There's No Health Care Crisis In Japan, So Why Is There One Here?

I'm sitting in my Tokyo hotel room, studying the conflict over US health care reform from a comfortable distance. Here in Japan, they don't understand our problem. Here in Japan, there is no health care crisis - even with a rapidly aging population. No one goes bankrupt over medical bills. No one is denied medical services. If someone wants a special medical treatment, they can buy it here or in Switzerland or wherever. Yet they have a private system with no public option. What they do have is a strictly regulated medical insurance industry. While some shortages of specialized care exist and some rural hospitals are understaffed, they have a more robust primary care system than we have in the States, which means people see the doctor more often. More visits mean early detection and lower long-term treatment costs. The poor - and there are lots of unemployed people here - receive health care via government insurance subsidies - something like Medicaid. So while health care professionals earn a fraction of their what their counterparts earn in the US, they are a respected group and earn a good middle-class living.

Here in this egalitarian middle-class society, they have one of the healthiest populations among industrialized nations, despite the fact that they smoke like chimneys. According to a recent post in The New York Times,

Japan has about the lowest per capita health care costs among the advanced nations of the world, and its population is the healthiest. That is largely due to lifestyle factors, such as low rates of obesity and violence, but the widespread availability of high-quality health care is also important.

In Japan, adequate health care is a right that comes with being a member of this hardworking society. Their government does not allow health care to become a major profit center for big businesses at the expense of public welfare.

With this in mind, I mentioned my particular situation to a Japanese colleague. I explained that I had a very mild heart attack about nine years ago. It was a wake-up call. I had gained a bit of weight, and my cholesterol was up slightly. Since then, I've been taking my meds and watching my diet. Today, the doctors can find no sign of artery disease, but no insurance company will give me coverage. Their adjusters simply right me off because of my 'pre-existing condition'. My friend wonders if that is legal. Sadly, it is completely legal, and then I quoted from an article by T.R. Reid for the Washington Post:

American health insurance companies routinely reject applicants with a "preexisting condition" - precisely the people most likely to need the insurers' service. They employ armies of adjusters to deny claims. If a customer is hit by a truck and faces big medical bills, the insurer's "rescission department" digs through the records looking for grounds to cancel the policy, often while the victim is still in the hospital.

So, what is the solution to our national health care crisis? In my opinion, it begins with insurance and pharmaceutical industry regulation - like they do in Japan and in other countries. Of course, these industries are large and powerful. They exert a lot of influence in Washington, DC and through their mouthpieces at News Corporation and the Wall Street Journal. Nevertheless, we need to ask ourselves, "Is this a nation 'of the people and for the people' or is this a nation that serves the interests of business at the expense of the people's business?" I don't believe the Founding Fathers ever imagined that business would grow so powerful that its voice would drown out that of the people. Maybe it's time to pass that Constitutional amendment to kick business and other special interests out of government?

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Comments

[Ted Rogers]

"The poor - and there are lots of unemployed people here - receive health care via government insurance subsidies - something like Medicaid."

that IS their "public 'option.'" let's get on the same page: in the US an individual without kids, absent being extremely disabled and approved (i.e, exceptional cases) CANNOT get Medicaid. hello?

for example, basically ALL an individual can get in the US WITHOUT having kids is Food S
tamps, and THAT is a PITA. i got food stamps. i got a $10. a month raise in my VA disability benefits (yearly cost of living increase) and my state took it away from FS level, DESPITE that i remain far in the red.

so, just like there is far less street crime in japan (open car windows in the city, etc.) in the US the GOVERNMENT BUREAUCRATS "rob" you.... next time, do your homework before you take such expensive trips to pontificate from abroad.

[Avajp]

"Yet they have a private system with no public option."

Pretty sure everyone is running on public insurance here (EHI, NHI), I know I most definitely am.

[DinkSinger]

Thank you. I was sure that this was the case but I could not find numbers later than 1997. Back then about 75% of Japanese were covered by public plans and the rest were covered by Society Plans and Mutual Aid Association Plans, which are private but not-for-profit and very heavily regulated. I also understand that there substantial coinsurance levels of 20% to 30% and that many people have private insurance to cover these costs, somewhat similar to Medigap insurance for Americans covered by Medicare. Is this correct?

[DinkSinger]

The New York TImes ran an interesting story on June 13, 2008, about Japanese health care:

"Under a national law that came into effect two months ago, companies and local governments must now measure the waistlines of Japanese people between the ages of 40 and 74 as part of their annual checkups. That represents more than 56 million waistlines, or about 44 percent of the entire population.

