Looking from the outside in can give one a unique perspective on many of the ailments the United States is experiencing. Having worked in the United States for 12 years and worked in Japan for 20 years, I can see in many sectors how the American society has spun out of control like unmanageable fireball.
Let’s look at the health care debate raging in this election year. I am no expert on public health care or insurance other than being a consumer, an avid reader and a careful observer. Japan has stark contrasts to the United States.
First let’s look at litigation and liability in comparison. The Japanese do not traditionally sue their mentors, educators, community leaders and healers. And no, they do not sue their EMT or the fire departments often either. Yes, it does still happen in certain cases, but far from commonplace. Nevertheless, court litigation rates are a fraction of what they are in the United States. Some years ago, there was a case of blood tainted by HIV and the Japanese courts and government held some health care providers and suppliers culpable, and monetary compensation was awarded.
Since the early 1960s, the Japanese have had universal national and social health insurance coverage. There are still some people, often foreigners working in Japan that are not enrolled in the national or social health insurance program and must pay for their care up front in cash. However, even in such an instance, medical care is significantly more affordable even without insurance. An MRI would cost 200 dollars in Japan. The same MRI would cost as much as 1800 dollars in the United States. Japan is not a third world country and has an extremely advanced medical system. Is there any justification for care to cost 9 or 10 times more in the United States?
Several months ago, while surfing the internet, I ran across an excerpt from a doctor’s memoir written by a long-lost cousin I don’t remember ever meeting in person. It was for her father, my uncle with whom I also share a name. I contacted the publisher who got me in contact with her and got my hands on my own copy of one of the most informative books in my library. My uncle was a general practitioner in a small town in Warren County, Illinois. In other words, a typical small town house-call making family doctor of yesteryear.
Below, taken directly from the Wild Rides and Shiny Dimes book are some informative insights how regulations, out of control lawsuits and general micromanagement of our medical professionals has chased people like this doctor out of the practice.
It was not common for people to have medical insurance to pay for their medical care 50 years ago.
“Farmers, sometimes paid their bill with sweet corn, tomatoes and other produce.”
What a coincidence! It was 1961 when half-way around the world the national social insurance was established in Japan. We were basically on the same street at this point in history. His daughter, who went on to become a psychiatrist at the famed Mayo Clinic in Minnesota recalls instructions he gave her. “A colored farmer would come to the back door of the clinic with produce. Presumably, he was not literate and she was to write his name down on a piece of paper so her father could adjust his bill for his medical treatment. As he was an older gentleman, it was assumed that was the way he was raised using the back doors although the front door was more accessible.” Fortunately, there wasn’t any mention of livestock being brought to the back porch.
Uncle Glenn began his medical practice delivering babies, setting simple fractures, giving anesthesia, performing minor surgery and assisting in major surgery. Some years later, he had to give up obstetrics when a specialist came to town. The malpractice insurance rates made him drop fractures that had to be reduced. If the fracture was on that a cast could be put on and did not need to be reduced, he could still do that. He also decided to drop minor surgery for insurance reasons. The final years he practiced, he did not even assist in surgery because of the insurance costs.
The final two years of practice they did so in arrangement with a hospital. Up until that time, all the doctors were independent.
He did not really want to retire at age 65, but his malpractice insurance was due to run out. Things by that time had really begun to deteriorate with the new government regulations. It became very frustrating to comply and to understand the regulations. To ensure doctors complied, a very severe sounding penalty was attached. So every time you do something wrong, it is $5000 and five years in prison. Even if the nurse makes the error, it is hanging over their heads all the time. There was always the fear of lawsuits.
After my uncle retired, his partner, another good doctor thought he would continue. He only lasted six months. The system had successfully removed two good doctors who just wanted to help people get well.
Today, the two countries could not be farther apart in serving their patients. Although advances in medical technology have moved forward at rapid pace, making care accessible to all has not. In the United States, the working poor are particularly excluded from affordable care. The truly destitute can get free medical care through programs and charities. Believe me, if you have ever visited Rockford, Illinois there are more than a few destitute people. The rich can pay for the large insurance premiums. The middle class and those who are working two jobs are increasingly left without affordable health care options. Japan, on the other hand has maintained its system for universal coverage for all. Even as a traditional fiscal conservative, I am thoroughly enjoying my “socialized” medical care in Japan. I had mini-stroke in 2009. Lucky for me I was in Japan and six months of blood-thinning medications and monitoring did not destroy my livelihood. I paid less out-of-pocket for a damn stroke than I did in 2008 for a dental abscess with Aetna Insurance from my employer. I had to pay my co-pay out-of-pocket insurance back to the hospital in installments. Let’s face it. We wrecked our system in the United States. I have no choice but to support Obamacare after experiencing what I did. They do have to remove stupid stuff from the Affordable Care Act, however. I vehemently oppose provisions for birth control and abortions that may be funded with tax payer dollars. As a practicing Catholic and an American, I expect my religious freedoms not to be trampled on. After all even in Japan these provisions are not covered. I hope both the conservatives and the liberals learn not to put polarizing items in something so important as basic health care.
A final point worth mention. Today, America’s hospitals are increasingly being operated by health care corporations with obvious financial incentives to overcharge and over prescribe pharmaceuticals. Across the ocean in Japan, hospitals remain firmly in control of doctors and only doctors. I ask you which system is working better?
I will return to the United States, and assuming this debate won’t be settled, I have a plan. Should I be catastrophically ill, I will pump myself up with whatever drugs I can get over the counter at the local Walgreens or CVS pharmacy. Then, I will board a plane in a semiconscious state bound for Japan.