The Nightmare of Japanese Health Care
Recently I took a trip to Japan. I love that place and go as often as I can. This particular trip was my fourth journey to the land of the rising sun, so I wanted to do something I hadn’t done before. Unfortunately, I got my wish.
On my way up a flight of stairs on a pedestrian overpass in busy Shibuya, my shoe got caught on the lip of the top step. I stumbled forward, but got my feet under me just long enough to think, “I’m going to make it; I’m not going to — BAM!”. I felt my head slam into something hard — a square metal post, as it turned out. I came to a dead stop.
I stood up and pressed my hand against my head.
“It’s bad,” I told my husband, who trotted up to help me.
“Let me see,” he said. I removed my hand. Blood poured down my face. He gasped. He never gasps. “That’s bad,” he said.
The Japanese EMTs showed up and rushed me off to the nearest hospital. They wheeled me into a room right away where a nurse promptly took my vital signs. About 15–20 minutes later the doctor, a neurosurgeon I found out later, came in and checked me out. The nurse washed my gaping 10 cm gash. The doctor expertly sewed it up (my GP in the U.S. was impressed by his work), then I waited another 15 or 20 minutes or so before they wheeled me to radiology where they gave me a CAT scan and a head x-ray.
After they completed the scans, they wheeled me back to the emergency room. I waited a bit longer this time before the doctor returned with my husband. The doctor showed us the scans, and in his limited but adequate English, explained that there was no bleeding in my brain and no skull fracture (proof positive, I think, that I am thick skulled.) He prescribed an antibiotic and a painkiller, which we picked up from the hospital pharmacy that night.
Treatment complete, the doctor released me, and we were sent to billing. The clerk presented the bill to us and pointed to a disturbingly corpulent figure: 24,600. I hoped they had a cardiologist on call, because my heart had stopped at the sight of that number. Fortunately, my non-head-bashed husband had the presence of mind to ask, “Is that yen?” The clerk pointed to the yen symbol next to the number. Knowing the exchange rate was about 88 yen to the dollar, I quickly estimated the conversion in my head. The bill was less than 300 dollars American.
I returned to the hospital two more times, first so the doctor could check on the wound and ensure there was no infection, and second so he could remove the 12 stitches he had sewn into my scalp. Each visit cost us 700 yen. We were also informed that they had not charged us for everything the night of my ER visit, so they handed us an additional bill for around 18,000 yen. By the end of it, my Japanese medical emergency adventure, scans, drugs, ambulance ride and all, came to a grand total of just under 500 dollars. And that without the help of any insurance whatsoever. I was incredulous.
Upon returning home, I decided to research the reasons for my brief and cheap jaunt through the Japanese health care system. There are a few key reasons. First, Japan’s ministry of health strictly regulates the health care system, primarily by establishing fixed costs for medical services based on negotiations with the health care industry. Second, by law all hospitals and insurance providers must operate as not-for-profit enterprises. Finally, the government mandates that everyone have coverage, that no one be denied coverage for any reason, and that no claim can be denied. This decreases administrative processing and costs. It also ensures that people can receive care anytime and anywhere without the worry that said care will bankrupt them.
Although the government regulates the health care industry, most hospitals and medical practices are private, and aside from cost issues, are run as their administrators see fit. Additionally, patients are allowed to choose what doctor they see and where they go for treatment. And while patients may have to wait an hour or longer to see a doctor for what is usually a very brief visit, they can typically get appointments for the day they want to be seen. The system is funded by a combination of taxes and job-based insurance premiums and consumes around 8% of Japan’s gross domestic product, which is half as much as in the United States.
In short, the Japanese have universal healthcare with strict government controls. They have the system Obama’s health care bill once aspired to enact…the poor bastards. I mean, sure I received care that I, as well as most Japanese, find amply proficient and thorough for a fraction of what it would cost in the U.S. But living with that sort of governmental control and the security and fairness and it provides has to be a nightmare, right? I can’t imagine what it must be like to live, day after day, with the horrific equity and peace of mind that system must have unleashed. How the Japanese bear the yoke of such unmitigated tyranny, I’ll never know.
I only hope that someday, we suffer a similar fate.
