funny how that’s true almost everywhere) to meet Amanda for pizza at Neighborhood. Bellies full, Amanda led us back through the city for a parting hug and drop off at Copenhagen’s Tivoli Gardens, a famous amusement park and pleasure garden located in the heart of the city. Tivoli is the second oldest operating amusement park in the world and supposedly inspired Disney. Hitting the park at dusk and then night wound up being perfect - the park and its buildings and attractions were beautifully lit. Even if you’re not into rides, it’s worth a walk-through. We wondered its pathways and rode a few rides, before closing our visit with a spontaneous music concert that we happened upon. 

Sunday morning Kyu led us to breakfast at Torvehallerne, a second marketplace, for some oatmeal at the world’s first porridge bar, Grod.  

I added fresh strawberries and cocoa nibs with almonds whereas Greg opted for a berry/peanut butter concoction reminiscent of PBJ. I forgot to mention this is the trip that also got Greg started drinking a daily coffee... but that’s another story. We walked to nearby Stroget for a bit of souvenir shopping during which I decided that I am Scandinavian at heart stylistically since I too prefer the Dane’s casual, clean style. We met back up with Amanda and co. at Torvehallerne and I fulfilled my reputation as ‘oreo girl’, buying Amanda’s kiddos (and me too) all the sweets their little hearts desired (try the Flodeboller). Walking hand-in-hand with Casey, our little party ambled through the city to the harbor to catch a ferry for a bit of sight-seeing and a cool breeze. We zipped across town, over the water to a park where the Little Mermaid Statue was located. Let me just say it was probably the least impressive sight of the whole trip (so tiny!), but the surrounding park area was gorg!

After more hugs, Amanda and co. departed and we journeyed over to the Design Museum of Denmark - totally recommend. Really neat exhibits, and what could be more Danish/Scandinavian than the design museum, check out all the chairs! I left a bit early on my own to shower and get cleaned up for our fancy dinner later that night. After reading and researching, I made us reservations at Manfred’s in Norrebro so we could try the highly regarded ‘New Nordic’ cuisine. Manfred’s is a veggie-focused restaurant most famous for its raw meat (yes, you read that right). It was neat to try such a different style of (haute) cuisine but it certainly wasn’t something I’d care to eat regularly or even again really; I’d totally recommend the wines though! All in all a really cool experience. We returned to the hostel a bit buzzed and quickly rounded up another round and a few Aussie friends for a round or two of shuffleboard before passing out in our beds. 

Monday brought a return to Stroget for more souvenir shopping, Danish hot dogs at a stand, and our train back to the airport. Copenhagen 10/10 would recommend! A beautiful city, with architecture locked in time and people who appreciate their natural surroundings. Perfect for a quick trip! Not to mention our lovely hostess, Amanda, and her charming fam--Mac, AG, Casey, and lil miss Charlotte. 

Many great reads today, pay attention folks:

In Jail, Pads and Tampons as Bargaining Chips (aka a debate I had with my boyfriend) - periods are inconvenient they are also largely involuntary for most biologically-born women of menstruating age. I equate tampons and pads with toilet paper; it’s a biological function that I don’t have a lot of choice in. So I don’t see why they’re not provided for just as toilet paper is in all settings, cost-free. I mean shoot, they’re not even available in all settings with a cost at this point. All women, including those imprisoned, should have access to these supplies as a point of equity and basic human necessity. It’s disgusting that these supplies were withheld as some sort of punitive attempt to discipline, ‘educate’, or moralize. If it’s a problem in New York, I guarantee it’s a problem elsewhere too. Believe it or not, this was even a problem in the gosh darn White House. #sosalty #blurgh

And don’t even try to tell me periods are optional--controlling periods through birth control or other contraception is an option available to SOME people BUT this choice is not without its own myriad of consequences ranging from cost, to health concerns, to religious beliefs, etc.

Why White People Don’t Use White Emoji - fascinating piece from The Atlantic that explores data on the use of racially-toned (is that correct nomenclature?) emojis. Truthfully, it’s not something I give much thought and I usually just go with the yellow auto emoji. But it does make me think, would I do that if the yellow emoji was instead a black auto emoji? So much to dig into. 

How realistic are NY apartments on TV shows? - not very. Who comes close? Unbreakable Kimmy Schmidt, The Cosby Show, and Marnie from Girls (aka NOT Friends).

Adult skill #34 (that’s arbitrary numbering): How to Clean and Maintain Cast Iron

From my friend Amanda, Behind the Photo that Changed the Boston Marathon Forever - In 1967, Katherine Switzer ran the Boston Marathon and the photos showing race organizers attempting to tear her from the race for daring to run as a woman marked history. I’m grateful for the forerunners before me who laid the groundwork for women’s full participation in society. Read the story.

For the Washingtonians (and the tourists, walk left, stand right!): Ten bus lines around Washington, DC everyone should know how to ride - Such a great deeper dive into the DC bus transit system. Consider it essential reading for a visit or move to the city. Neat to think about too why these lines are the ones to know (centers of entertainment and/or employment) and how those trends developed over the history of the city. 

America’s health care cost problem might shut down Hollywood - you may have heard that The Writer’s Guild of America is threatening a strike and a big reason as to why is health care. Union members are in a unique position of receiving health coverage through the union itself rather than through a private health insurer. Money goes into an account and is paid out to cover costs of care, with the account receiving most of its funds from the studios (the employer). Well guess what? Health care costs are going up, up, up and the account is experiencing serious financial problems, aka running out of money. Here’s a hint, this isn’t a problem unique to Hollywood. Double hint, don’t look to DC anytime soon to solve this issue. 

Again from Amanda, The Trash Can Unit - in this beyond disturbing account from Buzzfeed’s Outside Your Bubble feature, stories from patients and their families detail the horrifying neglect and abuse suffered at a psychiatric hospital (also a recipient of public funds and a “Top Performer” in quality measures according to The Joint Commission). This is not ok and god does it make me worried for the invisible, vulnerable members of society. Look closely. 

A long time ago, I read and thoroughly enjoyed Studs Terkel’s Working. I wonder how a modern update would read given that his work was originally published in the 70s:

The case for being grumpy at work - I’ve been thinking on this for a while. Fake happiness can do more harm than good for both the recipient and ‘emoter’. Attempts to coerce the American workforce and more broadly the public into this kind of faux happy are misguided and an overreach.  

The United States of Work - It’s long been theoretically promoted that individual freedom / rights are restored when we loosen corporate oversight. This article makes the case that the opposite is true and traces the trend of increasing employer control over employee lives both in and outside the workplace. 

Quiet night tonight. Thinking a lot about friends made, friends kept, and friends lost tonight. As I get older, those categories have expanded and contracted in different ways. What makes one friend stay and another friend go? I’m not sure. I feel like I’ve lost more friends than the average Joe or Jane but that’s probably me being myopic. And it’s not been to disagreements really, but rather time or change. Life happens. I’m really grateful for my friends old and new and to those long gone, it’s never too late to say hello. 

On to the reads:

Housekeepers Versus Harvard: Feminism for the Age of Trump - one trait that really gets to me is insincerity or disingenuous behavior. I like follow-through and people who have the gall to say what they mean and mean what they say. This article touches on that kind of behavior from today’s brand of liberal feminists: self-proclaimed feminists who encourage their fellow women to lean in yet neglect in vivo opportunities to lift each other up. I read Lean In, it didn’t resonate; it felt false, phony and untrue to so many women’s reality. Read on to find out how Harvard’s renowned feminists failed and neglected to stand for their sisters. 

