Friday, September 25, 2009

If I had to Choose Between Current US System and Current Japanese System...I Would Unequivocally Choose the Japanese System

"I’ve been living in Japan for over four years now and my experiences with the Japanese health care system have been universally positive. During my first year in Japan I was covered by the Kokumin-Kenkō-Hoken 国民健康保険 (national health insurance — i.e. “the public option”).

Since I had no registered income in Japan for the year prior to signing up with the national health insurance system I ended up paying the absolute minimum amount (the amount you pay into the national system is calculated as a percentage of your previous year’s income). I ended up paying 18,000 yen for a year’s worth of insurance, or the equivalent of around 180 U.S. dollars. This allowed me to see any doctor I chose with no limitation on consultations or on treatment. Of course, there were co-pays involved depending on the services that I needed, but these were so incredibly low as to be practically non-existent. For example, a consultation with a doctor would run me between 300 and 700 yen (three to seven U.S. dollars) and a two-week prescription for antibiotics might end up costing about 1,500 yen (about fifteen dollars).

In my second year of living in Japan new rules came into place and I was required to sign up with the insurance program offered by the university that I work for (supplementary insurance is available if you feel that the university insurance is insufficient). Now I pay somewhere between 100 and 300 dollars a month for my health insurance (I’m not sure exactly what the precise amount is since it’s taken out of my paycheck automatically and it doesn’t make enough of a dent in my earnings for me to spend very much time thinking about it).

As with a great many employers in Japan, the university that I work for requires its employees to take an annual medical exam (at no expense to the individual). This exam includes a host of standard tests (urine, blood, etc.), as well as a mandatory chest x-ray for teachers (tuberculosis is a problem in Japan, as is lung cancer). What this means, of course, is that doctors are able to offer preventative medical advice about lifestyle choices based on the readings they get from your annual exams, in addition to the obvious benefit of catching medical problems early enough that they can be dealt with at the stage when treatment is most effective — i.e., before symptoms escalate to the point of an emergency room visit.

Here's a more detailed account dealing with a sinus infection that I had: I came to the hospital with no appointment and was directed to the ear-nose-throat specialists. I did have to wait almost two hours (luckily I brought a book), but I was finally seen by the doctor who checked my sinuses, sent me for an x-ray to confirm that I had a sinus infection, and then prescribed antibiotics for me. The total cost out of my own pocket? About 3,500 yen, or 35 bucks in U.S. currency. I had a followup appointment the next week. I had to wait for about 15 minutes, the doctor asked me how I was doing and checked my sinuses again, saw that the medication was doing the trick, and sent me away. Cost? 300 yen (about three U.S. dollars).

Since I’ve been living in Japan I’ve had nothing but good experiences with the Japanese medical system and even though I have had two waits of longer than an hour, I was still able to see the doctor on the same day without an appointment and get the treatment that I needed. On the days when I had made a prior appointment I was able to see the doctor within 15 minutes of the appointed time (comparable to the States, except for one time in Berkeley when I was left waiting in the examination room for about 45 minutes before the doctor showed up). My visits to the doctor are unconscionably cheap, the doctors are always nice enough (though it’s true they don’t spend a lot of time with pleasantries), and they’ve listened to and addressed my questions. Whenever I’ve had medicine prescribed it’s been cheap and done the trick. When friends from abroad have come to visit they’ve had similar experiences (including being amazed at the incredibly cheap doctor bills). I have had the proverbial three-minute doctor visit (which was indeed a blunt instrument), but it worked —prescription given, problem solved.

Let me be absolutely clear — If I had to choose between spending the rest of my days with the Japanese health care system as it stands now or spending the rest of my days with the U.S. health care system as it stands now, I would unequivocally and without hesitation choose the Japanese system."

Trane DeVore
Kansai, Japan

Saturday, August 15, 2009

The Japanese Receptionist Apologized for the High Costs

I have Diverticulitis which sometimes becomes inflamed and I have to go to the doctor to receive antibiotics. The pain subsides within 24 hrs and disappears after about three days. My last problem with it occurred about 4 yrs ago.

Well, while I was visiting Japan a couple of years ago with my Japanese wife, it became inflamed and within 24 hrs I developed a slight fever and knew I would have to go see a doctor or go to the hospital. I was a little concerned as I had no national health insurance, but it had to be done regardless of the cost.

