Health insurance reform in the US has been, and continues to be, a complicated affair. Before, during and after the passage of the Patient Protection and Affordable Care Act (a.k.a. “Obamacare”), the amount of furious blogging, protest, screaming and yelling was almost surreal. But in Japan, I have never witnessed such turmoil, and I doubt I ever will. Contrary to my first impressions, the national healthcare system works well—and the US would do well to emulate it.
When I arrived in Tokyo 16 years ago, I still had my expensive Blue Shield insurance, assuming I would only be in Japan a year or two. One of my first instances of culture shock was learning that enrolling in the national health insurance system was considered mandatory (although that’s not to say everybody does), and that the level of coverage was the same for all. As for the premiums, while the amount might vary based on which ward I lived in, the Japanese government otherwise determined how much I would pay based on my salary.
My first few years here were great salary-wise, and as a result, I ended up paying nearly the maximum for my Japanese health insurance—over ¥500,000 annually. Based on my age, my excellent health and the type of work I did, this didn’t make any sense to me, and I spent many hours discussing this with the personnel at my ward office. Needless to say, this led nowhere.
Meanwhile, as I stayed on in Japan, my US premiums increased year after year. As the insurance company constantly reminded me, “Costs for medical care continue to rise,” and there was “no choice” but to pass those costs on to customers. At one point, I was spending over ¥1 million a year to cover my health insurance in both countries.
Eventually, like many other Westerners I knew, I stopped paying my Japanese health insurance premiums. After a few months, I started receiving letters from the ward office with angry red kanji demanding I pay up. My friends told me to ignore the letters. “Eventually they’ll just write you off,” they said. Better yet, “Move to another town and don’t register for health insurance; they’ll never know.” I still see this type of “advice” littered all over gaijin discussion forums. Maybe everyone else has been lucky—I wasn’t.
When I went to America for six months to take care of my sick mother, the ward office found out my bank account info—to this day, I don’t know how—and took ¥1 million to cover unpaid premiums. From that point on, my premiums would be automatically deducted from my account. If I wanted to stay in Japan, I had to find a way to live in harmony with the system. I investigated all kinds of alternatives, but finally decided the best thing for me was to accept it. I let go of my precious American insurance, which had become cost-prohibitive—and soon after I did, I began to discover the value of the Japanese scheme.
When you apply for health insurance in Japan, you aren’t given a blood test or interrogated about your health history. This means, in essence, that even if you have cancer or are HIV-positive, you won’t be denied coverage. Once in the system, you don’t have to wait in fear to find out whether certain procedures or tests will be approved by some God-like doctors in ivory towers. You can also choose your doctor and/or the facility where you want to be treated.
Another valuable feature of national health insurance in Japan is, the less you earn, the less you pay—and you still get the same level of care and coverage. In America, insurance companies bide their time until you get older so they can raise your premium dramatically, all without the least concern for how you will pay for it.
Illustration by Eparama Tuibenau
It’s true that, statistically speaking, the older you get, the more health problems you have. But why should anyone have to go broke to pay for health insurance—or, worse, go without? When I first came here, I thought it was insane that I should have to pay more for premiums because I was earning more. But now that the work isn’t coming in like it used to, my premiums are actually affordable. More importantly, there are now more excellent clinics that have English-speaking doctors who accept national health insurance (at the same time, there are some “private practice” doctors for the foreign community that do not). This year I had a number of procedures done, including an MRI (that I requested). It cost about ¥10,000, as opposed to US$1,500, and in the States I would have had to have been “approved” before the doctor could have ordered one. Here in Japan, I ask, I receive.
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5 Comments
Anywhere in the developed world is better than America. Do some research, though for the average Toru Japan’s system effective, but under the surface Japan’s service is also dysfunctional. The system is becoming more and more expensive and little is being done to make it more efficient. There is a severe lack of staff and practitioners, and the government’s plans to improve this recently floundered (increasing of foreign staff).
While the Japanese system is definitely more cost-effective than the U.S. system, and actually covers EVERYONE, it too is dysfunctional in many ways. If you’re ever in a serious accident, there’s a good possibility that you’ll spend your last minutes in an ambulance while the driver frantically tries to find a hospital that will admit you and treat you. Hospitals here don’t want any trauma cases brought to them out of fear of having a death on their record. ‘Trauma’ could include something as minor as severe heatstroke, as happened a couple of years ago to a high school student in my area who suffered dehydration during the school summer sports day. After collapsing, the school had an ambulance transport him to….where? Nowhere. They drove in circles, as hospital after hospital refused him admittance. He died enroute. If the Americans want to emulate a system that actually works, try emulating the Canadian system. More cost-effective than the U.S. or Japanese system, covers everyone, and comparatively speaking, few complaints. Compare it to your average HMO. Like comparing Attila the Hun to Mary Poppins.
What if you have a sizeable amount of people that don’t have jobs or exist only on welfare? Japan is an honorable society where gaming the system would be looked down upon. If America inacted the same system it would quickly become overrun with people trying to take advantage.
Although Japan has more advanced procedures than most countries, what happens if a patient’s only option is a cutting-edge procedure not yet authorized by the government?
Also, I don’t live there so I’m not sure, but do you just have your choice of doctors in your area? What if you want to go to a doctor that’s a considerable distance away?
im protesting the Japanese system. I could be a prick and accuse you of smoking crack, but I wont, instead I’ll just state the facts. My wife and I recently had a child in Japan INSURED, which cost us over 750,000 (minus half for a rebate from the government) yen, for her to stay in a crowded room with no bathroom.We had a child in the US and it cost less then a few hundred dollars total, in an immaculate hospital with plenty amenities. So don’t even go there and suggest that the system here is in any way better. The system is so inferior that doctors have developed methods of milking money from the patients by having repeat visits. I think you should do a little more practical research in all areas of the system here before you bother to even suggest that it is superior. And whats with targeting the US? why not compare Japan with another flipping country, I’m sick of folks comparing the US and Japan. Find a new angle please, its boring
So you’ve lived in Japan for 16 years and you’re now comparing it to the U.S. system which you haven’t been in for that long. You complain about the cost of U.S. expat insurance while living in Japan. Brilliant! Yes, U.S. medical care (and private expat insurance) is expensive but I’ll take emergency rooms that are open 24 hours a day, qualified doctors that are willing to treat patients of any race/nationality and current technology any day. I certainly haven’t had that experience here with the exceptions of the highly qualified expat and worldy Japanese doctors that I’ve found at private clinics here (the ones that don’t take national health insurance). Hats off to them. My hospital experiences here have been horrendous.
Yes Japan has universal health care and yes there is a focus on preventative medicine. That, however, is also independent of the legal regime that has been pushed in the U.S. for so long by those of your political ilk. Perhaps if, and by way of example, ob/gyn doctors in the U.S. weren’t spending six figures a year on malpractice insurance there would be some hope of bringing down medical costs. Of course this was not addressed in the new legislation that was pushed through will little thought and less discourse. Yes, discourse (or as you call it “screaming and yelling”), something a healthy political system needs to thrive. Perhaps you could pay a visit to the Chinese embassy so you can see real “screaming and yelling” from the Japanese nationalists. Oh wait, that doesn’t happen here, right, because there is no “turmoil” in Japan?