The Debate

Could ‘Obamacare’ Emulate Japan?

Dr. John W. Traphagan explains what American healthcare can learn from Japan

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. 

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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.