Problems With Japanese Universal Health Care?

The 9/10/2011 Economist describes growing problems with Japan's health care system: "Health care in Japan: Not all smiles".

An excerpt:

Doctors are too few -- one-third less than the rich-world average, relative to the population -- because of state quotas. Shortages of doctors are severe in rural areas and in certain specialities, such as surgery, paediatrics and obstetrics. The latter two shortages are blamed on the country's low birth rate, but practitioners say that they really arise because income is partly determined by numbers of tests and drugs prescribed, and there are fewer of these for children and pregnant women. Doctors are worked to the bone for relatively low pay (around $125,000 a year at mid-career). One doctor in his 30s says he works more than 100 hours a week. "How can I find time to do research? Write an article? Check back on patients?" he asks.

On the positive side, patients can nearly always see a doctor within a day. But they must often wait hours for a three-minute consultation. Complicated cases get too little attention. The Japanese are only a quarter as likely as the Americans or French to suffer a heart attack, but twice as likely to die if they do.

And despite Japan's image as a high-tech mecca:

The system is slow to adopt cutting-edge (and therefore costly) treatments. New drugs are approved faster in Indonesia or Turkey, according to the OECD. Few data are collected on how patients respond to treatments. As the Lancet says, prices are heavily regulated but quality is not. This will make it hard for Japan to make medical tourism a pillar of future economic growth, as the government plans.

(Read the full text of "Health care in Japan: Not all smiles".)

For some reason, most of this information doesn't make it into the American popular press.

Medical Bribery in Canada and Japan

Under the system of medical rationing in Canada, some patients are resorting to very desperate measures:

A Quebec woman who claims that she paid a doctor $2,000 to expedite surgery for her cancer-stricken mother is raising questions about whether bribery is being practiced in the province's health-care system.

Vivian Green said she was doing what she had to in an effort to save her elderly mother, who had been diagnosed with pancreatic cancer after she developed a pain in her side.

"When you're desperate you don't care who you bump and how sick they are," Green told CTV News. "I was desperate."

(Read the full text of "Quebec woman claims she bribed doctor for treatment".)

Basically, the Canadian medical system puts decent people in an impossible situation where they must choose between following the rules vs. saving their own lives.

Nor is this limited to Canada. In Japan, those willing to pay appropriately large "gifts" to doctors and hospital administrators get bumped to the head of the waiting lists.

Under such socialized medicine, those who are able to "grease" the system through money or political influence will always do well. In contrast, ordinary people will lose out.

(Link via Zip and K.V.)

Update: More details at the Montreal Gazette, "Want fast care? Slip an MD some cash":

Minimum $2,000 to guarantee that a woman's doctor will be there for the birth. "And it can go up to $10,000," he added.

For general surgery, the cost runs between $5,000 to $7,000 to jump the wait list into the operating room, he said.

For Green and Marcus, the $2,000 got their mother's operation bumped up -- but not the surgeon they wanted.

(Via @debbywitt and Mark Perry.)

"VIP" Treatment Under National Health Care

Blogger Sachi describes the experiences faced by her parents under the Japanese universal health care system.

I highly recommend reading her entire post, "'VIP' Treatment Under National Health Care".

But her take home point:

National health care works great... so long as you're rich enough to afford the premium level of government insurance and to buy multiple additional private policies; so long as you have influential relatives; and so long as you're willing and able to brazenly bribe the doctors and bureaucrats who run the system.

Nor are such problems isolated to Japan. Similar "queue jumping" is routine in Canada and other countries with socialized medicine.

There's no reason to expect that the US will be immune to this problem either.

(Link via HotAir.)

Fat In Japan? You're Breaking The Law

In the November 10, 2009 Global Post, David Nakamura describes the Japanese anti-obesity laws in his article, "Fat In Japan? You're Breaking The Law".

Here's an excerpt:

...Under Japan's health care coverage, companies administer check-ups to employees once a year. Those who fail to meet the waistline requirement must undergo counseling. If companies do not reduce the number of overweight employees by 10 percent by 2012 and 25 percent by 2015, they could be required to pay more money into a health care program for the elderly. An estimated 56 million Japanese will have their waists measured this year.

...Health care costs here are projected to double by 2020 and represent 11.5 percent of gross domestic product. That’s why some health experts support the metabo law.

(Read the full text of "Fat In Japan? You're Breaking The Law".)

Such nanny-state regulations are already present to a lesser degree in the United States. If we adopt some form of "universal health care", we can expect to see them explode in scope and number.

As I described in my January 7, 2009 Christian Science Monitor piece, "Universal Healthcare and the Waistline Police":

...Government attempts to regulate individual lifestyles are based on the claim that they must limit medical costs that would otherwise be a burden on "society." But this issue can arise only in "universal healthcare" systems where taxpayers must pay for everyone's medical expenses.