In health news, An Hour of Running May Add 7 Hours to Your Life. New research shows that running may be the most effective exercise to increase life expectancy. Read on for the deets. 

The Return of Lorde - for a long time, I considered Lorde’s Pure Heroine a guilty pleasure. No longer. I look forward with anticipation towards her next album and greatly enjoyed this profile. Can we be friends Lorde? I’ll brood with you. 

To be honest I hate all the generational hierarchies and the concurring stereotypes. They feel stupid and silly. But damn if this article doesn’t get at one of the novel trends of my generation: the side hustle. I babysit once a week, often twice. I have picked up consulting work, writing, researching, and reviewing. The side hustle is life!  

Some people are just good. Read this man’s personal story of his good samaritan kidney donation and consider doing so yourself if able, or at least sign up to be an organ donor upon your death. 

The Fighter - we are failing our veterans. We send young, impressionable men and women off to high-stress, dangerous locales and put them in impossible situations and then fail to equip them to deal with issues earned from their experiences. This articles makes that failing crystal clear. I find myself wondering... what if he had shot someone? What if he had killed the man defending the house? What if he didn’t have advocates? One of the best things I read lately.  

In Politico’s newly released Agenda, writers share stories from the rural heartland. Read on to find out how:

Social isolation is killing rural Americans;

Rural America is restoring its reputation as the ‘frontier’, in health care;

Your farm is trying to kill you; and 

Rural providers face tough choices when treating patients’ mental health.

How does current (and proposed) policy affect smaller hospitals, rural hospitals, and independent hospitals (vs. large networks)? (How much has negotiating power affected who is paying and how much?)

This is an excellent and quite thoughtful question. The bulk of the impact from health policy proposals on health systems and providers is shaped by the implications it has for insurance coverage. To say that more simply, people pay for insurance → people use health care provided by hospitals → insurers pay hospitals for health care.

To understand how health care in the U.S. is financed you need to know who is paying the bills:

Private insurers

The Marketplace (individuals and small business employees)

Employer market (otherwise known as werkin the jerb)

The Government

Medicaid (kids, pregnant women, parents, other nonelderly adults, individuals with disabilities, and very low-income seniors)

CHIP (kids)

Medicare (adults 65+, adults < 65 receiving Social Security Disability Insurance (SSDI), individuals with end-stage renal disease (ESRD) and amyotrophic lateral sclerosis (ALS))

Other public programs (TriCare/DoD/VHA for veterans and their families, IHS for Alaskan Natives and American Indians, Black Lung and Uranium Mining Programs, etc.)

At the simplest level, anything that takes away from any one of these programs is going to ding hospitals because it takes away from their bottom line. Smaller, rural, and independent hospitals typically have a much thinner profit margin than larger systems so they’ll be more strongly affected (hence part of why you see so much market consolidation in the healthcare industry these days).

Rural hospitals have it especially hard because they typically care for a patient population that is older, suffering from chronic conditions ($$$), and who have fewer insurance options / if they’re insured at all which also means they have a higher percentage of patients on public programs like Medicaid and Medicare. If patients come in without insurance, it's the hospitals who largely foot the bills.   

A quick look around identifies a few, primary policies under consideration:

Policies aimed at eliminating or curbing the Marketplace

Drives down coverage/affordability and drives up uninsurance → uncompensated care and lower patient volumes / health care utilization

Weakening funding for Medicaid and/or Medicare

See above

Policies aimed at eliminating or curbing insurance protections

Essential Health Benefits - 10 categories of services which insurers in the Marketplace and Medicaid Expansion markets must cover

Community health rating - insurers have to price insurance based on the community and not on the individual (cannot be based on age, gender, or health status)

Pre-existing conditions - insurers can’t deny you insurance due to preexisting health condition

While discussed separately, repealing any of these provisions can be roughly equated to repealing all of them. And they all have the effect of coverage for fewer benefits / higher prices for consumers → drives down coverage/affordability and drives up uninsurance → uncompensated care and lower patient volumes / health care utilization

What are the other issues these groups are facing?

Nationwide trends toward outpatient care, trouble recruiting staff (exacerbated by immigration policy since many of these systems especially rural rely on foreign medical graduates), industry consolidation, low-patient volume, preference for newer hospitals among private-insurance (higher paying) clients.

Bigger health systems have more opportunity (greater purchasing power) to provide concierge services, new technologies, etc. and these are attractive to patients who can afford them. They also have better data analytics capabilities in general that enable quality improvement.

Don’t forget that these hospitals are huge sources of employment in communities they serve. If they close, communities will definitely face greater unemployment.

This is an excellent graphic from the Massachusetts Health Policy Commission on this topic:

On your last question re: negotiating power, now in this instance these groups are roughly aligned with larger systems in that they both want the ACA to stay so people can continue to use and pay for their health care. They have their own lobby groups just like anyone else and just as you expected, they’re not as powerful as the larger ones. So… where their interests divert, the pendulum usually will swing for larger health systems although not always because policymakers do recognize the unique role these systems play in serving special and vulnerable populations, especially for rural hospitals.  

BUT they are significantly inhibited by their limited negotiating power with private insurers:

“Griffin gets by on payment rates from insurance companies that Charmel estimates are 40 to 50 percent less than larger hospitals nearby receive – a result of its relatively low leverage in negotiations.” 

These hospitals have fewer patients with private insurance paying insurance companies--therefore they have less negotiating power. It works like this: the hospital provides the service, the patient receives it, and the insurance pays for it. It gets tricky in that third portion:

Each hospital maintains a master list of charges for different services and these vary hospital to hospital.

Insurance companies don’t pay these charges though. They instead will negotiate lower prices with each hospital and doctor on every plan. These prices vary not just by insurance company (Blue Cross v. Aetna) but also by insurance company plan (Blue Cross HMO v. Blue Cross PPO).

These negotiated rates are highly secretive -- no one wants their competitors to know what they’re paying. I don’t know what I / my insurance company is paying until the bill has already been paid. I won’t know the true cost of the service either unless I dig into my insurance statement, the explanation of benefits. Even still, I have no idea what my friend Sally paid for the same service if she’s on different insurance.

Check out this article for more.

However… the move to value-based payment is helping as it rewards providers and systems for efficiency as compared to the fee-for-service model. But in order to move to a VBP system of care you need better data collection and analysis and small, rural, and independent hospitals typically struggle with this.

Hopefully that answered your questions. As always, please feel free to ask, comment, or share in response.

DISCLAIMER: This information is accurate to the best of my knowledge / there may be mistakes / differences of opinion. 

Source 1

Source 2

A quick roundup of what I’ve been perusing: 

US Women’s Hockey Scores... for Women’s Rights - USA Hockey struck a deal with the women’s team in their fight for adequate support and compensation. Big deal when you consider players were only paid $6,000 in years leading up to Winter Games and NOTHING during off years, despite devoting their time to training, practices, and games. 

Every had a reading rut? I definitely have and I’m learning to be more forgiving with myself when they pop up. Too often I’ve lingered with a book I just don’t want to read when I could’ve been shifting to different subject matter in a new novel. 

Midwest is best. Watch this goofy reporter explain the Midwest to the rest of the U.S. 