My wife called a doctor in the neighborhood and an appointment was made for an hour later. It was a Saturday morning and I figured it would probably be crowded. I had not received medical care in Japan since the 80’s when I was living there full time and, not knowing the present cost without insurance we took 60,000 yen (about US$600) with us as, in the US, with no health insurance the cost would probably be at least $200 if not more.

We walked the 10 minutes to the small clinic and upon entering, after removing our shoes and using the slippers (pink for females, blue for males) I was amazed that there were only two patients there, an elderly gentleman and a woman with a baby. Surprising for a Saturday morning as in the US on a Saturday the offices are booked solid and one must wait at least an hour over ones scheduled ”appointment”. The nurse behind the counter took my basic information and asked that I take a seat and said the doctor would see me shortly. Unlike the US there were no pages and pages of info to fill out for a first time visit.

Within 10 minutes the doctor called us in and I noticed his diploma on the wall from Tokyo University. I explained my situation to him in Japanese with help from my wife and what kind of penicillin I usually take for the symptoms. He understood what I was talking about, checked his computer for reference and asked that I lie down. Locating the pain on the left side of my abdomen he asked that I take a urine test. I left the cup on the counter in the restroom and as soon as I returned to the room he said that my urine was ok. Now that was fast!

He said that he would give me a 5 day prescription for antibiotics and pain killers and that if the pain did not subside within 24 hrs that I was to return. We went to the counter and we were given the medicine right there! No pharmacy to go to! Our bill was calculated and it was presented to us.

To my astonishment the total bill for the visit, urine test and two prescriptions was 4,610 yen!! Approximately US$38 at the then exchange rate! And that was with no National Health Insurance! My wife and I looked at each other with wide open eyes. I asked her if this was the normal cost and she asked the nurse. Yes it was and they apologized for the cost with my having no health insurance! Unbelievably reasonable in my opinion and there was no need for them to apologize if they knew the cost of such a visit in the US. It was way lower than either of us expected. Had I been living in Japan it would've cost me about US$7 - $10 for the visit under their health care system.

I calculated the cost of what this would have cost me in the US WITH insurance. The co-pays for the doctor, urine test, and two prescriptions at a pharmacy would have come out to about $60 and, with no insurance the cost would have been at least $200! This just goes to show how unreasonable medical costs are in the US.

Anyway, within a couple of days I was fine and my visit to Japan was not interrupted at all as I was still able to function thanks to the pain killers and had a wonderful time during the rest of my visit. I am very grateful that in Japan you are not ripped off for emergency medical care even if you have no health insurance!

Therefore, if you are visiting Japan and become ill, don’t fear that it will cost you an arm and a leg if you have to receive emergency care as the costs are very reasonable to one without insurance.

It's funny how many of the major pundits never mention Japan's Single Payer System and how successful it is. Rather they point fingers at the UK's and Canada's bad systems. In Japan anyone can go to any doctor or hospital at any time for any test or surgery or care. In Japan's system no one is turned down due to pre-existing conditions and everyone is required to participate and the monthly premiums average around US$250. THE per capita cost in Japan to the government is around US$2,500 whereas in the US the per capita cost, with the present system, is over $6,000!

Would such reasonable and affordable care happen in the US with a national health care system and the prices be so affordable? I think not as the US system is designed for profit whereas in Japan all prices from major surgeries to prescriptions to the number of stitches is set by the Japanese government every two years and hospitals must be not for profit. It would, in my opinion be a disaster in the US. The US must go slow on this and all congress people should be required to read the bill before it is passed. If not it will cost the US and their people trillions and will fail. Besides, the system is too corrupt in the US for it to be a success as the majority of our government is bought and paid for by the pharmaceutical industries and the insurance industries IMO. It's doomed to fail unless the people are vigilant and ensure that a reasonable system is enacted and where the average person can read and understand the bill now before congress!


Americans Who Can't Go Home Because of Health Care

Can't Go Home from Turtlebox Productions on Vimeo.

Cost for care in Scotland was zero

I'll make this short. Our daughter suffered for years in the United States with an undiagnosed case of Myasthenia Gravis. Her doctors, including a neurologist in New York, failed to diagnosis her disease and dismissed the symptoms as psychosomatic. Mind you, the symptoms, as we learned later, were classic for a young woman with this admittedly rare disease.

