This is Covered, Right?

“To everybody out there who pays taxes, we just bought an insurance company! And it only cost us… $85 billion. Well, if it keeps our government from socializing health care, I’m all for it.” – Jon Stewart on the federal government’s recent bail-out of AIG.

Whenever election time rolls around (and let’s face it, with campaigns starting earlier and earlier, it’s always election time) we are bombarded with dire warnings that some people want to socialize our health care system. Even the name is enough to strike fear into the heart of any patriotic American. Socialized Health Care. It’s socialized. That sounds like Socialism, which we all know is just a another word for Communism. They’re communists! And they want to turn us into communists, too!

And now for a few caveats from our author. I am no expert on health care systems: free-market, publicly-funded, or otherwise. The statistics presented in this blog come from a 1994 monograph titled, ‘Japan’s Universal and Affordable Health Care, Lessons for the United States?’ by Victor Rodwin, Ph.D., Professor of Health Policy and Management at New York University. Observations and real world situations come from my own experiences in the American health care system and from what my friends and acquaintances here in Japan have related to me.

Back to our regularly scheduled program. The dangers and threats of socialized health care; or as the rest of the world calls it, publicly funded health care; have been fully catalogued by it’s opponents: no choices for the consumer, a labyrinthine bureaucracy impossible to navigate, a steep decline in the quality of health care received – ridiculously long waits to get a doctor’s appointment, shorter hospital visits, rationed high tech medical care, and medical decisions being taken out of the hands of doctors and patients and in the hands of the bureaucrats, and most threatening of all – the outrageously high cost in form of taxes.

When talking about the dangers of publicly funded health care, most opponents refer (often misleadingly) to the health care systems of Canada, Cuba, or European countries. Rarely, do they mention the Japanese universal health care system. So, I thought I’d share a few of my observations of how it works and it’s results with you.

First, the set-up. Yes, Japan’s health care system is compulsory for all Japanese citizens. For permanent residents, it is possible to not participate: however, once in the system, it is extraordinarily difficult to leave – kind of like what I’ve heard about Bally’s Fitness Club. (With my 1-year work visa, I am considered a visitor in Japan and consequently purchase my health care through my employer as I would if I were in the States.) So yes, there is little to no choice for the consumer. Though, as an American citizen who has purchased her own health insurance for almost 10 years now, I can’t say I’ve ever felt overwhelmed with choice as health insurance companies vie for my patronage.

But back to Japan, virtually all residents are covered without regard to any medical conditions they may have or to their actuarial risk of succumbing to illness. And they do not lose their insurance when they change jobs or move to a different region. Again, as an American who has had 6 different health insurance plans in the last 10 years, because of changes in my employment and situation, Japan’s system appears very attractive in this regard.

But what about the labyrinthine bureaucracy they warn about? Well, if you’ve never had to battle bureaucracy in the American health care system, then my hat’s off to you. Whenever I’ve gotten a new health insurance plan, I spent way too much time worrying and checking to see if my doctors accept that insurance and if not, which doctors will. I arrive at any new doctor at least twenty minutes early to fill out all of the insurance forms and expect to spend an extra fifteen minutes for the receptionist to ask her fellow co-workers if they deal with this particular company before calling the company to iron out paperwork discrepancies.

Here in Japan, there is never any question if the doctor accepts the insurance and no bureaucracy telling you which doctors or specialists you can or cannot see. There’s little to no paperwork, either. At the first visit, they make a copy of the patient’s insurance card and they ask to see it at all following visits – much like in the States. And since there are only dealing with one insurance provider, the workers in the doctors’ offices are experts at the paperwork and technical details.

Probably the biggest concern for most Americans is the quality of health care received. I’ll rely on Dr. Rodwin and his well-researched monograph for my data here. Japan has the lowest infant mortality rate and highest life expectancy at birth. Japan has 15.8 inpatient hospital beds per 1,000 persons, more than three times the American ratio. And at 50.5 days, Japan has the longest average length of stay for inpatient hospital services, focusing on bed rest and complete recovery while the patient is in the hospital- a rate more than five times that of the United States. Japanese doctors have the highest number of physician contacts per capita, almost three times the American rate, and 45% of appointments are same or next-day.

My friends and acquaintances confirm that last fact. I’ve never seen anyone wait longer than two days for a doctor’s appointment, even for a routine physical. I, on the other hand, once had to wait close to four weeks to get an appointment for a physical. A friend of mine also visited the emergency room recently for a severe cold - a national holiday had the doctors’ offices closed - and was in and out within two hours having received an I.V. of vitamins and fluid and a filled prescription of antibiotics in hand.