(Most) Women menstruate and have boobs. Well guess what? So do homeless women and they need our help! Don’t forget to drop off a new or gently used bra next time you’re thinking about making a donation. Or maybe start a donation drive for women’s sanitary items.

The biggest threat facing middle-aged men? Loneliness. I LOVED this article and can’t stress how important I think it is to carve out social time with friends as we age. Don’t make me dig up the studies about how loneliness leads to premature death and poor health!

David Letterman. I didn’t watch him but I find this interview with him interesting. Worth it for the picture of his hermit beard. 

Time to confess. All you Bachelor contestants out there, I’m calling you. This article describes the post-shill operations of the former Bachelor/ette contestants as they shovel gimmicky products for cash. 

What Your Therapist Doesn’t Know. Can Big Data transform psychology and psychotherapy practices?

Animal mouths are terrifying. Ew. But also ooooo.

A man drives into the woods, surrenders his car and most of his worldly supplies, and proceeds to survive as a hermit on the lam for 27 years. Wut. 

“ Before the bill was pulled Friday, Rep. Bradley Byrne (R-Ala.) called it the “first big vote in the presidency of Donald Trump,” one that would be “a statement, not just about him and the administration but about the Republican Party and where we’re headed.”

“So much about political power is about perception. And if the perception is that you can’t get your first big initiative done, then that hurts the perceptions down the road about your ability to get other big things done,” Byrne said.

… “Doing big things is hard,” he (Paul Ryan) added. ” Source

There’s so much good coverage on the autopsy of the failed passage of the AHCA and the future outlook of the ACA. Here’s a rundown of what I’m reading:

Myths About The Medicaid Expansion And The ‘Able-Bodied’ - a quick and dirty summary: 1) a very small percentage of adults on Medicaid are able-bodied and not working (a smaller percentage still are able-bodied and not working, not in school, not seeking work, and not a care-taker for family members); 2) insurance availability in low-wage jobs is poor either because employees are ineligible (part-time/low tenure), the job doesn’t offer insurance, or when they do, the insurance is too expensive; 3) limits (e.g., Arizona’s proposed 5-year lifetime limit) on Medicaid eligibility for this small percentage of able-bodied adults are irrational and ineffective at stemming costs (taking a long term outlook).

Five Lessons from the AHCA’s Demise - pay attention to #3 and #4 especially. The ACA was bipartisan and grounded in conservative principles (I don’t care what you think you know, it’s true). The whole 3-pronged repeal process is very real; Tom Price (DHHS administrative chief) now has immense power to change how the ACA is enacted via the regulatory process and agency implementation (a little-known and perhaps less-understood pathway--also where most of my job sits). Oh and don’t forget the courts… google subsidies and House v. Price… and waivers (i.e., 1115 and 1332). Number #5 outlines the work that’s still to be done.   

Why the AHCA (and more importantly, the strategy behind it) failed - in order to pass the bill, Republicans turned to a process known as reconciliation, which allowed them to draft a bill that only needed 51 (instead of the usual 60) Senate votes to pass with the downside being the legislation had to impact the budget deficit (putting this in simple turns). Read this piece on why they chose that path and how it ultimately dictated the bill’s failure along with Trump’s divisive popularity, the AHCA’s plain-old bad policy that divided leftists, righties (that’s technical term), and centrists, and Trump/Ryan’s political maneuvering.

Check out the chart that shows the distribution of Republicans critical of the AHCA against their ideological bent (and laugh at the article title, low-hanging fruit nonetheless… that’s what she said).

Examining post-AHCA Ryan/Trump tensions - who gets the blame both publicly and factually? Dems?

AmeriCare and so can you! - in 2006, Rep. Pete Stark (D-CA) introduced the AmeriCare Health Care Act, which provides a realistic, tangible pathway to universal coverage in the U.S. Read more about his proposal and why it could work along with its challenges.

There’s been a lot of press around Trump’s comments on the ‘impending failure and collapse of the ACA’. The ACA is not going to fail… without help. Here’s how Trump and fellow supporters can change shift its fate:

Refuse to run outreach campaigns so that uninsured Americans will miss deadlines or remain unaware of opportunities to sign up on the ACA exchanges for coverage

Result: fewer enrollees → only those who really need it, the sick (and the costly), sign-up → higher premiums → fewer enrollees, it’s a self-perpetuating cycle otherwise known as the death spiral

Empty shelf counties - in places where no insurance plan wants to sell coverage on the ACA exchanges, will the Trump admin do as Obama’s did and work to ensure at least one insurer signs on?

CSR subsidies court case - currently, the feds pay insurers cost-sharing reduction (CSR) subsidies so that they will in turn lower the cost of coverage for low-income ACA enrollees. There is a court case (House v. Price) alleging that the ACA legislation did not appropriate the money for this part of the law. Will Trump continue to fight the lawsuit or will he drop it?

Result: no subsidies = higher costs = fewer enrollees… (see above)

Read more about what happens next and executive actions Trump could take to doom/alter the ACA (these are really important, hint hint!). 

The State Option - giving back power to the states is a big facet of the Republican / conservative ideology, a decentralized government (aka the kind of arguments we should be having rather than Rs pretending they’re extending coverage, but that’s another story). The AHCA claimed to do this, but failed. This article discusses why state-by-state reform may still hold promise (and challenges, duh) and how the Republicans messed it up in the AHCA.

Why can’t health insurance incentivize a healthy lifestyle just like auto insurance promotes good driving by giving safe drivers much lower premiums? People have no insurance-based incentive to maintain a healthy weight and exercise in this country. It seems so common sense to have doctors “sign off” for health-minded individuals when they have their yearly physicals ( in both private and public health arenas) and these folks get discounted premiums. So tired of seeing America get fatter and fatter and sicker and sicker… can we learn anything from the auto insurance industry???

You raise some good points. Here are some of my thoughts:

Obesity is still a somewhat recent development. I don’t think we’ve fully understood what the drivers are and how to curb it.

Would a financial penalty even work to help curb obesity OR is it less of a tool to do so and more of a punitive measure? If the latter, then why/should we penalize people for being obese?

Americans are really resistant to the idea that the government/business, etc. should dictate how they ought to live. Take the example of soda taxes.

It’s a really slippery slope from penalizing for obesity to penalizing for preexisting conditions. Arguments from a different side of the same coin:

Obesity is multi-factorial and may stem from factors which people have limited personal control over. How would you design an insurance policy that penalizes obese individuals? Would it be by BMI? Weight?

What if I have a thyroid condition that causes me to retain weight?

What if I have juvenile or pregnancy-induced diabetes?

What if my family is obese? How do you account for genetics?

Americans have highly differential access to a healthy lifestyle. What does it take to be healthy? Do you have access to those elements? Do you know HOW to access those elements? If the answer to those questions is no, then should you still be penalized?

Now, contrary to what you say above, I think there’s definitely an incentive to avoid obesity. Being obese is uncomfortable both from a public stigma standpoint and from complications of daily life (e.g., flying in an airplane, climbing stairs, physical appearance, shopping for clothing, etc.). It’s hard to appreciate just how difficult daily life is for someone who is extremely or even mildly obese. I don’t think you can dispute though that they face challenges which incentivize them to lose weight; I mean just look at the huge industry we have around weight loss.

In terms of insurance, I’d still argue there’s some incentive there.

Obese individuals often face related health concerns, like diabetes and/or high blood pressure/cholesterol, whose treatment raises additional costs. That’s a huge financial incentive to lose weight.

