Hee, hee, that is a good one. Thanks.

I have heard stories from English teachers i know over there... and not good ones. You can imagine how the language abrrier can get in the way. Gaijin [foreigners] can look foreward to some strange stuff...

But, to the point of the medicine itself... It shows the difficulties of the system, but I would suppose it shows some of the vaguries of Japan itself that wouldn't transport here. It is my impression that oft times Japanese people will accept things that are unfair that we would never put up with, and that is re-enforced by the system itself.

that doesn't change the problem with a lack of competition in the market. You KNOW that there would be ironclad rules in place to keep docs from accepting gifts and such that would make things unfair, if implemented here... it would be miserably fair here unless you had the money just to hire a doctor privately. Assuming of course that they wouldn't allow extra insurance policies to "supplement" your public coverage.

In the long run, I can just never figure out this concept that healthcare should be a 'right' that you have to pay for. I can see the idea of education from the society perspective, where it pays to have productive citizens. Medical care? Is a lot more expensive for a lot less gain, from the society's perspective. For the "State" however, it is a greater degree of control over you. But to what end?

The problems in health care have accumulated over time in response to bad government policy, and it is a mistake to attempt a "comprehensive reform" by applying three times the government policy to supposedly fix it.

High cost is the problem that most people care about. It is unlikely that doctors "overcharge" more than other professionals. People observe that simple medical services incur a high bill, and they don't like it. Their insurance may pay for the $10 aspirin in the emergency department, but this communicates that the medical "system" is ready to overcharge them and their insurance company. They want government to step in and stop this.

Ironically, the government is causing this situation in the first place. The government should immediately stop gaming the system by offering to pay only 60% of usual amounts. The "system" would quickly adjust toward real, more reasonable prices.

The Political Distribution of Wheat

This is a short analogy to what is happening in the market for medical services. What does a market for wheat have to do with healthcare? It is easier to understand. Excerpt:

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A politician sees a warehouse full of wheat. He takes some of it to distribute to poor voters and prospective voters in his district. The warehouse will have to bear the burden. He is applauded for his sensitivity and charity.

The politician is dismayed at the consequence. Maybe the warehouse goes out of business, as people switch to using a warehouse that the politician doesn't see or can't tax. Or, the price of wheat goes up as the warehouse is not completely refilled. The politician ignores the people who paid for the wheat or were expected to buy it.
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This seemed like a nutty story. Buying multiple private-insurance policies and still not getting care? LIke America?

How is that the fault of national health insurance, if private-sector policies do not provide coverage? It would seem to argue for a much simpler system-like one payor.

Of course, the story is an anecdote. So, when the PBS reporter went to Japan and found all roses, and many rosy anecdotes, what does that mean?

Jpaan, Canada and Wsetern Europe are democracies, They could vote to move to our system if they wish. They never do. I know the Canadians are a bit slow, but Germans and Danes strike me as pretty shrewd.

The most regulated, subsidized, protected and molly-coddled sector of the US economy is agriculture. Yet our farmers are routinely extolled as the best in the world. The Defense Department is, of course, a creature of the federal government, and we all know it is aces all around in our military.

If you think our ag sector is good, and our military does a good job, then you should look forward to federalized health care.

To BOTU,
You say: "The most regulated, subsidized, protected and molly-coddled sector of the US economy is agriculture."

I would like your link to those facts. My understanding is that there are some highly subsidized segments, like sugar and wheat. There are some Market Order controlled segments, like citrus fruits, that we have to thank for the high price of consumer oranges and juice. The government limits entry into the orange market. US sugar prices are twice the world price; this causes US sugar users to substitute high fructose corn syrup, which also raises the price of corn.

What part of this government policy makes agriculture strong? It is a payoff to politically valued rural states which costs the rest of us more, and hits the poor hardest.

You say: "The Defense Department is a creature of the federal government".

Yes, but mostly not subject to detailed congressional administration. There is no 2,000 page bill saying what the military is supposed to do. When I hear of congressional management of the military, it is when congress mandates weapons systems that the military doesn't want, at great expense. Congress arranges for weapons systems to be built by sub-contractors in as many states and districts as possible, so that every congressman can point to the "jobs created".

Again, what part of congressional adiminstration of the military makes us stronger and reduces costs? Much criticsm of the military in Iraq was how slow and bureaucratic they were in making and distributing appropriate equipment. Thankfully (for the reputation of Congress) there is no direct competitor to the military, so we don't have direct evidence of how much better they could be.

There is some direct evidence of how good the government would be in controlling all of health care. Government has created and administers a separate medical system for the military. How is that working out?

Military Healthcare is Not a Shining Example: Fix Military Healthcare First

Andrew-
Actually, I agree with you.

I think the "The most regulated, subsidized, protected and molly-coddled sector of the US economy is agriculture."

The Defense Department is very similar. Never faced private-sector competition, so it is ossified lard, through and through--on a Cold War relic force structure.

We can't mount an force to fight a few punk terrorists. We spend $1 million per solider per year on the ground. That is in marginal costs.

I am not sure federalized health care would be worse than what we have. But probably.

BOTU, I can't address your assertions regarding agriculture, I've heard similar suggestions before, and it wouldn't surprise me in the least if you are right on that point...but as for the rest, when it comes to the military, well to put it lightly:

You're one of the dumbest goddamned people I've ever heard.

