I was talking with Jen the other day about a variety of things and she had mentioned that her husband watched a TV program by Frontline, called “Sick around the World” on the “social” healthcare systems in five countries that “worked” compared with the
I agree with everything the specialist Naoki Ikegami is saying in the transcript of the interview in
I will include the comments that I believe are, to me, of the most value in the interview, although I recommend reading the entire interview through to get a good overall picture of the differences between the Japanese and American systems. Before I do so, I would just like to give my own thoughts on this overall system with a few short examples of when I needed major care in the hospital (cut my fingertip off and had emergency appendectomy).
I love this system, and have never found my "copays" to be overly expensive.
When I cut my fingertip off it cost me about JPY 3,000 I think for the initial visit. Then I went back every day for two weeks and they changed the bandages. The cost per visit then was just a few hundred yen a time and the amount of time I was in front of a doctor was like he says in the interview, just a few minutes. I would say that I didn’t pay any more than JPY 15,000 in total when all was said and done, and that includes medication, antibiotics, and all the follow-up visits. The wait time was less than 30 minutes. It was no problem at all.
One of the reasons why we have “3X then number of visits to hospitals compared with Americans” that the interviewer mentions is that the doctors have us come back regularly to continually inspect, change bandages, and watch the healing process. I don’t think it is like this in the
When I had my emergency appendectomy, the entire thing, including 10 days in the hospital didn't cost me any more than $300 to the hospital. That was it. Of course there was the national healthcare I pay which varies every year depending on how much money I make in the year. If I make very little money, I pay very little. When I made a fair deal two years ago, I ended up paying about $2,000 for the entire year. That's about $166 per month. It’s peanuts, really.
There are two kinds of coverage; one is funded over 50% by employer. Mayu was in that when she was working. The other one is national health care and I have opted for that. It revolves around your salary, and the copay used to be more than the employer based, but now it's the same: 30%. I did my calculations years ago to decide which one to go for and chose National because I don't get sick much at all.
Also the company-related one includes deductions for pension, etc. and since I don't pay pension here I chose not to, even though it is mandatory and instead invest overseas my monthly pension contribution for my future. The reason I chose not to is that in order to get pension I have to be working in
Also the number of elderly and retiring baby boomers is skyrocketing, and we are at critical mass plus the numbers of young not working, and not paying pension is at an all time high, a very bad situation. This is a separate problem, and not really directly related to healthcare, but related to the amount of money the elderly who get sick more often have to use on healthcare, so it indirectly affects the situation.
It works very smoothly indeed, and because the government is involved, it can be considered "social medicine" but it is in no way anything like it is portrayed as in the
Please be sure to read the interview and then you will understand my next comments: I can see doctors in the
I believe that "the business of healthcare" should NOT be treated in the same way as “the business of products and services”. In the latter you provide basic commodities, luxuries and services to people at a price, and try to make as much money from it as possible. That’s business. The people who can afford the product at the highest profit margin, will pay it, and those who cannot will go elsewhere to find a lower level, lower quality basic product that suites their needs. If they can afford it, they will purchase, but if they can't they learn to do without.
In healthcare, if you can't afford the product you have a good chance of becoming extremely ill, or even of dying. It isn’t a matter of “doing without” if you’ve cut your fingertip off, or just finding some “discount 100 yen shop” to run in for an appendectomy. It doesn’t work that way. And it shouldn’t, in my opinion. I feel there is a fundamental difference in these “businesses” and only those who understand this difference should be in "the business of saving lives". Healthcare should not be about making the highest profit margin that the market will support. It is not the same.
I think this pretty much covers my experience here in the Japanese system that runs very smoothly. It will be interesting to see how it works over the next 10 years as the baby boomers, retirees all age and our aging silvers are more than the paying and working population. There will likely be a big stress on the system. It may get more expensive and they may find way to shift taxes around, and the working population may have to pay more in taxes to cover the retired, but it won't break us; we won’t be put out on the street wandering around confused, and drugged because we don’t have the funds to pay grossly over-inflated prices. The country will most likely continue to provide medical care to everyone who needs it, without making them go broke. -
Here are the key points that I believe hit home in this interview:
So here we are in a country with the longest life expectancy, good health results, low costs -- sounds like paradise. Are there problems in paradise?