After moving to Scotland to start a Masters program, she could finally no longer swallow reliably or talk for more than a few minutes before her muscles no longer worked. After receiving no useful care at an emergency room, she went to see our local GP who referred her to the local teaching hospital. There, based on nothing more than a conversation and superficial examination, the UK equivalent of a new resident correctly diagnosed the disease. Since then, she has been hospitalized for a month, given two very expensive courses of IVIG treatment, and had her thymus removed in major, open chest surgery. Thankfully she is now much better and about to head off for a Ph.D. program in England.

Recently, we flew back to New York to consult with perhaps the world expert on Myasthenia. After reviewing her symptoms and treatment he declared that the doctors in Scotland were doing all the right things. He then asked how much this cost. He had a bit of a hard time understanding that the cost was exactly zero. By the way, I spent about two months paying various bills associated with that one visit to his office. Quite a contrast I'd say.

Is the system in the UK perfect. Of course not. Did they provide superlative care for our daughter. Absolutely.

New York

Wednesday, July 1, 2009

Some Comments on French Health Care System

I just thought I'd put in my two pennies worth about the French system of universal healthcare.

In fact, I am a person who avoids doctors like the plague and only seek medical care in an emergency. Even so, I'd much rather be in France than in the U.S. when that emergency happens.

Medical emergencies
In 25 years, our family has only had two major emergencies and in both cases, the medical care was exceptional and cost us nothing. The first was when our 5-year-old daughter caught her foot in the spokes of my bicycle while in the carry-on seat. She almost lost her heel. The neighbor rushed us both to the emergency room of the nearest medical facility, a private clinic. We were met by a surgeon and she went straight into the operating room. We both stayed in a private room for a week. I had a cot in her room, could stay with her 24 hours a day, and had meals in the room with her. All we had to pay was for my personal telephone calls. Everything else was covered between social security and our teachers' mutual insurance. To this day, whenever any medical person sees her scar, they are amazed at the terrific job the surgeon did - she was within one centimeter of losing her entire heel.

The other occasion was when the coffee machine exploded on me and burned both hands and arms up to the elbow. Again I rushed to the same medical facility, was met by the same surgeon, and received instant top care. Again it cost us nothing. In fact, we then contacted our mutual and asked for household help, because I could not use my arms or hands. That same day, a specialized caregiver arrived on our doorstep, and was there to do anything that needed doing -- housework, meal preparation, driving.... She came every day for three weeks, until the burns were fully healed. Today I have no scars whatsoever, although at the time, all the flesh of my inner right arm had disappeared....

Giving birth
The French system has positive and negative points. One is that because everything is free, people tend to go to the doctor on the slightest pretext. They are also heavily over medicated. Each time I was pregnant, I was required to have an examination every month, plus an ultrasound at four months and another at 8 months. These experiences were traumatic for me -- they felt like a violation of my privacy and not necessarily good for the child. However when it came to delivery, I, like every other woman here, was kept in the hospital or clinic, for a full week after giving birth, and again, at no cost other than my phone calls. I have been told that in the U.S. costs for staying in the hospital just overnight after giving birth are astronomical.

Mental Health
When discussing medical coverage, we need to include mental health. When close relatives have needed mental health care, they have been able to walk straight into a clinic, and receive counselling, therapy, and psychiatric care at no cost. No identity papers had to be shown, no forms filled out. The care continued as long as needed.

Alcoholism is treated as an illness. One member of the family went to his doctor, confessed the problem, and was sent to an alcohol specialist who treated every aspect of the problem -- physical consequences, addiction, psychotherapy. If necessary, the person would have been sent to a reatreat -- however in this particular case, other solutions were found. The entire attitude towards alcoholism was very enilightened and effective -- and the person was charged nothing.

Similarly, when another member had a mental breakdown, she was able to go to a psychiatrist in a socio-medical center and follow therapy without ever laying out a dime or filling out a form or even showing an id card.

Pros and cons
The French social security system is much more comprehensive than anything in the U.S. The way it is financed contributes to the economic gridlock of the country, because social charges are so high that employers can't afford to hire additional personnel. Furthermore, the employer has to pay these charges whether or not s/he has had any income at all. This problem is being addressed in a variety of ways, as the government tries to find more flexible means of financing social care. In terms of medical and mental health care, as I mentioned, people tend to abuse the system -- going to the doctor for a sniffle, overmedicating, and not taking responsibility for their daily life.

