This isn’t going to be an entry filled with fancy charts or economic gobble-talk. This is, quite simply, what happened to me the other day, and what I did about it. For real. In the real world. In a country other than the United States.
I live in Japan, you see. For those new to this blog, I work in the public schools in a tiny town nestled deep in the mountains along a river valley. It’s about as far from the Big City as it’s possible to get in Japan.
Last Monday, I wasn’t feeling great. My tonsils were hard as rocks and I was feeling tired. My throat hurt. I know I didn’t have the flu so I went to work. After my last class the school nurse took my temp and discovered I had a fever. The principal told me to go to the doctor. I bowed and off I went.
There aren’t any hospitals in my town, just little clinics, but they’re good, too. I went in to see the doctor. At the front window I presented my national health care card and wrote a list of symptoms on a little square of paper. Then I waited for about 30 minutes. It normally doesn’t take so long but the flu has been going around here and there were a lot of people waiting.
I went in and saw the doctor. He asked me some questions and examined me. He asked about my job and how the students were doing (as the only white guy in, literally, fifty miles, I kind of stand out, and my function in town is kind of obvious). The examination took fifteen minutes. Diagnosis: tonsilitis, with involvement of the lymph nodes, plus a touch of early-season hay fever adding itchy eyes and runny nose to my miseries. We chatted for a few more minutes and I waited again as he wrote a prescription.
I went to the window to pick up the prescription and pay the doctor’s bill. Total: $10.
I went next door to the little pharmacy (actually the pharmacist’s house, office on the first floor) and presented my prescription and my health care card. I got an antibiotic, a cough supressant, a non-steroidal anti-inflammatory, something for my runny nose, a gargle, a nose spray, eyedrops, and medicinal throat lozenges. Seven day supply of each. These weren’t cheapie drugs, either- most of them had Glaxo Smith-Kline emblazoned all over them. Total cost: $33.
It’s a few days later and I feel great. Total cost to feel great and have peace of mind: $43.
So how does this magical system work?
Well, you pay into it according to your income. I know in the USA this is a weird concept, but if you make MORE money, you are expected to pay MORE into the system. I make about 35K a year (my wife is currently not working) and both of us are covered for about $150 a month.
What do we get for that money? Well, national health covers anywhere between 70 and 90 percent of the total bill, depending on what the procedure is. In the example above, both the doctor visit and the prescription drugs were covered 80%. This means the doctor got a total of $50 for his work, $40 from national health and $10 from me, for fifteen minutes of work, which works out to $200 an hour. Not a bad wage, huh? Can’t really say that national health care is stealing any of his livelihood. Same goes for the drug companies and pharmacist. Of course, there are price controls here, to make sure things don’t get out of hand.
Well, what about freedom to choose my own doctor? No problems there. I could have done the exact same thing at ANY doctor’s office in Japan, from Okinawa to Hokkaido, from Tomiyama-mura (the smallest town in Japan) to the biggest hospital in Tokyo. The card is accepted anywhere, and is handled in exactly the same way.
Well, what if I still think this national health care stuff is nonsense, and I still want private insurance? Well, guess what, mister tinfoil hat lover? You can get it. In fact, many people do carry supplemental insurance here. While getting 80% of brain surgery covered is a great thing, a $200,000 operation will still dent you for $40,000, so many people buy insurance that will fill this gap. Aaaaand, if you want to opt out entirely, there are also private health insurance plans available, too! But guess what? Since the private plans are competing with national health, they actually DO cover you, they are priced to compete, and they are regulated by the government so they don’t do things like, say, suddenly refuse to cover you if they don’t feel like it. Imagine, private insurance companies DOING WHAT THEY’RE SUPPOSED TO! This is called COMPETITION, and I hear it’s a good thing for the free market and stuff, as opposed to COLLUSION and MONOPOLIES, which are bad.
In fact, when we first returned to Japan in ’08, my wife and I were covered by one of these private plans while we waited to transition to national health care. The company was Inter Global and they operated out of New Zealand. Inter Global was about the same price as national health and covered the same stuff, with slightly different procedures. What was interesting was that they offered coverage in any country in the world, so that you could travel and not have to worry. Every country in the world… except the USA. I talked to the representative about this and he basically just laughed and told me, as politely as he could, that the USA’s system was completely f$#&ed up. I told him I knew that.
Well, the final argument goes… surely this system could never work in the USA, because of the bureacracy and corruption blah blah blah. Having lived in Japan on and off for nearly ten years I can definitely tell you that the USA’s bureaucratic system is a wonder of streamlined efficiency compared to Japan’s. Japan is a nightmare of red tape, both public and private. How so? In order for my wife to get her birth certificate, for example, she must travel to her home town and appear, IN PERSON, to request it. Most important records are still kept on paper on complicated documents, which is why many of the dead in the 3/11 disaster will never be identified, and why their next-of-kin face a daunting task- all land records were recorded on paper which washed away or burned. The banks are finally relaxing their standards so that you don’t need a physical bank book or inkan (personal seal) to access the accounts (related- banks don’t check photo IDs. If you have anyone’s seal and bank book, you can drain their account and there will be no record or trace that you did so). I could go on and on but I hope I’ve made the point- things do not run smoothly here, at least not as smoothly as we are used to in the USA. So if the Japanese can make a health care system like this one so simple, then we can do better.
And if you’ve heard there’s a funding crisis in Japanese health care, that’s true, but part of it is due to a falling birthrate (which we are not experiencing) and part of it is due to corruption (money being drained off to go to other uses) which is preventable.
Again, this is real. This is a real system, that I use when I need it, and it works. All of the things the neocons warn about are just fantasies. There’s no red tape, no rationing of health care, no exodus of doctors, no stealing money from doctors, no punishing drug companies or insurance companies, no loss of religious freedom or guns (if you’ve heard that Japan is gun-free, you’ve heard wrong- about half my neighbors own shotguns, and some of them go hunting for wild boar. Wild boar stew is delicious), no death panels or review boards or forced examiniations.
There are, however, voluntary examinations. Last year I got screened for liver and kidney function and prostate cancer. My wife got a breast cancer screening. All free. Last summer, a bus came and loaded up all the high school-age girls and took them to a hospital in Shimada (a bigger city south of us) so they could get their anti-cervical cancer shots (forget what it’s called, sorry). I’m happy to report that there were no protests or wild-eyed 70 year-old men on TV claiming that this would magically turn them into sluts.
Japan, which is one of the great basitons of the free market and practice capitalism with a capital C, seems to have survived the socialist menace of keeping their people healthy just fine, thank you very much.
Why can’t we just look, and learn, and adopt, and try to make better, instead of wallowing in lies and bullshit? Who actually believes the lies that spew from neocon pundit mouths? We who have lived in the rest of the world need to speak up and spread the truth. I’m starting now. Who’s with me?