The following is a guest editor's entry by Dr. John W. Traphagan, Department of Religious Studies, University of Texas at Austin
With the Supreme Court upholding the Patient Protection and Affordable Care Act (PPACA) it is a good time to think about what the United States can learn from other countries, such as Japan, about ensuring affordable and accessible health care for its citizens.
It is well known that Japanese are among the longest-lived people on the planet with a life expectancy at birth of 84 years, ranked third globally. The U.S., by comparison, ranks 50th as of 2011 with a life expectancy of 78.5 years. At the same time, the infant mortality rate in Japan is 2.8, while in the US it is 6.9 per 1,000 live births.
The long life expectancy and general health of the Japanese is often attributed to their diet, which while perhaps better than the American diet is by no means perfect, tending to be very high in sodium and also including many foods such as tempura that are deep-fried. A more likely explanation is that they have an outstanding healthcare system that provides easy and affordable access for the entire population and that covers medical, dental, and prescription drug needs. No one in Japan goes bankrupt due to high health care costs, nor is anyone denied insurance due to pre-existing conditions or denied a claim. If you lose your job or simply cannot afford to pay the monthly healthcare premium, which is normally under $300 for the average family, the government pays. Out-of-pocket expenses are low and the poor and elderly receive significant government subsidies to ensure that they can afford care.
The Japanese use a universal healthcare insurance scheme that requires participation (like the Obama program) and has several different methods by which insurance is delivered depending upon whether one is self-employed or employed by a company or government entity. For those who are employed by corporations, payroll taxes paid by both employees and employers support the program, while the self-employed pay premiums adjusted to income levels. In 2000, the system was expanded to include long-term care insurance, which is mandatory for all persons over the age of 40 and involves an additional premium payment beyond the national health insurance plan. This program provides various types of care, such as nursing home stays, home-helper services, permanent residence in Alzheimer group homes, participation in day-care centers, and general long-term care for age-related illness that lead to immobility.
In general, the Japanese system costs roughly half of what the American system costs and often achieves as good or better outcomes for patient care. One way in which the Japanese government manages to keep costs down is by setting fees for procedures, office visits, and so on and preventing insurers from competing—all insurance pools pay the same rates for the same services and drugs. If you become sick in Japan, you go to one of the numerous clinics or hospitals, most of which are privately owned and operated, present your insurance information, pay a small co-payment, and receive good care. There is no concern about whether or not one’s insurance will cover a procedure or office visit or whether one can afford the cost of seeing a doctor. While the Japanese system is not perfect—many doctors, for instance, complain that they are underpaid for their efforts—it is a highly egalitarian one in which people simply do not need to worry about receiving adequate healthcare.
The Patient Protection and Affordable Care Act in the U.S. is certainly a step in the right direction, although much more can be learned from countries like Japan that have done a better job than the U.S. in maintaining a healthy population. Perhaps the most significant thing Americans can learn from the Japanese in terms of healthcare is not simply that their system works better than ours, but that the Japanese government conceptualizes the health of its population as a component of national security. There is a widespread attitude among both government officials and many citizens that the health of individuals contributes to a healthy society and that having a health citizenry is a fundamental element in maintaining a secure and prosperous nation. Unlike Americans, who tend to see national security only as being related to external threats, the Japanese recognize that maintenance of a healthy population is just as important as protecting that population from potential external threat. Those on the right in the U.S. who would dismantle the PPACA should give serious thought concerning their own ideas about national security. They should recognize that national security is not simply a matter of keeping terrorists or rogue nations from harming Americans; it is equally a matter of insuring that all Americans have equal access to health and, thus, have the potential to contribute to building a strong society. An unhealthy population is just as much a threat to national security as terrorists and other political enemies.
Reddit
Digg
StumbleUpon
Delicious
Technorati
Yahoo
Google
Plurk
Moo
Actually, Japan is ranked 7th in the world in terms of military expenditures. While it calls its military the Self Defense Forces, it is a military nonetheless. In fact, Japan has some of the most sophisticated weapons in the world including the Kongo class destroyers which have Aegis fire control systems, F-15 fighters, the F-2 Mitsubishi (similar to the f-16), close to 1,000 tanks, and a variety of self-propelled artilery and other weapons. While the US is certainly a major ally and has contributed a great deal to the defense of Japan (which it did not out of altrusim but out of self interest), Japan has an able military and spends quite a bit on keeping it well armed with high tech weapons.
level-headed.
While true, 7th in the world is till at approxiamtely 60 billion, while the US, at no. 1 in the world, is 711 billion. An entire order of magnitude. (http://en.wikipedia.org/wiki/List_of_countries_by_military_expenditures)
Just because Japan is 7th in the world doesn't mean that it spends nearly as much as the US does.
Now consider that Japan is 3rd in GDP behind the US (http://en.wikipedia.org/wiki/List_of_countries_by_GDP_(nominal)) and you'll see that it's not even a fair comparison to talk about Japan miliatry spending vs the US, and how Japan and certainly the rest of the world benefits from US military supremecy — they don't have to spend as much when they're allied with us.