Nonetheless, as I stated in the beginning, I'd rather be in France in an emergency than in the U.S. Furthermore, healthcare and a wide variety of childcare facilities were major reasons for staying in this country when the children were small.


Don't Believe What You are Told by Republicans

An American in France responds to a CNN story about Health care.
It starts with this:
"As an American living in France I speak about government health care based on experience. Don't believe it when you're told you won't be able to choose your doctors or treatment."

Watch the video here

Blog posted by Linda
Video by Sally in Paris

Friday, May 29, 2009

Prostate Laser Surgery for the Equivalent of $1500

I'm a permanent resident of Japan and therefore am an automatic Japanese National Health Insured Payee; I had the latest laser surgery (as per date of surgery) for prostrate complications, for around $1,500 on February 5, 2008. Period!!!!! It's called HOLEP.

I've researched the internet and wasn't able to come up with the costs in the US, but I do recall it cost almost $1000 alone to get checked in NY. And people who are familiar with this procedure are well aware that $1500 would barely cover the room costs in the US.

PJ Johnson
New York

Tuesday, May 19, 2009

Why Make Life Worse for High Risk People

I feel that in the United States there is a general tendency to be more nervous about the government trying to "help" with health care support than one really needs to be, and those of us living outside the United States in countries with government-supported health care plans which are really helpful do have some insight into how useful such programs can be.

I retired a few years ago, and am now receiving a state pension from Austria as my main source of support - after having paid into the system for more than 30 years. (The minimum for receiving an Austrian state pension is 15 years - which I exceeded by more than a factor of 2.)
The Austrian state pension is very generous if compared to some countries like the United States, but I presume that you also pay much more into it during your working years.. (This is basically a good idea, I think.)
Being retired and receiving an Austrian state pension, if I were to be living in Austria (including perhaps certain other EU countries as well), I would still be eligible to be participating in the Austrian National Health Insurance.. But, living in Japan now more than in Austria I am not currently eligible to be in the Austrian National Health Insurance program. I am eligible however for the Japanese National Health Insurance program, which I have joined.

The impression I have is that with the National Health Insurance plans,
"everybody" is eligible, irregardless of whether you have the "bad luck" of falling into a high-risk group or not. But, when there is no National Health insurance program, and you must get health insurance from a "private" group, or have none at all, these companies may well discriminate against high-risk people, and they may be left "out in the cold". These people are in an "unlucky situation" anyway, and to make the situation for them even harder, that is something one should want to avoid somehow, if possible. By including a substantial fraction of the entire population of the country in a National Health insurance program of some kind, one can spread the risks over a very large number of people, so that individual people do not need to be "singled out" for difficult situations.
This is even more true in countries with large populations like the United States.

Jim McNaughton

Moving Abroad for Treatment of Genetic Illness

Several years ago, a reporter told my story in the WSJ ( about how my husband was fired (and later rehired when I was now pre-existing) when I started showing signs of a genetic autosomal dominant disease. We have a self-funded health plan through his employer. My husband was a die hard believer that the USA is best in everything, esp. health care, since his father was a doctor until he died in the early 1990's. When we lost our care, and I started going downhill fast, I suggested we go to Belgium and see what kind of care I can get there. I must add that I was previously married to a Belgian, lived there for a while and became a citizen. We went, talked to the leading geneticist in the world for the disease, and got a game plan for treatment--all for free. My husband cried. We are now trying to sell the house here in CO before I die. I am already becoming very ill, but we need the cash from our home in order to move. I was featured on a Flemish TV show as an example of how health care is issued in the USA. Also, I corresponded with several high school students in Belgium about how poor the US system is, even for those who have insurance when they get ill. I write to Obama, Max Baucus, etc., daily because this madness has to stop.

Please pray that our home sells so we can move. My Ehlers Danlos syndrome is getting worse. I can hardly walk. I was able to qualify for a free colonoscopy (when my husband lost his job. We had to pay the medical bills our insurance reneged on, we were close to being destitute and lived on my husbands unemployment and what aluminum cans my then 11 year old could pick up). The doctor doing the colonoscopy said he did not believe in Ehlers Danlso-he said it was what people who bend a lot think they have. After the colonoscopy he thought I belonged in a hospital because my colon tissue was so fragile he wondered how it still held up, and because my colon had no structure and was falling apart. He asked me never to come back to him because it took him 3x as long to do the procedure since he had to be so careful and go so slowly. He said, I don't know what is wrong with you, but is is not good.
Can't wait to sell the house and move.