Many insurance companies and/or employers offer some kind of wellness plan which provides incentives for healthy lifestyle choices. Again another financial incentive. Bad news, the evidence says they’re not working to bring down costs. I’m not sure how the evidence is re: health outcomes.

So, we’ve largely created policies on the ‘carrot’ rather than the ‘stick’ side.

Next up, can you avoid auto accidents / speeding with minor difficulty and limited reduction of benefit? I’d argue that’s a BIG YEP. Can you do the same for obesity? BIG HECK NOPE. Losing weight is HARD. Health is more than just clinical or physical health, it’s social and mental well-being (e.g., social determinants of health). Think about all that goes into maintaining a healthy lifestyle:

When do I exercise? When do I eat / prepare my meals?

How do I exercise? How do I eat / prepare my meals?

Where do I exercise? Where do I eat / prepare my meals?

What do I need to exercise? What do I need to eat / prepare my meals?

Take me for example: I’m a 25 y/o female living in DC. I work a sedentary office job with somewhat flexible albeit long hours. My commute to and from work can be anywhere from 30 minutes to an hour. My office has a gym (but 4 of the 6 treadmills are broke and the other two are always taken and it’s cold… excuse my tangent). I live in a city with good access to public transportation, good infrastructure (sidewalks, bike paths, parks), and neighborhood markets with healthy food options. I have an advanced degree in a health field and generally have the right knowledge to make healthy choices. I have insurance and the financial means with which I can purchase food and cooking and exercise equipment. I don’t have any chronic health needs at present but my family history isn’t great. I was raised in a household with somewhat limited exposure to new foods and until college, was pretty picky. My stress and mental health is generally pretty stable / good. I LOVE sweets… and bread.

Some of those characteristics make it easier and some make it harder to live a healthy lifestyle.

All this being said, can we learn something from the auto industry? Of course. Is this something we could investigate further? Yep. I don’t disagree per se but I think we need to have a more complete picture of this situation when considering a solution like this.

Soda taxes (a penalty on an unhealthy lifestyle CHOICE not health OUTCOME) are working! And there’s more to be done -- how can we incentivize health life choices and de-incentivize unhealthy life choices that lead to obesity? Basically what I’m thinking is maybe we can just shift some of the carrots and sticks around. More upstream. This article shows how using a combined approach can be successful.

BUT you’re right. You’re absolutely right. Healthy individuals bear some of the cost imposed by obese individuals in the insurance market (sourced in 2005 admittedly so there’s probably better sources out there / could have changed). Society is premised on that social contract - either we ban together to prevent the bad or we ban together to grow the good. Sometimes we (individually) suffer for the whole. And yeah, it can be frustrating. I just think we don’t yet know enough to fix it and we need to do some test runs / background research before we go ‘whole hog’ so-to-speak. Maybe some small-scale trials?

I wanted to stick to the can’ts because that was your question. But in reality. We can. And we kind of have before in the form of insurance rate setting for pre-existing conditions. Obesity as a preexisting condition is just a bit more tricky to define since so much goes into its causation.

We need to do more to understand obesity and what works/doesn’t work to curb it and we can only do that with research and innovation (hint hint not by decreasing funding to the NIH or by capping the abilities of the Agency for Healthcare Research and Quality or the Center for Medicare and Medicaid Innovation).

I wrote most of this based on opinion vs. facts I found. So I’ll throw out my DISCLAIMER: This information is largely based on personal opinion / there may be mistakes / differences of opinion. You should do your own research before acting on any information above.

One last thought that just came to me, insurance only matters if you use it--that is to say, insurance companies LOVE people who stay out of the doctor’s office yet continue to send them premium $$$ to enrich their bottom line. That’s usually healthy people. But just because someone is obese it doesn’t necessarily mean they’re more likely to use insurance (i.e., need health care). There’s some research to back this up.

People with class 1 obesity, or those whose BMI is greater than 30 but less than 35, pretty much have no elevated health care costs. When we say lots of people in the US are obese or overweight, many of them still have BMIs less than 35.

The paper further reports that a person who has a starting BMI of 40, and can lose 5% of their weight, might expect to see reductions in health care costs of $2137. But only about 6% of adults have a BMI that high. Losing 5% of weight if you have a starting BMI of 35 would save you $528. Losing that weight if you’re starting with a BMI of 30 would save you $69.

The article goes on to explain the role that diabetes plays in all this. Whereas in auto insurance, if you get into an accident, you’re definitely incurring costs from the get go. So the comparison just isn’t that easy. Risky drivers carry higher costs; obese people don’t necessarily until they hit that high level of obesity OR until they also present with obesity-related chronic conditions like diabetes.

Link to an analysis of myths and facts on obesity

The Obesity Epidemic — Understanding the Disease and the Treatment

UPDATE: according to eHealth’s Health Insurance Price Index report, in 2017 during the first two months of Open Enrollment on the marketplace/exchange, the average individual premium was $393 for an individual not receiving subsidies. 

I’m turning 26 – what are my options for coverage if I’m not employed full time!

Insurance through your job / trade group

Some trade associations will offer members health insurance similar to how employer-sponsored health insurance works. Not sure if you belong to any, but it may be worth investigating. This stems from the historical role of unions.

Insurance through a spouse

Purchase insurance on the marketplace / exchange

Created by the ACA, the marketplace is a sort of host where insurance companies can offer different plans for consumers. There are 4 different levels of plans on the marketplace: bronze, silver, gold, and platinum. Better coverage = more money; they vary by cost and coverage. Depending on income, you may be eligible for a premium tax credit and/or additional savings on out-of-pocket costs.

Prior to the ACA, consumers largely got insurance through their employer and/or spouse; if they didn’t have those options, then they had to turn to the individual market. The individual market operated like auto insurance does today: companies offer plans. The individual market was often extraordinarily expensive and consequently, only people who really needed insurance bought individual plans (i.e., the chronically ill or people with chronic conditions), which drove up the price even more.

The underlying theory of insurance rests in the idea of shared risk -- the individual market stunk because everyone in that ‘shared market’ was high risk. The ACA sought to correct this by broadening the ‘shared market’ to include more health people, driving down risk and costs.

For arguments sake let’s say you’re a 26 y/o female making $20k a year living in Webster Groves, under the ACA you’d be eligible for $166/month (1,992/year) in tax credits which would bring down your premium cost for a silver plan to $83/month. Whenever you sought care, for certain services there might be cost-sharing so that’s an added charge on top of the monthly premium (e.g., I go to my doc for a cold and pay a $20 co-pay and my insurance picks up the tab for the rest of the cost of the appointment).

Right now, it looks like there are 13 different silver options for our hypothetical scenario. Take a look here to run through more hypotheticals. Note: for many individuals, there will be fewer options among types of plans as some health insurers have pulled back from or dropped out of the marketplace. 

If the AHCA (American Health Care Act) passes, you can kiss the ACA tax credits good-bye. The feds had also arranged to lower cost-sharing for the public by providing $$$s to the insurance companies so your copays / coinsurance / deductibles will also go up.

Now, good news the marketplace appears to stay open. You would be eligible for a $2,000 one-time tax credit to go towards the cost of your health insurance premiums (the credits are determined by age under the AHCA and you’re in the 25-29).