"Those exceeding government limits — 33.5 inches for men and 35.4 inches for women, which are identical to thresholds established in 2005 for Japan by the International Diabetes Federation as an easy guideline for identifying health risks — and having a weight-related ailment will be given dieting guidance if after three months they do not lose weight. If necessary, those people will be steered toward further re-education after six more months."

Here's a link to the full story:
http://www.nytimes.com/2008/06/13/world/asia/13fat.html

[norman60]

We need this health care reform now. If you don't have health insurance, you will finally have quality, affordable options in the proposed health care reform. If you do have health insurance, the proposal makes sure that no insurance company or government bureaucrat gets between you and the care that you need.The insurance companies will not cancel your policy when you need care most, for any reason.

Sadly, many are hiding under unfounded fears to resist a health care reformed that has been designed with their best interest taken into account. Many groups are using their influence and political allies to scare and mislead the American people. They start using scare tactics. This is what they always do. We can't let them do it again. Not this time. Not now.

Can anybody explain why nearly 46 million Americans don't have health insurance coverage today? In the wealthiest nation on Earth, 46 million of our fellow citizens have no coverage. They are just vulnerable. If something happens, they go bankrupt, or they don't get the care they need.

[DinkSinger]

I agree with you that we need the health care reform in HR 1300 now, but we are not the wealthiest nation on Earth. According to three different sources we rank somewhere in the teens. Among the nations ranked ahead of us on all three lists are Norway, Ireland, Denmark, Sweden, The Netherlands, Finland, and Australia.

The CBO says there will be 51 million Americans without health care in 2010. If we pass HR 1300 now, that number will not decrease until 2013 but in 2015 it will be reduced to 16 million about half of whom will be unauthorized immigrants.

[redlinemetro]

Why is Japan being singled out? It's certainly not the only country with better healthy care and there are MANY on the list. Not even going to touch the fact that the US is more likely to bankrupt a person on their way to good health.

[DinkSinger]

It ranks second in life expectancy of all world countries (Andorra, population 86,000, ranks first) and spends the second smallest percent of GDP on healthcare of any large industrialized country (South Korea spends the smallest percent).

[Paramendra Bhagat]

Japan also has sane gun laws.

[J Q]

The Japanese healthcare system also *requires* that every person get a *very extensive* physical each year. This isn't just a "check-up" but includes something like full body scan and extensive testing--much more extensive than an annual here. The result is that diseases can be caught at a very early stage. Thus, survival is better and cost is lower in many cases. In the U.S. preventive medicine is often cut by insurance companies and people sometimes only get treated when they reach a catastrophic stage. Of course, in this country it would be tough to require each and every person to do get a yearly all-day exam. But think of all the suffering that could be prevented.

[DinkSinger]

Most evidence I have seen shows that preventive care, while usually improving life expectancy and/or quality of life, frequently increases costs. A test that costs $100 might save $500,000 in the treatment of one patient, but if that patient is one out of 10,000 tested, the total cost of the testing is $1,000,000 and the net increase in cost is $500,000. It may be money well spent but it is a cost increase.

CBO discussed this in a recent letter that relied heavily on an article published in the New England Journal of Medicine last year that found less than 20% of preventive services it reviewed reduced overall costs. The CBO letter can be found here:
http://www.cbo.gov/ftpdocs/104xx/doc10492/08-07-Prevention.pdf

[J Q]

Actually, there is something of a health care problem in Japan, but it is quite different from ours. In Japan there is a shortage of doctors, especially in rural areas. I believe that certain specialties like obstetrics are particularly shorthanded. There was even a dramatic mini-series on television a few years back that featured a resident dealing with ethical issues surrounding a shortage of doctors.

However, other than that it seems like a generally good system. I think that Japanese expectations are quite different from American's though (perhaps for the better). There are also different kinds of prevalent diseases and health issues. Even though the population is older, people eat *much* healthier than the average American. Culturally, there is a sensitivity to health that is not present in American society. Food is medicine.

It would be great to have a national health system like Japan's or (virtually any) other country. But, if we want to be like Japan in this way we need to start living healthier lives too.

[BarryS]

how about reciprocity: if an insurance company lies, ore misleads, or denies a claim improperly, they must insure the party forever with the best policy they offer anyone including their CEO. If the opatient dies, well, it sounds like [premeditated] manslaughter to me.

[J Q]

One reason that the private only system works in Japan is because there's some dignity left in business. The insurance companies are too greedy here. I'm sure they would find some way to get off.