Thanks for all you do for the movement of HR 676.
Barbara Calder, dying in Colorado Springs, CO

Tuesday, April 14, 2009

We Urge the US Government to Implement Universal Health Insurance

My wife and I have a Japanese national heath insurance, which covers our basic needs with about $650 a month. It includes basic dental cares as well. It makes us feel secure since we are getting old. I am 61 and my wife is 48. So we urge our US goverment to implement some kinds of universal health insurance now since we get back to the US in a few years.

A. Kishida
Orange County, California

My daughter's ER care was free

On Thursday night, April 9th, 2009, my daughter (9 years old) spilled boiling water on her foot. Since I was not sure of the severity, we took her to the local hospital ER and were seen by a doctor within 20 minutes (fortunately, it was not so severe). Since we had also registered the children in advance with the city (and received the papers stating we had done so) I just had to show our insurance card and the preregistration for hospital care. Her treatment was free. We were given a letter of introduction for a local clinic to follow up her care the next day, and that examination and treatment were also free. We were told to return after two days for another examination and treatment at the clinic--again free!

There is absolutely nothing to be afraid of in changing the healthcare system in the US! It will only benefit the thousands of people who don't have access to it in the present situation.

Brooke Yamaki

Coming from a Conservative Family, I was Suspicious of Universal Health Care

As an American citizen, I know how it is in the states. During college, I was slightly covered by the university's student insurance plan, but when I actually needed it, it only covered a part of the costs, and I found out how little when I got the bill. I could have bought a nice car for the price. I had to use my student loan money to pay it off.

After University, I tried my hand at working independently. But with the plans being confusing and requiring a separate university degree just to understand what I was supposed to be choosing/paying for/ and getting, it isn't any wonder that I gave up on trying to be insured. I just tried to keep myself healthy and rely on over-the-counter medicine.

Then I came to Japan. While working for the government, I was first introduced to the universal healthcare plan. I admit, having come from a conservative family, I was suspicious of this system. It certainly took a large chunk of my salary, but once I was familiarized with the ins and outs of it, I grew to respect it. To be fair, I will list both the bad points along with the good points.

Bad point 1: senior citizens, who pay almost nothing for a visit to the doctor, will go to the hospitals almost every morning to get looked at for whatever ails them. However, it should be noted that there are a growing number of small clinics connected in some way to the larger hospitals, and so people can go to the small clinics, see a local (read as family) doctor to get a first look, then if needed, get a referral to a doctor in the major hospital, jumping to the head of the line when needed.

Bad point 2: Dentists here are all about painless dentistry. that means that each visit will be a week apart and last for 10-15 minutes. This will continue for 3-5 visits depending on what is needed. The first time will be about 1500 yen, which includes X-Rays, and subsequent visits will be about 6-700 yen. Detractors will say this is evidence of the dentists milking the system, but the visits are truly painless. Unlike when I had a cavity filled in my homeland of the U.S. I was given 2 hours of excruciating pain as the doctor jabbed, drilled, filled, etc. then had to deal with a lot of pain when the local anesthetic wore off. To make matters worse, the filling came out not 3 days later, and I had to pay another 80 dollars for the dentist to put it back in... (dentistry wasn't covered by my u.s. insurance at that time). I have had a root canal, and 2 different cavities filled while here in japan, and the price hasn't changed one bit.

Good Point 1: Children are free. Depending on which prefecture you live in, the government gives a subsidy in cash every 4 months to care for babies through to elementary age. And the medical visits for children to pediatricians is 100% free. that includes the medicine as well. That also includes all the shots and check ups that babies need to become immunized. All free.

Good Point 2: Medical expenses are refunded. Go the hospital in Japan? Save the receipts if you are living here, and when you go to pay your taxes, submit a form with the receipts and whatever wasn't covered by the insurance (which covers about 90% of any medical fees and medicine fees) can help land you refund money.

Good Point 3: no paperwork. Seriously. I was SOOOOO tired of filling out requisite forms in the U.S. for my insurance company I initially used when I arrived in Japan. Here I get a card. I give the staff my card, and they give it right back when I am done. That's it. I don't have to get a doctor to write forms in triplicate.