[Specific US nanny-state health regulation examples omitted...]

Just as universal healthcare will further fuel the nanny state, the nanny state mind-set helps fuel the drive toward universal healthcare. Individuals aren't regarded as competent to decide how to manage their lives and their health. So the government provides "cradle to grave" coverage of their healthcare.

Nanny state regulations and universal healthcare thus feed a vicious cycle of increasing government control over individuals. Both undermine individual responsibility and habituate citizens to ever-worsening erosions of their individual rights. Both promote dependence on government. Both undermine the virtues of independence and rationality. Both jeopardize the very foundations of a free society.

The US will soon have to decide whether we will base our health care policy on the principle of individual rights or a collectivist model, as in Japan.

For our sakes, I hope we won't be "turning Japanese".

Coverage vs. Care in Japan

Japan's universal health care system supposedly guarantees "coverage" for all residents. However, theoretical coverage isn't the same thing as actual medical care, as this unfortunate man found out:

Injured man dies after rejection by 14 hospitals

After getting struck by a motorcycle, an elderly Japanese man with head injuries waited in an ambulance as paramedics phoned 14 hospitals, each refusing to treat him.

He died 90 minutes later at the facility that finally relented -- one of thousands of victims repeatedly turned away in recent years by understaffed and overcrowded hospitals in Japan.

Paramedics reached the accident scene within minutes after the man on a bicycle collided with a motorcycle in the western city of Itami. But 14 hospitals refused to admit the 69-year-old citing a lack of specialists, equipment and staff, according to Mitsuhisa Ikemoto, a fire department official.

The Jan. 20 incident was the latest in a string of recent cases in Japan in which patients were denied treatment, underscoring health care woes in a rapidly aging society that faces an acute shortage of doctors and a growing number of elderly patients.

Nor is the problem one that would be solved by imposing a law like the US EMTALA statutes which force hospitals to accept and stabilize emergency patients. In the US, this has creating yet more overcrowding of emergency room. EMTALA has also driven away physicians from working at these hospitals. What cardiologist or neurosurgeon wants to take ER call if he isn't compensated for any care he delivers, but can still be sued for any alleged malpractice?

Instead, Japan's problems are more systemic and "is nearing collapse". When people are told they have a "right" to care without limit, costs will also rise without limit. Soon, the only alternative will be rationing, as is already commonplace in other countries like Canada and the UK.

Will the US be next?

(Via Gus Van Horn.)

Government Medical System in Japan Requires Mandatory Waistline Checks

According to the June 13, 2008 New York Times, government officials in Japan have instituted a mandatory program where all men and women between ages 40 and 74 must have their waistlines measured and recorded by the government. The purpose of this program is to reduce costs from obesity-related health conditions, because the government health system must pay the bills:

Under a national law that came into effect two months ago, companies and local governments must now measure the waistlines of Japanese people between the ages of 40 and 74 as part of their annual checkups. That represents more than 56 million waistlines, or about 44 percent of the entire population.

...To reach its goals of shrinking the overweight population by 10 percent over the next four years and 25 percent over the next seven years, the government will impose financial penalties on companies and local governments that fail to meet specific targets. The country’s Ministry of Health argues that the campaign will keep the spread of diseases like diabetes and strokes in check.

The ministry also says that curbing widening waistlines will rein in a rapidly aging society's ballooning health care costs, one of the most serious and politically delicate problems facing Japan today. Most Japanese are covered under public health care or through their work.

The government limits are very strict -- "33.5 inches for men and 35.4 inches for women" -- literally a "one-size-fits-all" standard.

One Japanese man did express his disdain for the new regulations:

...Kenzo Nagata, 73, a toy store owner, said he had ignored a letter summoning him to a so-called special checkup. His waistline was no one's business but his own, he said, though he volunteered that, at 32.7 inches, it fell safely below the limit. He planned to disregard the second notice that the city was scheduled to mail to the recalcitrant.

"I'm not going," he said. "I don't think that concerns me."

Once a government starts violating individual rights by creating a "universal" health care system, this inevitably leads to further infringements of individual rights. This is not unique to Japan.

For instance, universal health care in Great Britain has led to infringements on the right to free speech. In 2007, the British government banned television stations from playing classic 1950's-era humorous advertisements encouraging people to have an egg for breakfast, on the grounds that "the ads do not encourage healthy eating".

When a government has to pay for everyone's health care, it will naturally demand a say in whether people are leading a "sufficiently healthy" lifestyle, as defined by the government.

Colorado writer Steve Schweitzberger made a similar point in this June 30, 2007 letter to the Rocky Mountain News, referring to universal health care advocate and filmmaker Michael Moore:

If Michael Moore has a toothache, it is not my responsibility to pay for his dentistry. If it were, then I would have the right to tell him not to eat sweets. I don't want that kind of government-paid medical policy. Do you?

This is a question that all America should be asking.