This is great, it’s more than what you would’ve gotten on ‘Obamacare’. Right? Wrong! Yes, you’re getting more tax credit value but the question is what will you be able to buy with that tax credit? Insurance under the AHCA is guaranteed to offer poorer coverage at higher prices (CBO analysis). That same plan $83/month plan you would’ve bought under the ACA, well the premium is now more expensive, your plan doesn’t cover certain procedures/prescriptions/treatments that it used to, and the cost-sharing is higher.

Is it still worthwhile to buy insurance? Hmm. My initial answer was yes, but after weighing this, if you’re relatively healthy you may be able to forego it and just pay for whatever you need in cash. The AHCA rescinds the ACA’s mandate that everyone must have insurance and instead places a one-time 30% premium penalty on individuals who don’t maintain continuous coverage. This means for the year which you DO buy insurance after a certain period without it, you would pay insurance premium prices 30% higher than you would have otherwise (i.e., $1,300 instead of $1,000). It’s really not that much and when you consider what you could have been saving in those years where you didn’t buy insurance, it really doesn’t make sense.

Now all of this is hypothetical because the AHCA hasn’t (and may not) pass.

Purchase insurance on the individual market

You can still go to any health insurance company’s website and buy insurance directly through the company’s brokers. They’re subject to a bunch of consumer protections again thanks to the ACA but this will likely cost you some cash moneyz since you have to go to the marketplaces to get the subsidies.

DISCLAIMER: This information is accurate to the best of my knowledge / there may be mistakes / differences of opinion. You should do your own research before acting on any information above. 

Reads: I’ve been on a bit of a reading block lately. I was stymied by Ghost Wars -- I’m sure it’s very good, but it’s also so dense that I’m having trouble pushing through it. I finally granted myself permission to deviate after my friend Amanda and I swapped our own recent reads and she lent me Mira Jacob’s A Sleepwalker’s Guide to Dancing. It alternates between the childhood and adulthood of a first-generation Indian woman as she travels back to her childhood home to support her aging parents. I’d definitely recommend it. 

TV: As my close friends know, I’m a huge Survivor nut. Survivor Game Changers began last week and it’s the 34th season of this long-running reality tv show. I love the game play and the BIG personalities of the contestants. This year I’m rooting for Malcolm, Varner, Aubrie, Cirie, and Andrea. Tune in and we can discuss. I’m always down for some hypothetical Survivor strategery. I’m looking forward to some new shows that I’m excited to try out: Trial and Error (NBC), Harlots (Hulu), and the Handmaid’s Tale (Hulu). For all you peeps finishing up the Bachelor, do your brain cells a favor and go watch Unreal (Hulu) after you’re done. 

Work: I’ve been working on some analysis of the Republican’s American Health Care Act at work. Curious about what it means for you? Send me your questions and I’ll do some digging. I just wrote up a fact sheet on one, popular component of many Republican ACA alternative proposals -- HSAs -- not to mention I also just went through a ton of insurance rigamarole with my own health insurance company. This was the first year that I traded the comfort of my parents’ health insurance for the financial strain of my own through a high-deductible health plan. 

Podcasts: Greg and I drove to STL from DC a week or so back and during our drive I became obsessed with the second latest podcast from Pacific Northwest Stories, Tanis. It’s a trippy mystery story laden with sci-fi plots and historical references. I’ve also been listening to Pod Save America and With Friends Like These. 

Food: Made Kenji’s 3 ingredient macaroni cheese (although I spiced it up with paprika, cayenne, mustard powder, and black pepper plus peas for healthiness ;) ) and it was super yummy. Also enjoying sheet pan meals: I used butternut squash, potatoes, onions, garlic. kielbasa, and bell peppers with a spice mix of cayenne, seasoning salt, black pepper) roasted at 425 degrees for 20 min. then bumped up to 500 degrees for another 10 or so min. 

It’s been a bit harder to share articles since I don’t go on FB at all while I’m on my work computer -- but I’m definitely still reading those too. Just not including them in today’s post. 

Underage marriage in the US - why is this still happening?

Women less likely to apply for corporate leadership roles if they’ve been previously rejected for similar roles. Find out why by reading here. Also, if anyone calls me/women a snowflake because of this, I’m gonna verbally eviscerate them. 

Games Drugmakers Play. One of the best articles I’ve seen on how drugmakers play the system (legally!) to reap profits while sowing rising health care costs for consumers and payers. Seriously, if you’ve ever wondered about this topic, read this article!

This is the kind of example I point to when I say policy (and politics broadly) affects people and has very real world implications. Read on about how this family has benefited from the ACA’s ban on lifetime limits and how that could change once/if repealed.

I really like cooking -- I think it’s relaxing and I’m at the point now where I don’t always need to follow a recipe to the tee. A little pinch extra here or there. I also really enjoy cooking for people and one my favorite recipes is Alexandra Cooks’ chocolate chip cookies with sea salt.

I HATE bugs. Especially cockroaches. Ask me about the time one attacked me in the shower. Destroy, destroy, destroy! 

How to Culture Jam a Populist. Hopefully the title alone intrigues you. Being a huge history buff, I recognize many of the markers of past populists in today’s political environment. Read on about how to counter a populist. 

A crazy, true long read story of a man with a talent for running and impersonation. Read here.

WhatsApp. I used it exclusively in Iceland and was impressed that I could stay checked in with fam from the middle of nowhere. This articles talks about the apps growth within immigrant/refugee/expat communities.

A friend sent me a few questions in response to the post:

Were there any actions that the march was trying to stimulate? An apology, a policy etc., or was it more of a just know we’re here event?

I think the march broadly was a ‘we’re here event’ in order to encourage action / caution regarding specific policies. If you ask individual marchers then I’m sure many of them including myself have specific policy goals that we hope the march brought attention to. So the answer is both! 

As far as an apology goes, I don’t think any of us would be/are satisfied with apologies. Words are just words without action to back them up. 

What is your interpretation of the vulgarity that was such a big part of the event? Do you see that as the venting of emotion... or as a principle of the movement itself? ... Isn’t that what they are trying to stop?

Three thoughts here. 

One: our President used his own share of vulgarity during the campaign and I think the intentional use of vulgarity by marchers was done in order to call attention to that -- it’s hypocritical to critique the one side but not the other kind of thing. 

Two: these are really important issues for many people and because they’re so important, people can get emotional when they feel they’re threatened. When people get emotional, they often use strong language to underscore that emotion / passion.

Three: the public at large is so afraid of women / women’s health. You shouldn’t have to hide your tampon as you walk to the bathroom due to embarrassment. And there’s a double standard there too: guys can engage in ‘locker room talk’ and it’s seen as just a guy thing. There is a movement to reclaim words like vagina / pussy and related terms in order to empower and engender more equitable treatment.

I’m being somewhat brief in my comments here but I think those thoughts touch the basics. Now, I’ll say this. I personally don’t think that name calling or profanity like Fuck Trump is helpful. In fact it turns a lot of people off. BUT I do understand how when people feel emotional, it feels good/makes sense to resort to strong language in order to express what is a strong reaction. 

Can you explain the pink hats? How are they supposed to look like a vagina?

They don’t look like vaginas. Pussy is slang for vagina. They’re supposed to look like pussy hats because many have pointed tips to simulate a cat’s ears. 

This past weekend I attended two historic events: the Inauguration of the 45th President, my first inauguration, and the Women’s March on Washington. I was also lucky enough to attend both of these events with my sister, Maddy, and friends from the DC area. 