Good Point 4: The prices don't change. The premiums are the same every year. They don't change as a result of having used the insurance. Here is a negative example of what happened to my father in the States. He had a problem that required him to stay in the hospital for a few days. He remembers only receiving two asprins for pain during his entire stay. Yet when he got the itimized bill, he found that they charged him for having supposedly received pills every hour for the entire time he was in the hospital. Yes, that's right! They charged him for apparently taking hundreds of pills that never entered his room let alone went down his throat. When he told his insurer about the fraud, they told him there was nothing that could be done. They would still raise his insurance premium for having used the insurance at a hospital and cost them so much. As for the hospital overcharging him, that was explained away as the way hospitals operate nowadays. when
someone doesn't have insurance and comes into the ER, people who have insurance are charged for their medicine. The insurance companies raise the rates of the people paying money for their insurance and don't do much to stop the hospitals unless too many people complain, and then they just stop allowing their customers to use their insurance at the hospital. They don't do anything to stop the fraud itself. So in the states, those who pay for insurance pay more for paying for those who don't pay anything for their visits to the ER. Wouldn't it just be better if EVERYONE was covered, and the rates stayed the same regardless of who used them or how much was needed?


Lining up for Great Care in Japan

I have been in Japan for 1 1/2 years and have had nothing but positive experiences with their universal healthcare system. When I got sick with a sinus infection last year for the first time, I went to see a foreign trained doctor that does not take Japanese health insurance. I was given a bill for over $250 that I submitted to my medical insurance company in the United States. I have never heard back from the insurance company about my claim although I know that it would have been excluded or applied toward my deductible anyway. The doctor had not given me antibiotics even though I needed them. I suffered for a few weeks until I got better. A couple months later, I became ill with the same symptoms and this time I went to a Japanese clinic that was recommended to me by a friend. It was a modern facility that most Americans would be impressed with. It was very efficient with me lining up to sign in, me lining up to see the ears, nose and throat
specialist, me lining up to have my airways cleared by a ventilator, me lining up to pay and me lining up to get my medicine including expectorant, antihistamines, and antibiotics. The doctor spoke fluent English, it cost around $20 which included the medicine and took about one hour with no paper work to do or bills to pay later.

Next time I went to the same clinic to see someone about a uninary tract infection. I had no appointment and lined up that morning at the front desk where I was asked what my problem was. Soon thereafter, I was told to line up outside the specialist's office. I had another positive experience and it took a total of about one hour and cost less than $20 which included medicine and a lab test.

In October, I had a routine gynecological check up and I felt the equipment used was of a much higher caliber than in the United States with a robotic motorized table that rotated so that I would not have to scoot down to put my legs in the stirrups and the use of ultrasound to look for the presence of tumors - the was a routine procedure. Again, my doctor spoke English fluently and the care was superb. It cost around $15.

Then I saw a dentist recently for a chipped tooth and cleaning and it was covered as well under universal healthcare in Japan. The dentist has a PhD in the United States, during the cleaning the dental hygenist used an ultrasound descaler which made it much less painful, and I was charged $30. Can't beat that.

We are now in a position that we are thinking of not returning to the United States to live because of the cost of medical insurance and care since we are getting older and the cost of private medical insurance after retirement and prior to qualifying for Medicare will be prohibitive. I never thought that the USA, the land of plenty and the greatest country in the world would have an citizen like me who now must choose to not return to her homeland in order to receive better and less expensive healthcare.


Some reasons why national health care is necessary

Some reasons why I think national health care service is necessary:

* it supports preventative care which actually cuts down on costs in the long term
For example: I believe the annual health check up offered in Japan is very important for all people.
I have gone to a local clinic for the complete check up most of the years I have lived in Japan.
For a small fee you can get screened for lunch and stomach cancer, have your gyno health checked, get blood and urine tests and have a general consultation as well as a separate consultation on weight and diet control.

* weight and diet control-- many people in the US could use such "metabolic syndrome" support service. In the US it is politically incorrect to criticise people's weight, but the reality is Americans suffer from many illnesses (diabetes for example) because they do not take care of their health. I think an annual check up with professional support would help people develop better habits over time.

One example of when I realised it was good to live somewhere with national health care service:
In 2001, I had heart palpitations while on vacation in the EU. I did seek help there and even though no trouble was found I decided to seek care when I got back to Japan.

