Thursday, September 24, 2009

30 Seconds Over Tokyo

Marginal Revolution quotes from a recent book on the superior aspects of the Japanese health care system: Facts About Japanese Health Care

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 do
The 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...


  1. I agree with your points! Japanese people prefer living with moderation and like cooking fresh, healthy organic foods every day, even some drink to excess like Americans.

  2. LOL!!! I lived in Kyoto for five years, and the idea that Japanese, especially Japanese men, don't smoke or drink as much as Americans do is a crock. Malarkey. Codswallop. Merde. Kuso. Unsinn. Organic foods???? have you been into a Japanese supermarket to see row upon row of processed food? Hell, you can see some of them in American supermarkets, as various kinds of cheap noodle soups. Then there's the fifty kinds of dried and processed fish, many heavily smoked and nitrite-enriched. Stomach cancers, anyone? That's just for starters. And btw MacDonalds, KFC and other American chains have done quite well there, for at least 30 years.

    Crikey, I am so sick of reading how the Japanese are the Greatest. One would think that their flat-lined economy the past fifteen years, after we were told they would be Number One, would wake people up to the fact that they put their zubon/pantsu on one leg at a time.

    Another dirty little secret: it's only by adopting a more Western diet after WWII did the Japanese grow almost six inches taller than their parents. That's a fact.

  3. Thanks for commenting Jelink. And thanks for your info re: Japanese stores. I lived in Tokyo for seven years, am married to a Japanese, and regularly shop at a Japanese market. I am not saying the Japanese are perfect. They just don't abuse their bodies with food as much as the typical American does. As a dedicated consumer of Japanese sweets, I am comfortable saying they are lighter and less filling than American ones. Anyway, my point wasn't that the Japanese are wise ascetics, only that they do things in moderation. Even their alcoholism is more moderate than the American version!

  4. Left this at Just One Minute, and for what it's worth, my two cents were:

    "As a fifteen year resident of Kyoto, a white guy immigrant, and before a brief comment on the Japanese health care system, let me respond to Jack is Back: learn to read, write and speak Japanese fluently, not much to demand of an immigrant to any country, in my opinion, and not only does one assimilate into Japanese culture, but one is able to thrive and all and all is at a major advantage in many ways (including access).

    Racist is certainly the wrong word. There is a strong and vital culture here, a shared learning, mostly based on the word, written and spoken, and for ex-pats who after some time in Japan return to their native countries crying "racism, racism" I always ask one question: how's your Japanese? Inevitable those who say "great" can't even read at a fourth grade level and speak even less well. Which is not to say the Japanese won't treat you well if you are a culturally illiterate "white" person , but you certainly won't find yourself being assimilated. Thankfully. Rightfully.

    As for the health care system. What the national health care system allows by way of procedure and treatment is fairly restricted and cost is directly controlled. However, additional insurance, in the marketplace, to cover procedures outside the box, is easily attainable and competitively priced and many doctors and hospitals thrive in this subtext. Costs here too are fairly low. Access to MRIs and other high end diagnostic tools are very inexpensive and available without delay.

    The biggest difference, as an American brought up in U.S. healthcare, is time. Very wham, bam. Five to ten minutes with the doctor. Likely in a room where your conversation is overheard by other patients in queue. A doctor may see 50 to a 100 patients a day. Ten beds to a room are normal for stays in a hospital, with a few feet and a thin curtain you can draw, between beds. If you have money or additional insurance, though, you can get your own room, still very Spartan though. In a word, there is no luxury to the medical experience. I for one have few complaints, but there is cultural subtext that is wholly inappropriate for U.S. healthcare, as the linked piece correctly outlines, and for a hypochondriac like myself, one the one hand I don't get much touchy-feely time with the doctors, but, on the other hand, I can get MRI's for three hundred dollars a pop anytime I want."