Regarding high-tech medical care, Japan has the highest number of computerized axial tomography (CT) scanners per capita and the highest number of extra-corporal shock wave lithotriptors per capita. Japanese have nearly twice as many magnetic resonance scans per capita as Americans do.

And as for bureaucrats, I’ve seen and heard of no evidence of bureaucratic interference in medical care. A friend was recently informed by his doctor of a possible reoccurrence of cancerous cells on his stomach. He was given the choice of an invasive surgery to confirm, and if necessary, remove cancerous cells, or he could visit the doctor once every three months for non-invasive tests which would alert them immediately if there was a need for the surgery. Either decision would have been similarly covered by his insurance. Choosing the quarterly non-invasive tests, the total bill for his appointment with the specialist to have the tests done and again for the results comes to the equivalent of $1.46. I suppose the insurance doesn’t cover the Winnie the Pooh band-aid or watermelon flavored lollipop.

As always, everything comes down to the money. Looking at the big picture, spending on health care accounted for a mere 6.6 percent of Japan's total gross domestic product versus 13.4 percent of America's. On the more individual scale: yes, Japan’s health care system is based primarily on payroll taxes. Once a year, citizens pay a tax which roughly equals or is slightly less than what American’s pay a year for their health insurance. And when comparing co-pay for doctor’s visits, prescription costs, etc., Japanese pay significantly less.

And once over the age of 70, Japanese pay nothing in premiums, yet receive a significant percentage of health care services. An friend’s 80 something-year-old mother was recently in the hospital for a little over two weeks. Her total bill including the hospital, doctors, tests, prescriptions, etc., came to about $1,000. That’s less than a hotel stay.

There are, of course, significant cultural differences between the two countries and systems that would be dangerous to ignore. The overall good health of Japanese citizens in comparison to Americans can also be attributed in good part to their traditional balanced diet of fish, rice, fruits, and non-processed sugars. Japanese also put a high value on exercise. Most companies begin the work day with a mandatory stretching session with the employees and often have another in the afternoon after lunch. As I drove to work one day with the radio on, the radio station even stopped it’s programming for ten minutes to broadcast the traditional stretching routine. However, though I don't have the statistics, I would assume that the rates of lung cancer and emphysema here in Japan are much higher than America. They really are chain-smokers here. And to their great concern, studies show that the effects of globalization and Westernization are being felt as obesity, diabetic, and heart condition rates are on the rise in Japan.

And while Japanese blame rising obesity rates on McDonalds, I will admit that I find the following Japanese medical detail terribly disturbing. Though Japanese visit the doctor almost three times as often as Americans, the length of appointment is less than half the time. Japanese doctors rarely explain their diagnoses to the patients and to my horror to discover, often withhold their diagnoses from the patients if it is terminal, informing the family instead and often encouraging them to lie to the patient rather than ‘depress’ them with the truth. I've even heard of doctors not labeling the medicine they prescribe their patients to prevent them from discovering what is really wrong. That is a cultural issue, however, and not an effect of the state run health care.

It would be impossible to wholly compare the health care systems of Japan and America and decide definitively which is better. At least, it would take a much more intelligent and dedicated mind than mine. The Japanese publicly funded health care system is more complicated behind the scenes than I have described it here. Even the average Japanese citizen would be hard pressed to fully describe how it works. I do not claim America should import the Japanese system wholly and without pause, but I do hope that as Americans, we can open up our minds to the possibilities offered around the world without dismissing them categorically as un-American and therefore evil. There is much we can teach the world, but only if we keep our minds open to what the world has to teach us.

And there’s my $0.02 on fixing America’s problems :)

My current reading material – The Norse Myths by Kevin Crossley-Holland. Though I haven’t felt the transcendent impression of ‘these are my people,’ as Stewart described he did when reading these myths, I do admit that the fatalistic attitudes expressed does ring some bells in this mid-western girl. My favorite line so far: “Every morning the two ravens, Thought and Memory, are loosed and fly over Midgard; I always fear that Thought may fail to wing his way home, but my fear for Memory is greater.”

Album currently playing on my IPOD – Steely Dan’s 1972 ‘Can’t Buy a Thrill’. The first album released by Steely Dan and number 238 on Rolling Stones’ list of the 500 greatest albums of all time.

- Jenny