I think it's a mirror image of the
Health care went up 1/10 of 1 percent?
Right, and the reason why the government has this tight control over all prices is because the national government funds one-quarter of health expenditures, ... and the Japanese government now has a huge deficit amounting to 1.5 percent [of] GDP, and the debt is still increasing as a result of having to make tax cuts and investing in public works during the 10 years of deficit.
So in order to [start] paying back, they are making every effort to cut expenditures. This is across-the-board cost containment, and health expenditures are under that umbrella.
And remember that this is happening at the time when
I think what you're getting at here is that they've got a system that makes sure people don't go broke paying medical bills.
Right. I think the main goal of a public health insurance system is to prevent people [from] going broke.
How many people in
None, or at least there should be none, because first of all, they should be covered, and if they're not covered, then they can get covered by paying back one year's premiums. And if they can't pay back the one year's premium, then they will be on public assistance.
If somebody in
She loses the employment-based insurance, but then there's the community-based insurance, which is mandated for her to enroll and for the local government to enroll that person.
Can they turn her down if she has heart disease or something?
That is forbidden. ... Neither can the employer deny in hiring someone because of health conditions.
So if lose my job I don't lose my health insurance; in fact, I'm required to buy it, but from the city instead of an employer?
Yeah. ... It's more like taxes rather than having something that you want to pay or must pay. ...
These health care plans covering basic health care for a worker and his family, do they make a profit?
No, because they are not allowed to make a profit. And anything left over is carried over to the next year, and if there's a lot carried over, then the premium rate would go down.
Do you think the Japanese people feel that everyone in this country should all have a basic package of medical coverage?
According to opinion polls, I would not only say basic but egalitarian coverage [for] all. Over 70 percent of the Japanese, when they're asked that question, say they're not only in favor of basic coverage; they are in favor of egalitarian coverage.
Notes:
Link to Interview Transcript:
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/interviews/ikegami.html
Current Exchange: JPY 100 = USD $ 1.00
Have to read and process this, Cam ... will comment soon! *snuzzlehugs*
ReplyDeleteHave a good day. I'm off to the hills for a few hours. Probably it will kick my butt as I haven't been on the bike really since last October. But that's life! Gotta start somewhere, right? I love you!
ReplyDeleteIt's fun when our conversations turn into a blog.
ReplyDeleteYou had so much to say i figured you might blog it.
This is great stuff, Mou.
Now i should check with friends from the other countries in the series, Germany (Nicolle), the UK (Tez?), you covered Japan...
I forget the others, but i'll work on it.
Heading out now for coffee-Tasha run.
Love you, Mou!
If you cut the tip of your big toe I will have you come in and return for f/u and then return until I discharge you and then come back to talk and then come back for coffee and then come back to record a video for Jose I (yeah....right!) and on and on....
ReplyDeleteYou like it?
; )
Hiya Cam! Hope the ride went well and you were able to get to the sento afterwards. :o)
ReplyDeleteThis has a lot of good points and lots of things the US could learn from, but I don't think the US is ready for the same level of integration and cooperation that the Japanese utilize (which is too bad, really). I have such a hard time with the health care aspect - I know something needs to change in teh US, but I'm not sure what or how? Especially considering the financial, family considerations, current attitudes, etc.
I was reading your post and something struck me as I was reading - the bit about heading back in to see the physician repeatedly to check the status of an injury... even if that was more commonplace in the US, I'm not sure how many people would take advantage of it. At least not at first. Maybe if it was widely available and more people were aware of the cost (or lack thereof) they would utilize it (and possibly take advantage) A lot of people tend to equate a doc visit with incurring fees, and financial issues aside, sometimes finding the time for routine checks is outside of people's sphere of concern.
It seems like a few "little" changes could make a huge difference in US health care, but considering the current atmosphere and popular opinions, the "little" changes would probably not go over well.