I am glad I got to witness an inauguration and take part in the day’s events. I was saddened and disappointed in the inaugural address, as I had hoped it would strike a tone of unification and healing. I was treated with respect by those around me even when we clearly disagreed politically; no one taunted me or called me names.

I felt empowered by the strong showing of support at the Women’s March. So many women and allies joining together to support causes I care about. I am even more grateful that I got to take part in this event with my sister. I was overwhelmed by the huge turnout and genuine passion I witnessed (issues notwithstanding... see below).  

A friend asked me if I could help her understand the Women’s March and the objectives of the event. While I can’t speak to the entirety of the March and others participating, I wanted to try and share my perspective from this weekend and a bit about the March more broadly. 

Quick Summary:

The Women’s March was a grassroots rally organized in response to the President’s election and political views shared during the campaign, primarily those directed towards women. The original march quickly spread beyond DC into a national and then international event with marches occurring in multiple countries. 

The feminist movement is entirely complex and not something I can nor should attempt to explain; however, in brief, feminism and society at large have historically prioritized certain issues while overlooking others particularly those that affect PoC (people of color) and other minority groups. These issues are sometimes shared across groups and other times unique to that specific group. Moreover, black and LGBTQIA individuals have played significant roles in advancing feminist causes and their achievements and role in the movement cannot and should not be denied nor overlooked. The March organizers brought on leadership from some of these looks in order to address these issues. 

Recognizing that the March therefore should not be solely focused on women or on opposing Trump, the March takes broad platform on many social justice and human rights causes including climate change, race and ethnicity, LGBTQIA rights, immigration, and healthcare. 

The March is intended as a statement to say we are here, this is what we stand for -- you cannot ignore us. 

This is a super broad overview based on what I have read and I encourage anyone reading to look at the website for more info or to comment here on aspects I’ve missed. 

My Perspective

The presidential campaign was extremely vitriolic and the discourse exchanged was unworthy of the highest political office in the U.S. I was particularly offended by the hateful rhetoric Mr. Trump used during the campaign and his false generalizations aimed at entire segments of the population. His remarks regarding women were highly offensive and to excuse them as “locker room talk” is inappropriate and insufficient. 

I marched to ensure that the President recognizes there are individuals who disagree with him and who will call on him and his administration to uphold human rights if they are threatened in the great democratic tradition of our country. As a U.S. citizen, I feel it is my civic duty to advocate for what I believe in and to take action politically -- with my vote and my ‘voice’ (contacting my elected representatives, protesting, fundraising, etc.). In doing so, I hope that these individuals will feel called upon to represent the entire voting populace as best they can. 

Mr. Trump did not win the popular vote, though that is not how elections are decided. His mandate comes from a divided populace and he should recognize that. 

I also recognize however that Mr. Trump won the election and is now our President. He is our President and by virtue of that he is also our responsibility. His success and failure alike are our own. I truly wish him the best and endeavor to work with him and other elected officials where I believe I can. 

In short: Where I agree, I will strive to work together. Where I disagree, I will fight and also work to minimize negative impact in those instances where the fight is lost. 

Issues with the March

Race, etc.: There has been critique of the March in regards to its embrace of historically marginalized groups as outlined above. I do not pretend to know enough about this to write in any educated way about it. There are much more thoughtful, knowledgeable pieces out there on this very topic which I’d encourage you to seek out. For those that do know more, please share. 

It’s a tricky place for me because on the one hand I think the March organizers really made an attempt to make the event more intersectional and bring in diverse perspectives and voices. And I felt that at the March. On the other hand, I’m a white lady who does not feel the full effects of marginalization/racism nor do I know the history of all of these issues and how it manifests. I’m constantly trying to learn more about this because it’s not something that’s always readily there for me / easily perceived and I desperately feel the need to do so. 

For Christian women who feel left out due to contraception/abortion: I get it. The March platform plainly includes a women’s right to choose in regards to contraception and abortion. If you believe that life begins at conception and therefor that abortion is unconscionable, then there is nothing I can say to disagree. I also believe that women’s rights must include the right to CHOOSE contraception and or abortion until conditions are such that they are no longer necessary (e.g., comprehensive sex ed, access to affordable and safe contraception, family / medical leave, etc.). I wish I had better words to offer -- I truly don’t know how to reconcile this and can only acknowledge it. All I can ask is that you not judge women who do make these choices and seek to understand them as I try to understand you. 

For those that voted for Trump: I may disagree with you on some things, but I also respect your right to vote and take part in the political process. I also think that we would be well-served to listen to and learn from you in many instances. I think we actually have much we can agree or work together on and think that more open, respectful discussion is desperately needed. Please talk to me. 

Is it enough?: No. Change doesn’t happen over the course of a day. Statements can be powerful but action is also necessary. I hope that people will continue to stay engaged and act to support causes they care about in actionable ways. 

Hey friends. Still noodling on this past year. For now, peruse this list of Kelsi Reads from 2016. I think I captured them all. Favorites are bolded. Read on!

Fiction

All Our Worldly Goods: A Novel Between the Wars by Irène Némirovsky - a novel of two young lovers who marry against their parents’ wishes and their story across generations set in France during the war years. I’m a mush for this kind of thing; Némirovsky has a real talent for poignant, frank observations of daily life during this period.

All the Light We Cannot See by Anthony Doerr - a novel set in occupied France during WWII tracing the paths of a blind French girl and a German boy turned soldier as their lives dovetail. Great storytelling and I’m a big fan of the weaving together of disparate stories. Rich with detail.

Americanah by Chimamanda Ngozi - the novel tells the story of a young, Nigerian woman who emigrates to the U.S., alternating between life in the U.S. and her past in Nigeria. I can see why Ngozi has won such critical acclaim. Her characters have a real voice and personality. This is a great current novel reflecting on the realities of globalization / emigration.  

At the Edge of the Orchard by Tracy Chevalier - a family epic detailing one pioneer family's attempt to settle the Ohio frontier and subsequent generation’s own pioneering journeys.

Beast of No Nation: A Novel by Uzodinmalweala - if you’ve seen the movie, it follows the book pretty accurately. I thought it was well-told and moving but at the same time it was interesting to learn that it’s not a first-hand account and while I haven’t teased out exactly why, the fact that it’s an author writing as if it is a first-hand experience kind of made me uncomfortable. Still noodling through it, but definitely worth a read. The movie again is excellent.

Harry Potter and the Cursed Child by JK Rowling - meh. A play about the famed Harry Potter and friends’ children and their misadventures. Don’t waste your time unless you’re a diehard HP fan.

The Neapolitan Novels by Elena Ferrante - a 4-part bildungsroman (I wanted to use that word so badly!) set in 60s/70s Italy of an enduring, real female friendship and the external forces that shape the two women’s lives. Take Austen, make her darker and change the focus to female relationships, drop her in Italy. Recommended by my boss. This was my favorite fiction read of the year.

My Brilliant Friend

The Story of a New Name

Those Who Leave and Those Who Stay

The Story of the Lost Child

The Song of Achilles by Madeline Miller - fun. Again I love historical fiction and this retelling of the famous epic was fantastic and unexpected. Read for something fun.

The Tennis Partner by Abraham Verghese - I picked this up because I enjoyed Cutting for Stone so much. Verghese recounts a story of a friendship between two men - one a physician with a crumbling marriage and the other a medical student with a drug addiction.