Moo
Well, if you read my comment carefully, I did not compare the spending of Japan and the US. I stated that it ranks 7th in the world, that's it. The comment was in reply to the comment that Japan has no standing army–which is simply not true. And, again, I never indicated that 7th is the same as 1st. "The rest of the world" is a fairly broad, and not very careful, phrase. I'm not sure I see how China benefits form US military supremecy. THat's a fairly large chunk of the rest of the world. In fact, there are many ways in which other countries in the world, including Japan, aslo have significant problems due to US military supremecy–just ask the Okinawans. The US presence there is a mixed bag, it accounts for a great deal of the Okinawan economy on the plus side, but there have been many social problems as a result of the presence on the negative side (including horrific behavior by some US military personnel). That aside, the point of my comment–which is quite clear actually–is simply that Japan has a powerful military and it spends considerably on that military in comparison to most other countries in the world.
level-headed.
Well if that was your point, then it was quite useless to this article.
The whole point of this topic, and what I was trying to say (which kick-started your response), wasn't how powerful Japan's defense was at all. It was to show that they can afford socialized medicine without worrying about the costs as compared to the US.
It is completley irrelevant how much Japan spends compared to "other" countries since the direct comparison of this article was the US to Japan. In addition, while I'm sure the Okinawans have their own opinion of the US precense in Japan, the simple fact of the matter is that if we withdrew out, then the country of Japan would be worse off without us — Just see how they'd fare against China and North Korea.
So your point of stating that Japan has a "powerful" military and spends consierably on that compared to the rest of the world is completely moot.
Dan
Level headed, you are making 2 mistakes commonly made when we get into these discussions. In terms of can we have both guns and butter there must be a choice, and guns must always win.
1. To spend more on healthcare the US can not do it because it has to spend more on its military. Well the answer is the US already spends more on Healthcare than anyone else on the planet, it just does it in a dysfunctional system which gets relatively crappy results. The US Spend on healthcare as % of GDP is fast approaching 20% of GDP, the rest of the developed world spends somewhere closer to 10% the US manages to spend as much on the parts of the system which are public ally funded, I.e. VA and Medicare and Medicaid and SCHIP as the UK spends to cover the entire population.
2. In defence terms the point being made was the Japanese have a large and powerful military and spend around 1% of their GDP on it and are the 7th biggest spender on the planet they could happily defend themselves from North Korea, but war with China would be a catastrophe. They spend an order of magnitude less than the US but that is because they have no intention of going to war with the US. The US simply has a military which has become a status symbol for the sake of a status symbol, it spends more than almost the rest of the planet COMBINDED while having some form of alliance with almost every other nation on the planet. Hitler is long dead, Stalin is long dead, with hindsight the Soviet Union had stopped being a threat before it collapsed and it has ceased to exist over 20 years ago.
The US military does not defend anyone against anyone else, it is an instrument of US power and influence and it is OK to admit. That but the nonsense, that it is defending Japan against China or Russia or defending Europeans against Russia, is simply nonsense.
level-headed.
People also forget that Japan benefits widely from US Military support to protect themselves against Japan and N. Korea and doesn't have any sort of standing army (just a "defense team" — whatever that is). As such, they can comppletely fund whatever they want seeing how they're right behind us as an economy.
And yet, when there's a world conflict, who does everyone look up to? That's right. So please think before you speak so anti-americanly; no we're not perfect, but you guys would be far worse off without us. Think about that for a second.
level-headed.
oops mean to say China and N. Korea
ron
Japan PAYS a large part of the US Military presence. Japan is forbidden by the US written Constitution to have an offensive armed forces
Moo
Yes, indeed. Japan does pay a great deal for the military presence of the US–and not just in cash. Actually, if you read Article 9 of the Japanese constitution, the US seems to have been pushing for Japan to have absolutely no military capability at all. Of course, in typical US fasion, as soon as the US government realized in the late 1950s that Japan would not pose a threat in the future, they started pressuring Japan to build a military.
View from Europe
Tens of thousands Americans die prematurely every year because they lack health insurance. In the ten years since 9/11 the combined direct and indirect costs of U.S. response to the murder of almost 3000 of its citizens have totalled more than $3 trillion (source: Foreign affairs, march/april 2012). Health expenditures in the United States neared $2.6 trillion in 2010.
I think its proper to say that an unhealthy population is a matter of national security. At least if you see national security as way to protect your citizens from dying of unnatural causes.
JM Hanes
Life expectancy and infant mortality averages really don't accurately reflect the relative merits and defects of the U.S. healthcare system, and I would be very cautious about assuming that a healthcare system which produces better numbers in Japan would be equally effective elsewhere. The case for change so predictably opens with those same generic stats, however, that it seems worth at least a couple of the usual qualifiers too, before pressing on.
