Why Japan’s Health Care Is Better

 

University of Tokyo Hospital doctor Hirokazu Nagawa speaks during a news conference at a hospital in Tokyo. (AP Photo/Toshiyuki Aizawa, POOL)

Yesterday, when Tea Party protesters gathered near Capitol Hill in Washington, D.C., some held a sign that read, "No More Socialized Anything." The protestors bought into the stereotypes that America was modeling its health care reform plan off of socialized European systems. Such comparisons are all too common in the debate over health care reform. But on Thursday, an event hosted by the University of Michigan’s Center for Japanese Studies was an exception. The event was a forum discussing how the Japanese health care system—a hybrid system funded both by taxes and private insurance—works better than the American system.

T.R. Reid, a former Washington Post‘s Japan correspondent and author of the book The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care sat on the panel along with Michigan professor and political scientist John Campbell and anthropologist Susan Long of John Carroll University.

For an American, Reid’s description the Japanese health care system seemed almost fictional in its utopianism. In Japan, everyone is required to have health insurance, but that requirement doesn’t break the bank. All medical procedures in Japan have fixed rates, and the costs of staying a night in a hospital costs anywhere from about $9 for a shared room to less than $100 for a private room. The price in the United States for an overnight stay in a hospital room per night tends to be substantially higher. According to Reid, under the universal Japanese health care system, the Japanese spend half as much money per capita as Americans do.

The health care bill in Japan is paid through a mixture of low taxes and insurance premiums that don’t fluctuate much. Blaine Harden in the Washington Post described Japan’s system this way, "Health care in Japan—a hybrid system funded by job-based insurance premiums and taxes—is universal and mandatory, and consumes about 8 percent of the nation’s gross domestic product, half as much as in the United States. Unlike in the U.S. system, no one is denied coverage because of a preexisting condition or goes bankrupt because a family member gets sick."

Reid notes that Japan’s system is, by comparison, leagues ahead of the American one. "Why doesn’t the world’s richest country provide health care for all its citizens?" Reid asks. "And I’d say that in researching this book I think I’ve figured out the how. I think I’ve figured out why other countries do it, but I still haven’t figured out why we don’t." Japan, while not the wealthiest country in the world, certainly ranks among the world’s top economies.

Reid, despite his specialization with Japan’s health care system, also doesn’t buy the Europe-is-full-of-socialized-medicine meme. "Some countries are less socialized than America. In Germany, they don’t have a Medicare [equivalent] system. Everyone stays with the private sector, cradle to the grave; you just stay with your private insurer and that’s less socialized than America in some ways."

The Japanese is largely modeled after Germany’s, Reid says. One would think health care proponents would be flaunting Japan’s system more: A system where health care is provided to everyone can work, and it doesn’t mean socialism.

"That’s the model they have today, private docs … more private docs than the [United States] has. I argue in my book that Japanese doctors are the most commercially oriented and profit-oriented of any doctor in the world," Reid said. "What I’m getting at is that to me this looks like a private system —Japan is a capitalist country and this appears to be a capitalist system … everyone is covered and [it has] very low costs."

Reid warned, however, that as the Japanese population ages, health care costs will rise much as they are in the United States, but he predicted costs are still are nowhere near those for American consumers of the health care system. The Japanese are completely unfamiliar with the concept of going broke thanks to medical bills. Campbell explained that the core feature of the Japanese system was price controls. The lack of cost controls is the biggest obstacle to really improving the American health care system here.

"The answer that you usually hear is that Americans use too much health care," Campbell said. "Americans have this insatiable demand for using health care and so they use it so much that our costs are really high. That’s totally wrong. Americans by and large do not use an inordinate amount of health care … [the] Japanese go to the doctor on average 14 times a year; Americans go an average of four."

The reason America’s system is more expensive can also be the kinds of care that are common here. "We do way more back surgery. Back surgery has no discernable impact on outcomes 90 percent of the time. You’re as good getting it as not getting it. … Heart surgery is another such case and there are a lot of others," Campbell explains. "Generally speaking, in the cases where Americans do seem to be using overusing medical care compared to people in other countries, it’s in these areas where the profits where the profits for the doctors of the hospitals are particularly high."

Long warned that Japan’s system isn’t flawless. It has serious issues with emergency response and emergency care. While all employers are required to provide health care for their employees, the employees don’t get to choose the kind of health insurance they receive. Still, Long assured the audience, the Japanese system is better than the current American one.

Campbell echoed Long’s concerns and cautioned that prices aren’t the only reason why the Japanese tend to be much healthier than Americans. Part of it is diet and lifestyle, but their health care system also plays a role.

Containing costs is an important lesson the United States should learn from Japan, Campbell says, but unfortunately, Americans are unlikely to learn it on this round of health care reform. "If we pass this, it’s going to cover everybody and it’s going to improve private insurance coverage, but it’s not going to do anything about health care cost," Campbell says. "Then one way or another, what we’re going to have to decide is whether to fix prices with the government or something like the government."

Daniel Strauss is a Staff Writer for Campus Progress and a senior at the University of Michigan. Follow him on Twitter.

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