Non-fiction

Bad Feminist by Roxane Gay (in progress) - short essays and stories covering a range of topics. Humorous. A lot of these kinds of texts really turn me off because they can be overly prescriptive or limiting to a particular point of view. I think Gay’s is an approachable feminism that really picks up on the shades of gray, while not getting bogged down in them.

Between the World & Me by Ta-Nehisi Coates - this book ought to be required reading. Coates writes a series of essays / letters to his son exploring personal, historical and larger societal events concerning race and how it has shaped and continues to shape America. I’d like to think if white people read this and were forced to truly grapple with the text, there’d be less cognitive dissonance and more understanding of the black experience in America.

Bossypants by Tina Fey - I like Tina Fey. I like books. I really don’t think these celeb books I read this year were worth my time. They didn’t make an impact and I didn’t think they had much to say.

Dead Wake: The Last Crossing of the Lusitania by Erik Larson - Larson picks an event from history and unveils the mystery behind it. Like listening to my favorite social studies teachers from middle and high school.

Five Days at Memorial: Life and Death in a Storm-ravaged Hospital by Sheri Fink - a reconstruction in the vein of investigative journalism, the novel dives into the events through the eyes of emergency workers, investigators, patients and families, and more breaking down the systematic failure that occurred. Excellent, excellent and hugely time intensive undertaking thanks to the meticulous background research.

Gratitude by Oliver Sachs - too short to leave much of an impression but the man has a way with words. If I take away anything, it’s that I can only hope to face death with such calm acceptance and grace.

Hillbilly Elegy: A Memoir of a Family and Culture in Crisis by JD Vance - the author recounts his experience growing up poor in Appalachia. The book goes beyond memoir to offer some social commentary. A really interesting look at how class and culture can combine to form a unique identity particular to the area. Especially meaningful given the recent election.

Is Everyone Hanging Out Without Me? (And Other Concerns) by Mindy Kaling - of all the celeb books I read, this was probably my least favorite.

Modern Romance by Aziz Ansari - see above re: Fey. Ansari gets stuck between the scientific and more of the opinion/memoir/essay style replicated by other celebs. The actual science and research is interesting. He didn’t need to mire it in the little jokes and distractions (felt like pandering).

Nickel and Dimed: On (Not) Getting By in America - in this book, the author goes ‘undercover’ to work several different minimum wage jobs. I finally got around to reading this and I have to say I was unimpressed. My reaction was “so what?”. I guess I see why it was more revolutionary when it was originally published (2002) but now I find it a bit depressing when I read it and find that so little has changed. Also I’m left wondering why we need to send authors, etc. undercover instead of just talking to people who live in these realities.

Unfinished Business: Women, Men, Work, Family by Anne Marie Slaughter - I’ve read a couple of these women-boss books and I’ve found this one the most helpful / real. Still has its faults, but worth a read.

When Breath Becomes Air by Paul Kalanthi - I don’t have the words for this book. I kept reading late into the night to finish it and bawled. Moving. Dr. Kalanthi contemplates what makes a life worth living as he faces down stage IV lung cancer at the age of 36 shortly before he would have completed his training as a neurosurgeon.

Yes Please by Amy Poehler - same thing as what I said for Tina’s book. It had a bit more of a voice.

Other

Milk and Honey by Rupi Kaur - a book of poetry split into four chapters: the hurting, the loving, the breaking, and the healing. I normally have a hard time with poetry, but the rhythm and the topic matter really resonated. I found this book at a time during a time of need.

Somewhere in between Katherine asking me where I was going during my time off in between jobs and past viewings of WOW airfares, I decided to go to Iceland. Truthfully though the actual booking of the ticket took a bit more convincing from friends and colleagues to make sure I wasn’t totally nuts.

Hello again dear readers, my absence may have been long but I’m back for now. Admittedly I’m unsure what form and regularity this blog will possess moving forward -- surprise, surprise but blogs can be work and as my friends know, I kind of like to keep myself just a little bit busy in the day-to-day. This being said, back to Iceland.

I had just completed a site visit to Chicago and left my current position for a brief break before taking on a new position. I had planned on cleaning the apartment, lounging, and languidly exploring the area nearby my new offices in the intervening time before my start date. Yet, something in my brain clicked and I couldn’t ignore Katherine’s suggestion. I’ve had friends who’ve visited Iceland and had previously viewed commercials bragging about extraordinarily low airfares. The rumors were true; I jumped on and booked a trip at the low, low value of $260 round trip*. Iceland had seemed like the perfect destination for some post-old job and pre-new job rumination and reflection--plenty of beautiful, natural settings and a friendly towards travelers. Never mind that it was early winter, I was sold.

I already knew I would be making the trip alone. Having booked on a Sunday and set to take off on the following Wednesday, there was little time for others to request leave; moreover, I wanted to go alone. I needed the time and space for a fresh perspective and knew that from previous experience and Iceland travel blogs, I’d be comfortable solo traveling so long as I had my trusty Kindle Paperwhite or a good paperback.

The pieces all fell into place from there: I booked three nights stay at Reykjavik City Hostel (chosen over others more centrally located for a quiet night’s sleep), a visit to the famed Blue Lagoon complete with spa experience, and later a 2-day Extreme Iceland adventure tour of the South Shore and Jökulsárlón glacier lagoon and nearby Vatnajökull glacier ice caves at the recommendation of friends.

Day 1: 6pm ET - Depart BWI Aiport. 5am ISK - Arrive at Keflavik Airport. ~45 min. bus into town. Breakfast at hostel. 1 hr. bus to Blue Lagoon. Signature treatment at Blue Lagoon with in-water scrub, wrap, and massage. 1 hr. bus back to hostel. Nap! Hot dog dinner and nighttime walk of the city.

Day 2: 9am ISK - Pick-up and depart for tour. Stops at Seljalandsfoss and Skógafoss waterfalls. Stop at ? overlooking the area. Drive through Vik and stop at Reynisdrangar black sand beach. Stop at a tiny gas station in the middle of nowhere somewhere near Kirkjubæjarklaustur for Northern Lights and dinner. Break for the day at a country hotel near Höfn.

Day 3: Breakfast at country hotel and pick-up for Vatnajökull glacier and ice caves tour. Stop at Jökulsárlón glacier lagoon. Stops at various view points on the way book to admire scenery and good weather, saw Icelandic horses. Stop at lava fields. Stop at country hotel for dinner and to meet Northern Lights guides. Long, late drive to Northern Lights viewpoints. Back to hostel and Reykjavik by 2am ISK.

Day 4: Packing up at the hostel. Took the public bus to downtown Reykjavik and walked the main street, Laugavegur. Picked up a few souvenirs and stopped at Sandholt bakarí for coffee and a Danish pastry. Bus out to Keflavik and departed for the U.S. at 3:30pm ISK. Landed about 4:45pm ET.

Takeaways and questions:

Reykjavik

Granted I explored downtown when it was both raining and still rather dark / early on a Sunday, but still the city kind of let me down. I found it to be either a) hugely overpriced b) downright closed (I walked through from 10-11:30am) and c) overly touristy. The building are neat and there is some great street art but many of the more local / unique stores I wanted to visit were closed or simply out of my price range. Even the touristy souvenir stores were crazy expensive. If I return, I’d make sure to visit at a different time of day but wouldn’t otherwise plan to spend a ton of time within the city. I didn’t make it to the Hallgrímskirkja church due to time, but I did see the Harpa which was a very pretty concert venue located right on the harbor.