The life expectancy of Japanese-Americans, for example, is very similar to life expectancy in Japan itself — and thus more demonstrably tied to ethnicity than health care, per se. In the U.S., any infant, no matter how premature, who shows a single sign of life, is considered a live birth. IIRC, infants who merely measure less than 30cm (i.e. those at greatest risk) are not even counted in Switzerland's tally. I don't know how mortality is calculated in Japan, but if there were a uniform international standard, it's my understanding that the United States' numbers relative to other countries would be considerably improved.
It seems to me that the most admirable aspect of the Japanese system, as outlined here, is that it eliminates the indisputable disparities in the <i>distribution</i> of quality care which plague the U.S. system. National averages, however, ignore the whole complex of dramatically variable demographic outcomes which are emblematic, if not unique, to the U.S. Economic status certainly has a depressing predictive value, but the U.S. system must serve an unusually diverse population, both in terms of ethnicity and social mores as well, which is seldom factored into sweeping international assessments or the sweeping assumptions and recommendations which inevitably follow.
I am not touting the U.S. system, nor defending its patent deficiencies. I just rather doubt that the Japanese model, in particular, could be scaled up to a population which in addition to its diversity, is also immensely larger, with both state & federal sovereignties, and a bureaucracy of unfathomable complexity which almost none of our own lawmakers, let alone its citizens, can navigate already. I could obviously be wrong, but "conceptualizing" healthcare as an issue of national security sounds like just trying to rearrange the healthcare deck chairs under a more compelling umbrella, instead of addressing the real world structural differences upon which a system of Japanese design might easily, or possibly not, founder in the U.S.
That said, I believe the importance of examining the merits of successful alternatives cannot be overstated, and appreciate this remarkably concise, informative, description of the the Japanese approach.
Bert Kastel
@ JM Hanes
Thanks for a high-quality and thoughtful response! Very refreshing and constructive, particularly in light of some of the above more primitive "hate-speeches".
In summary I gather from your input:
1. Let's get the statistics directly comparable (not just about infant mortality, but let's also about costs of the system).
2. Empirically study reasons for the longevity of Japanese-Americans, in comparison to other groups of society.
3. Consider diversity of ethnicities, society and of the political systems.
I disagree that the complexity of the US political system, or the size of its population, substantially reduces the applicability of success stories of other large countries. It is a different story for ethnicities, but due to the diversity of the US political system I would expect to find at least in some political entities success stories comparable to Japan's.
If not, then that in itself lends itself to draw interesting conclusions. Just to be clear, "success stories" in my opinion would reflect the achievement of at least one of two main goals: extend health and quality life expectancy, and reduce health care expenditures.
RedChina
this article is a big smoke screen. it tells us how wonderful the japanese system is. to be true it is really good complete insurrance for the patient, once someone fell ill
But this article does not elaborate the cost that comes with full care. In the end someone has to pay for the cost, and there are high cost and it will costing more the more people are aging and the population is aging.
So that is the smokescreen, it tells us all the pro but not the contra that it is involved in such a system.
Fat Lazy and Stupid
These comparisons between Japan and the US are simply ridiculous because the demographics and educational level, not to mention the cultural and educational levels, are greatly surpassed by Japan above anything that the USA can imagine. The idea that Japan has some kind of national security incentive is preposterous. If anything, Japanese have better health because their education system has insured that they are not as stupid as Americans. You can boil the Amercan health system down easily to three words. Fat. Lazy. Stupid. That's why it costs so much It's expensive to take care of people who are fat, lazy and stupid.
klee
US are just arrogant and not to learn from anybody. Even they refuse to learn from their closest neighbor, Canada. Among the world nations, US spend the most and the life expectancy of their citizens is about or below on the list.
Because US rather spend very much money on building 11+ nuclear aircraft carriers and submarines and spy shuttle, like the X-37B and try to maintain world dominance by maintaining those 700+ foreign bases than to spend on their citizens. The right-wing Americans blame Medicare & Medicaid. Well, it is not true, according to most medical doctors, the Medicare systems are OK, but there is not enough oversight on those cheaters. Some surveys from bipartisan groups and some prominent doctors both conclude the single payer system is the best, not perfect though.
But, US want to maintain big brother status in the world by dreaming up enemies to satisfy the Pentagon’s needs instead of their poor citizens. I believe US’s debt and the health care costs will keep going up, so as the Defense budgets in the foreseeable future.
Gngottawa
Can you please be more nakedly anti-American? Your diatribe is grossly insufficient.
Errol T
Oh don't worry. If the US military realizes that socialized healthcare can generate savings, it would support Obama. That way the US military will be able to offset whatever budget cuts that will take place in the future. Even more high-tech gadgets can be developed for them. But I digress. We are talking about reforming the American healthcare system, after all.
gngottawa
The US is incapable of emulating anything foreign. American exceptionalism guarantees that national arrogance drive its public policies. Obama can't even emulate Massachusetts' health care system without deeply dividing American society, triggering the tea party movement, and rupturing the Supreme Court.