My experiences with doc's in the US has been widely varied, from having a "hometown" doctor that treated our entire family to a Naval Officer who was flipping patients through his offices every 20 minutes. Both had pluses and minuses... Sometimes it was great to get in and out, but sometimes I wanted someone more familiar with my situation, personal tendencies, etc.
Great post and definitely thought provoking - big thanks to you and Jen!!!! I feel like I'm glossing over a lot of thoughts or omitting them completely. (Possibly a carb related scatterbrained moment/evening/day? I'm trying to do too much at once and my brain won't slow down.) I'll try to gather my wits and come back again shortly, until then I hope this makes sense!
Jen - Thanks. I really liked our conversation. Thanks a lot.
ReplyDeleteInesta - I like a lot! That sounds like a great idea. But no videos for JI, OK?
Jaime - One of the other things I learned about the US, is that everyone is "too busy" for ... just about everything. This would mean that they wouldn't want to keep going back because they would feel they didn't have time. But you know what? Forcing yourself to take that time... really helps you to realize that you CAN make the time, just that you don't THINK you can. Then a paradigm shift takes place and you become a little bit more empowered (even if you have a little bit less finger).
It's a good read... click on that link and just read the entire interview. It's really good. Forget about my "opinions", and just see what really goes on here, not from a "let's fix the US system", but just from a "so how do they do it in Japan?" It's pretty refreshing. I love you!
I did read the article and could definitely see how it would work here - but the challenges the people that make the system work must face are enormous!
ReplyDeleteI'm always up for learning new stuff about Japan. Seeing the differences between here and there is very... enlightening? educational? I'm not sure what the right word is...
I like how the healtheconomist suggested that the next president try to make reforms within one term because one year is too dramatic a change for anyone, even those who would benefit from it, and there is no guarantee that they will be around for a second term. I also like that he said that it is "doable", but would be very very difficult in the USA because it would not be small changes, but a "sea-change". (I despise that term).
ReplyDeleteHow about "seeing the differences between here and there is very "eyebrow raising""... ? That lets you stay neutral, yet still affect an interest in the topic at hand!
Thank you for not showing us the pic of your finger again. There is so much here I am going to have to reread.
ReplyDeleteUntil then....loving you.
Or, Jaime (and anyone else)... if you want to watch the segments cuz you're short on time *snicker* here's a link to the PBS show
ReplyDelete(hope this works)
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/
It is a "sea change". It's the best term for America, because it means changing the course of our ship of State.
ReplyDeleteAs Jaime says it's a challenge.
But does that mean we should stick to the status quo because something new might be hard.
Not for me. I'm so ready for a change, and i'm up to the challenge.
Jen - I think most people are ready for change (at least, I hope so!), but I'm afraid of the naysayers and the attention they'll get. Seems that Americans can be fickle in what they get behind and for how long (dratted instant gratification syndrome!)
ReplyDeleteI'm really, desperately hoping to see Obama on the ballot this year. I want it like... like... well...... in a completely different way than I've ever wanted anything else, that's for sure.
Cam? Eyebrow raising is good. I'll definitely use that. And hope to avoid eyebrow furrowing. *winks*
I live in Australia and while our health system isn't perfect, it sure beats what America has.
ReplyDeleteI have spoken to friends online about health care and I have been surprised that such a forward thinking nation has such a crappy system in place to care for its people.
debosofi
ReplyDeletereply
debosofi wrote on Apr 20
"I live in Australia and while our health system isn't perfect, it sure beats what America has.
I have spoken to friends online about health care and I have been surprised that such a forward thinking nation has such a crappy system in place to care for its people."
And this is what's so infuriating and embarrassing.
It IS ridiculous that almost every other industrialized nation on earth has some system in place to provide for the health care of its people.
It is only greed and negligence that stands in the way in America.
It is to our shame that the world sees us in such a poor light in this, and other ways.
A friend of mine was just talking in her blog about how America used to lead the way... now they feel America is behind the times. It's a horrible feeling the whole way 'round.
ReplyDeleteHopefully something will give soon... I just feel like it's on the brink with people just waiting for something to follow, believe in, strive for...... or maybe it's just me being a little naive.
*crosses fingers for November*