Winter visits

Do it, do it, do it! I’m convinced that winter is THE time to visit (although I’m sure summer or other times have their own benefit).

It wasn’t crazy busy/crowded like the high-season tourist months

The prices were lower.

I had opportunities to try seasonal activities like ice caving and viewing the Northern Lights.

Holiday spirit was in display (fun fact: Iceland decorates cemeteries for the holidays with lights too).

It really wasn’t that cold - for most of my trip the temperature hovered right around the 40s.

Food / Shopping

See above, crazy expensive! Even when outside of the city, food was ridiculous. A gas station buffet cost me something like $23 for what was mostly chicken meatballs, potatoes, and a meager salad bar. I lived on Skyr yogurt (mmm) and Kind bars I’d brought with me. Like others, I’d recommend that you grocery shop and lower your expectations going in. Glad I tried the famous hot dogs the Icelandic way, but I wouldn’t necessarily recommend all the toppings next time.

Blue Lagoon

A lot of people argue this is over-rated, and I can see why. BUT, I think it’s worth a visit if you prepare appropriately. I would absolutely recommend going either in the off-season or during off-hours. The place fills up fast and from what I can tell Iceland is still figuring out how to accommodate the recent rise in tourism. Also, I think it’s worth shelling out for one of the pricier tickets -- otherwise make sure to plan on bringing your own towel, flip flops, and maybe even a robe depending on weather. The spa experience was definitely a highlight too and worth considering. I never left the water - that’s right the massage, scrub, wrap, etc. was all in water as was the masseuse. Just be sure to book ASAP because those fill up fast. I was there from 10-1pm and it had definitely filled up by the time I left. Oh, and definitely bring a waterproof camera. Don’t worry if it’s raining, it was for me and I was more than content in the water. Yes, my skin felt improved after.  

City Hostel

The hostel was perfectly fine. The dorm I stayed in was clean. The style was pretty plain/industrial. The staff was relatively helpful although not super friendly and there was a public bus station right outside that for 420 ISK would take you directly into the city within 15 or so min. There was also a nearby geothermal heated pool complex that is popular, but I didn’t have time for a visit. On the downside, the dorm didn’t have lockers so there was nowhere to lock luggage other than a large luggage storage room and the bathrooms were located either a floor down or up, which was a bit inconvenient. The other big minus for me was the location: I’d booked it over others because I heard the ones downtown could get super loud at night due to nearby clubs, but City Hostel was at least 30 min. walking distance from downtown and most restaurants, etc. Next time, I’d book something more central. Great value though!

WOW Air

Two thumbs up, would recommend! The plane was perfectly comfortable and seat size was either equivalent or better (I thought bigger after flying but didn’t verify) than other carriers. The in-flight service from the stewardesses was great - mine were all Icelandic and really nice. A caveat though, NOTHING is free not even water during the flight so stock up on snacks and drinks before you take off and downsize, downsize, downsize, downsize. They will check that your carry-ons/luggage are in compliance with their size limits prior to boarding and they will charge you if they don’t fit into the model that airports have to display size limits. This means you get a briefcase sized carry-on and a personal item (purse, laptop bag, NOT a backpack) for free. Anything larger will cost you, e.g., large carry-on is $40 I think and to check is $70. When you factor these costs into the cost of the flight, it’s still a great deal. May look into flying elsewhere in Europe with them in the future.

Spontaneity

Katherine asked me this question on a Thursday I think. By Saturday, I had my flight booked. I booked the hostel on Sunday and on Monday I’d booked the tour across the South Shore. I borrowed wool socks from my Aunt and from Greg (plus his travel backpack), got a parka (the white one in the pics) at Goodwill for $10, borrowed a travel charger from Jordan, and stole itinerary ideas from Danielle and Kyu. Now granted, Iceland in the winter makes for an easy spontaneous trip and I already had my passport. BUT I’ll say you’ll be amazed at how easy things can fall into place even on relatively short notice. Don’t be scared of it!

Iceland and Trump

I was really surprised that Icelanders actually seemed to be for Trump. Here’s a bit of what I heard in discussions:

Obama: was/is too weak; I expected more of him. Did not deal with ISIS and let them advance. OR on the flip side, why can’t he run again?

Clinton: is corrupt. Would not want her because Bill Clinton was already President.

Trump: said what he needed to get elected. Is playing the game. Will be a strong President. Good for business.

Wifi

There was wifi everywhere!! I was so surprised. There was wifi on the tour van, in the hostel room, in the middle of nowhere country hotel, etc. I used Facebook messenger to call my parents and sister and WhatsApp to chat with Greg and connectivity was near equal to connecting from my apartment despite the fact I was in rural Iceland!

Icelandic is really hard; not to worry though, everyone I met spoke English well. Check out pronunciations for some of the places I visited here. 

Did you travel alone? How was it?

YES! Oh my gosh, it was just great and I think just what I needed. I’ve done some traveling on my own but more often it was for work or I would join up with a group later on. This was my first true solo trip and I really enjoyed it. If you’re thinking about solo travel, I’d recommend planning your first trip such that it’s not too long and maybe include some social activities like a tour or two that way you can have some interaction along the way.

It was so nice to go at my own pace and really minimizes stress too in that if you don’t let yourself be bothered by situations, then all is well and you’re often better equipped to right them. Doing it all on my own and handling the bumps on my own also restored my sense of confidence and self. I came back feeling really secure in my abilities and that was a great place to be in considering I was starting a new job.

Moreover, there’s something about solo travel that really imparts the experience on your person -- seeing the beautiful vistas and processing them internally is an entirely different experience and impacts you in different ways than say traveling with a friend or family. And thanks to social media, friends and family are never truly too far away.

My tour group too made it easy to dial in and talk with people when I felt like joining in; I met a couple from Singapore (there were a lot of Asian tourists in Iceland), a quartet from Spain, and another couple from Florida/Turkey. I don’t think I would have connected as much with these fellow travelers if I’d had other friends along, so that’s also an opportunity especially for me since I can be a bit socially shy at times. People are friendly and will help you if you reach out.

You do you. You do exactly what you want, when you want, how you want.

Did you see the Northern Lights?

Yep, but I have to say it wasn’t a high of my trip contrary to popular belief. I saw them two nights in a row--once in the middle of nowhere past Vik, and the other time somewhere about an hour and half outside of Reykjavik. The kind of looked like cloudy moonbeams that shivered and moved and sometimes had a greenish tint to them. You could miss it if you weren’t paying close attention. You need clear and dark skies to have a shot and they’re mainly seen only during the winter. The amazing striations and colors you see in a lot of photos are only possible if seen through a camera (you’ll need a tripod and a point-and-shoot fancy camera, a cell phone definitely won’t cut it). One of my travel companions took some shots for me and promised to email, so I’ll be sure to share them if I hear from her. Still, it’s one of the wonders of our natural world and a kind of once-in-a-lifetime event so I’d definitely say worth it even if not quite what I expected.

What was the highlight?

Gosh, I’d have to say the tour through the South Shores and maybe seeing the basalt rock formations at Reynisdrangar black sand beach and the Vatnajökull glacier. The beach was just incredible for the sheer force of the elements: the wind knocking you off your feet, the waves crashing down, and the thought of lava forming the cliff sides. Really brought home Iceland’s epithet: the land of fire and ice.