First and foremost you ignorant cretin, we DO have private sector involvement in military affairs, not just in weapons construction & sales either, I mean boots on ground contractors with private security forces. So YES, we do have private sector involvement. NO it is not "competition" because...genius...the ones we are competing with are the ones trying to KILL us, not the one next to us.

I've spent almost 10% of my life in the sandbox that is Iraq, in fact as I write this I'm in northern Iraq right now for yet another tour. Don't spout that idiotic shit about us not being able to fight "a few punk terrorists". This isn't one of your little video games or made for t.v. movies, these are real, thinking, adapting enemies, and for the record, we've killed more of those worthless, vile, vicious, sadistic little fucks than is reasonable to count or than will ever be reported by our ignorant, incompetent, biased, lazy and sorry ass excuse for a mass media. From year one when we got rocketed and mortared and shot at for hours a night, sleeping in body armor & kevlar because rounds don't wait for you to get ready, to the much more peaceful present when we've learned to get along very well with the population, where the terrorists are more the outsider dogs than we ever were.

Yes, we've had problems, newsflash, reality does not conform to our plans, it doesn't stay static, it ebbs, flows, changes more quickly than a meeting can progress, and contrary to your absolutely misinformed opinion, we are not trapped in some ossified cold war force structure.

Military doctrine, strategy, and tactics have changed with our weapons, it has changed with our circumstances, it has daily adapted to the needs of modern war, from the boots on ground moving in the latest force protection gear calling in pin point air strikes, to proactive network defense protection and instant communications leading to a rapidity of movement never before seen on the battlefield...(in the latest in uparmored vehicles which sustain all but the very worst strikes I might add), the most dangerous place to be in the world is between an American military movement & its objective.

Let me be clear, sure there are empty suits in the military, just like every other organization, but after almost 11 years of service & counting, I'd put THIS organization against anything YOU could dream up.

Good day to you sir, and may you get some better sense next time.

BOTU: "I am not sure federalized health care would be worse than what we have. But probably."

Be sure. Here in Canada, I have to wait 6 months to see a dermatologist. My mother-in-law is probably going to die waiting for a heart operation that has been delayed for months. Her health is deteriorating and she is unable to walk around. After a recent heart attack, either she gets better (soon) and has her operation or she will die in the hospital waiting. Quality of life does not seem to be relevant, and even if she had money, all the heart surgeons are tied to the public system.

If you have an emergency, then the system SEEMS to work. You get taken care of, and you don't pay anything (other than huge taxes).

...and don't get me started about the BILLIONS wasted on IT (Information Technology) schemes built to government specifications.

You may wait a couple of hours for an office visit, but you'll get the treatment you need, you won't be denied cutting-edge treatment because you're too old, all treatments are equally available to all patients that need them, which is more than I can say for the US system, if the shabby way my parents have been treated is any indication. Part of the reason for the long waits is that they won't turn anyone away who shows up that day.

Shakai Hoken is not 'lesser than' Kokumin hoken. They each cover 70-80% of treatment, medical and dental. Shaikai hoken is for people employed by corporations, Kokumin is for the self-employed, government employees etc..non-corporate. Your insurance premiums are based on your income. That's it. Very simple.

The supplemental insurance mentioned is about $30 a month, it covers what the national insurance doesn't, and it pays for a private room (about $100 a day).

While many people will buy one of these policies, you certainly don't need more than one. People get snowed by TV commercials into getting cancer insurance and all kinds of other policies that overlap each other. If you incur medical costs over $750 dollars during one course of treatment or one hospitalization, you can fill out some forms and get the money back at your local ward office.

The gifts are gradually being phased out. They were traditionally given when discharged from the hospital. Many hospitals have strict policy against gifts for doctors or nurses, but try and get patients to stop sending the stuff! When refused in person, they send it by courier. It's a traditional thank you. Were it a bribe it would be given beforehand, I'd think :-)

I worked in an arthritis clinic for quite a while here in Kobe. The whole society runs on reciprocal gift-giving, it's really hard to make older people especially, understand that they don't have to give the staff anything when they go home. So as not to completely crush the little old ladies' feelings, the docs refuse the cash they try to give but take the cookies or sweets.

You need an introduction letter to be seen by a professor, a formality making sure the person really needs to see the professor, to keep the professor's office hours from being swamped. In the US it would be the same as by-passing your primary care physician and going to a specialist on your own. Being an old hierarchical society many Japanese think immediately going to the top ranking doctor at their local university is a great idea, regardless of whether their condition warrants it or not. Which creates logjams in the university waiting rooms. You will not ever be refused an appointment with a professor,but you need to go through proper channels, ie, be referred.

As to the last part, there is a shortage of nurses in rural areas. That makes a big difference. If a patient needs feeding etc, if there are not enough nurses (no one wants to work in the boonies anymore) then family members are asked to help.

The hospital my MIL is in now, they have enough nurses, it's 'kanzen kangou' meaning that the family does not have to do anything for the patient like feeding them if needed etc. All pajamas, towels etc are provided by the hospital for $5 a month, three changes of PJs and underwear a week. And she's on Kokumin insurance.

Many hospitals require a deposit, which is returned upon discharge. It's because some patients skip out without paying. 10 man, the thousand dollars mentioned in the blog post, is not an unreasonable amount for a deposit for a hospital stay. It's a cash-based society, we have no checking system, and it's a drop in the bucket in relation to most people's savings accounts.It is waived if they don't have it. MILs hospital requires 5 man, about $500.