My shoulder has been giving me pain for the last three weeks or so; and after surfing with it amongst the rough and tumble of the Californian swell I finally gave in and had it check out. This is an x-ray of it.

I need to get an MRI next but there is a bone chip in there from an Aussie Rules injury when I was about sixteen, there is also a spur, which might be the issue. Then again given where I was weak it also might be a torn labrum/labrial (sp?) which is bad since it requires surgery. Which is not cool.

As an aside this will be my second interface with the US medical system and to be truthful it makes me nervous. I far prefer the Australian system where I know I will be taken care of. In the US I am more dependent on the insurance my employer has, rather than a collective health pool or my own insurance. It is fine if you don't have much wrong with you, but I am aging, and this is where I would not be in the least bit concerned if the US adopted an Australian or West European system (like France's) as health care. I don't see it happening though.

I dealt with the US health system in detail when I first came to America and inconveniently broke my leg playing Aussie Rules for the New York Magpies in Cincinnati. My insurance at that time was through an Australian insurer. I did not transition to US health care until later. I recall it was a fight to get the insurance company to pay - but ultimately they did.

For my shoulder the X-Ray was covered, but the MRI is optional and has to be approved by the insurance company, in this Aetna. I suspect I am going to be out of pocket one way or another before the shoulder is fixed and back to fully functioning status.

Update: I damaged the shoulder doing incline presses at gym.

Update II: 1/4 x-post

Neal Krawitz writes that each year a large industry has collapsed in upon itself; insurance, finance, automotive. He argues that the aspects these industries shared were lack of transparency, over complication and a reliance on old technologies. His next candidate for complete and catastrophic collapse is health care for the same reasons:

So hospitals lack transparency and cannot give even a vague estimate for something simple. And the entire process, from the hospital to insurance, is overly complicated, vague on details, and intentionally confusing.

I had similar issues when having my shoulder operated on. I kept asking for how much it would cost me out of pocket and no-one was able to give me an answer. I got told all about 90/10 percentages; but no-one would give me a ballpark figure for how far out of pocket I would be.

If the purpose of a private health system that follows the free market is price transparency, then the US health care system fails it, and fails it horribly. Maybe the health care system needs to fail catastrophically in order to shake it up and weed out all the inefficiencies that have grown over the years; but the reality is they will get a bailout, like all the other industries that have failed catastrophically and no longer been economically viable.

I think that this commentary by Bruce Bartlett rings true:

In my opinion, conservative activists, who seem to believe that the louder they shout the more correct their beliefs must be, are less angry about Obama's policies than they are about having lost the White House in 2008. They are primarily Republican Party hacks trying to overturn the election results, not representatives of a true grassroots revolt against liberal policies.

I am not seeing any coherent policy response to the White House or the Democratic Congress. The incoherence is probably best epitomized by Sarah Palin and her public appearances. I should be in the constituency of the American Republican Party; however I consider them unfit to govern and I have seen nothing to make me change that view.

I dislike that the public option has been dropped from the Obama health care policies. Without an employer subsidizing a health care plan it is prohibitively expensive. Because I am married I have the choice of two plans, the one my wife's job offers and the company I am with. But it means every time we change jobs we have to re-asses our health needs and our health care providers. A public option would remove that complexity from it and at least give us a third choice that is not prohibitive.

I doubt forcing people to have insurance coverage to make sure the pool is complete for risk purposes will work. It is hard in a society based on liberty to get people to do what they do not want to do unless it becomes ingrained in the culture. The US unfortunately has a culture of a large percentage not having health care and trying to get by without it usually for reasons of it being too expensive. I doubt that will change unless you sign people up by birth onto a public plan and provide preventative health care.

I don't have an issue with health care being provided by government. I think it is one of those areas where moral expectations mean full coverage for all individuals requires a communal effort and organization and currently that means a central government being involved. I also believe that the private market should take part in health care but there are obvious inefficiencies of a pure private market and that leaves no other mechanism that government to become involved to ensure complete coverage for all citizens.

There seems to be a bit of a panic that has set in with the Democrats and American politics since the loss of the seat in the Senate to a Republican - especially in the area of the Health Care bill. What seems to be forgotten is that both the House and the Senate have passed health care bills.

This issue would not happen in the Australian system as the Australian Senate is not as powerful as the US Senate which creates budgetary bills - though this was not the original role of the US Senate, it is a responsibility they have accrued over time to the point that any major bill now has to be reconciled with a similar House version.

Additionally the Australian parliamentary system is dominated by the Executive. Since the Executive in the Australian Parliament is made up by members of the majority in the House of Representative (and by Senators in the same party) all legislation stems from the Executive and flows through parliament via Executive discipline on members of their party.

The American political system has a separate Executive from the Legislative. A structure that I think is superior to the Westminster system or the Australian Washminster system. This means that the President is only able to push through legislation or policy if the Executive has the buy in from Congress.

Bill Maher made the comment that George W. Bush was able to push through legislation no matter how retarded; but he didn't. Dennis Hastert and Tom DeLay did and they did so through repugnant means by breaking convention after convention; holding votes open till they had the numbers and bribing congress members on the floor during the voting time in order to get the numbers.

The Democrats do not behave like that as a group. There are corrupt individuals amongst them, but as a party and group they do not act with the arrogance, disrespect or carelessness that the Republican Party has done in recent years.

With the loss of the Senate seat the Democratic Party no longer has sixty votes in the Senate which can beat filibusters. The filibuster has come into focus recently as it is a convention that can be used by a minority to keep a bill in debate and not allow it to cloture so that it can be voted upon. To break a filibuster, sixty voters are needed - and this is something the Democratic Party does not have in the Senate.

While political commentators - from both the Bush years and the recent Obama years - have railed for the abolishment of the filibuster it is a good mechanism for the minority party to stop a bill that is repugnant.

The problem in 2009 is that the Republican Party is using it for everything and anything. The process is being abused.

In Australia a minority held the balance of power for many years in the Australian Senate and only recently lost that hold on power. The difference between the US Republican party and the Australian Democrats - who held the balance of power in Australia - was the Australian Democrats had policies around good governance and modified their policies as time went to maintain that. Their initial slogan, "Keep the bastards honest" is a good rally for a third party in that position.

The US Republican Party lost the 2008 presidential elections and the 2006 congressional elections because of eight years of bad governance. In Congress they have continued that form. I still do not believe the Republican party is capable of governing.

The problem for the United States is that there is fifty years or so of public policy on health that has produced a wealth of empirical data around the world; whether it be France, Australia, Switzerland, Denmark, Germany etc. In all cases this public policy, the outcomes and the costs have been drastically superior to what the US Health Care system has been able to achieve.

I think it is empirically obvious that the United States needs to adopt one of these health care systems and bundle it into American public policy. I personally think it is a no brainer. I have lived under the Australian system and I believe it to be superior from a consumer perspective than the US one. I wouldn't mind the French one, or the Danish one even. Anything has to be better than the current US one.

The United States has historically been more liberal economically and as a consequence the highs are higher and the lows lower though with the possibility of faster bounces back. I do not believe that will change if the US adopts a progressive health care system. I do think that public policy on health care in the United States is sub-optimal and needs to change.