The Japanese are the world's most prodigious consumers of health care. The average Japanese visits a doctor about 14.5 times per year -- three times as often as the U.S. average, and twice as often as any nation in Europe...The Japanese love medical technology; they get twice as many CAT scans per capita as Americans do and three times as many MRI scans. Japan has twice as many hospital beds per capita as the United States, and people use them. The average hospital stay in Japan is thirty-six nights, compared to six nights in the United States...Japan lags, though, in terms of invasive surgery; Japanese patients are much less apt than Americans to have operations such as arthroplasty, transplant, or heart bypass. This is partly economics -- since the fees for surgery are low, doctors don't recommend it as often -- and partly cultural. As a rule, Japanese doctors and patients prefer drugs to cutting the body. On a per-capita basis, the Japanese take about twice as many prescription drugs as Americans doThe book is T.R. Reid's The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care. It's one of those "Nickel & Dimed"-style works of journalism where the reporter investigates a complex system by trying to experience it first-hand, in Reid's case by treating his injured shoulder in different countries as a way to test the responses to each country's health care. Yawn. Call me when you try this concept after a cancer diagnosis.
According to MR, Reid is - you might want to sit down for this - very critical of the US system. I am at a disadvantage, having not read all of Reid's book, but I know this; there is no way the American health care system could ever be "like Japan's" because Americans are not Japanese.
1. the Japanese live healthier lifestyles. There is a strong social ethic in favor of moderation in all things. Americans, by contrast, are much more likely to smoke and drink to excess, abuse illcit drugs (a virtual unknown in Japan), and engage in risky sexual behavior.
2. The Japanese diet is famously healthy, with lots of fish, rice, and vegetables, but that's not all. Japanese prize fresh food. They are less likely to load up on processed food, or eat tons of restaurant food. Eating healthy occurs at all levels of Japanese society. In America, by contrast, and I don't mean to be catty, bad eating habits occur at all levels of society, becoming more prevalent the farther down the income scale you go.
3. Japanese people tend to live moderately in a manner that finds strong reinforcement in society. By contrast, Americans like to live with a lot more brio - which often means we are much more likely to get shot, die in car accidents, overdose in crackhouses, (or your parent's den), etc. The American "ethic" of living life to excess is reinforced in the media and at all levels of society.
4. I'm not going to say that no Japanese person ever sued their doctor, but the lawsuit culture in Japan is nowhere near the scale of America's. Anyone out there want to look up the average liability insurance premium for Japanese doctors?
5. The Japanese tend to get their health care through a combination of employer coverage, government options, and their own purchasing power. The Japanese are always well aware of the cost of their health care. The government takes a significant cut straight out of Japanese paychecks, the same way Social Security is taken from ours. There is no fiction RE: the disparate tax treatment between employer provided plans, and individual plans. Americans, on the other hand, have no idea how much health care costs because so much of it is hidden from them.
6. Japan lacks a large population of illegal immigrants and welfare recipients obtaining health care through visits to the emergency room. This doesn't just keep costs down. It also prevents the general resentment that is endemic in American health care, where the middle class rightfully believes they are picking up the tab for non-citizens and deadbeats.
7. The Japanese are much more careful about staying healthy and avoiding illness. The people you see on the Tokyo subway wearing surgical masks are not kidding. Americans don't stop smoking until after their first heart attack.
8. To be blunt, the Japanese do not try to exploit the system as certain free-loading Americans do. That's not to say that waste, fraud & abuse doesn't happen in Japan; but Americans' wilingness to screw the system exists at an absolutely operatic level.
9. Philosophically, the Japanese are much more accepting of life's limits. They are much more likely to age gracefully, face death stoically, and accept that medicine might not be able to save them. Americans are all about heroic measures, experimental therapies, and serial medical testing in the endless quest for the magic bullet.
The Japanese health care system is not perfect. But, it fits well with Japanese culture and society, for good and for ill. Same goes for ours. It's big. It's sprawling. It is a product of both the free market and rigorous government intervention. It performs miracles, yet it can also fail at its most basic functions. Everyone complains about its cost, but very few actually pay full price. It is what it is. Walking around saying it should be "like Japan's" (or England's, or France's, or Germany's, or etc) ignores the simple stupid fact that this is America, and TR Reid, Max Baucus, and anyone else calling for wholesale reform needs to remember that.
UPDATE: Linked over at Just One Minute. Thanks, and welcome all! Now, I'll just make a few grammar spelling changes...