After a visit to the hospital and consultation with a GP, I was able to get an appointment with a cardiologist. I went to one of the leading heart clinics in Japan, and got this appointment within about 2 or 3 weeks. It only took that long because all my tests were normal.

I spent almost a full day there getting al types of tests and was able to get most of the results before I left.

I had blood tests, urine tests, an EKG, an echo test, Xrays and physical endurance test besides the doctor's consultation 2X. Although I complained about it costing me about US$200, when I got home I looked into what it all would have cost in the States and was shocked. It all would have been way more than that and I would have had to wait much longer to get the appointment without the proper introduction.

Let me also share the blog and comments of a dear friend of mine who died on June 13 2008. She kept track of the cost of breast cancer treatments only for 2 years. She recognized that she had such good health coverage because she worked in the health care field. I would like to share her blog entry "Ka-ching! Put it on my tab (updated)" ... it says a lot in its short outline of 6 weeks of health care costs:
to get really upset at costs check out her 5 month cost listing

Sarajean Rossitto
Living in Tokyo and Shizuoka City, Japan
US address: New York, New York

Saturday, April 11, 2009

The benefits of social health care outweigh the costs

When my children were under six years of age, we lived in the city of Yokohama in Kanagawa prefecture. All healthcare for them was covered under the national healthcare. I did not have to pay for any of their health checkups or immunizations. Even in emergency situations, the copayment fees were so incredibly minimal, it was as if we didn't have to pay (I recall paying, at times, less than $5). I have not confirmed this news, but have heard the government wants to have free healthcare for all children through elementary school. Nice thought!

Even now, for the THREE of us to have a regular dental exam and cleaning, costs a total of approximately $60.

I can't imagine returning to the United States and losing such great healthcare support. The benefits of social healthcare definitely outweigh the costs of so many people not even having any healthcare at all.

Brooke Yamaki

The system works well, and I'm living proof of it

Four years ago I was diagnosed with invasive breast cancer. While I have lived in Japan for over 25 years and it is very much my home, the thought of undergoing treatment for a major, life-threatening illness abroad was something I had never contemplated and admittedly it was terrifying. However, I quickly learned that I was in the best of hands. The standard of care I received throughout the year-long process of surgery, chemotherapy, and radiation was equal to or better than what I would have received had I been living in the U.S. The period from diagnosis to surgery was fast, and there was never any question of access to the latest treatments and therapies for my form of the disease.

Because I am self-employed, my type of Japanese national health insurance covers 70% of the cost of any treatment with a 30% co-pay. This 30% is minimal for normal doctor visits because the cost of the visit is so low from the start. I did not know what to expect in the way of costs for major surgery and chemotherapy though. I had heard horror stories of single chemo treatments costing $4,000 in the U.S. However, I consistently found that the costs in Japan for the identical drugs and therapies averaged 70% less than the costs in the U.S. Hospitalization costs were closer to 90% less. Further, the Japanese system has several built-in safety nets to help families through catastrophic illness. Whenever the total co-pay for a family exceeds 65,000 yen (approx. $650) in a single month (under the rules four years ago), the insurance system steps in to pick up a larger percentage of the cost. I had several months where I exceeded the limit and each time I received a refund. The system also makes the cost of health insurance, all medical treatment, and the cost of transportation to and from the treatment tax deductible. Thus, what you do not receive as a refund during the year, you get back in a tax refund at the end of the year. Thanks to overall lower costs, an all-inclusive health insurance system, and these safety nets, my family and I never had to worry about the financial burden of my illness and were able to focus 100% of our energies on my recovery. The system works and it works well. I am living proof of it.

Marjorie Dewey
Chiba, Tokyo
Whiteside County, Illinois

The health care system in Japan offers safety, quality, and security

I have lived in Japan off and on for close to fifteen years and for most of that time have been covered by the National Health Insurance (now, at the university where I work, I am covered by a slightly different socialized medical plan that is union-based). I pay 30% deductible. In all these years, I have found this coverage to be nothing but a source of relief and peace of mind. Many people back home in the U.S., and this includes myself when I lived in Virginia and California, are at some times in their lives without insurance, which means they cannot afford basic preventative medical care much less necessary treatment. Indeed, it is only now AFTER having had coverage under Japan’s national plan that I truly understand how lax the U.S. is and no longer see it as “the way things are” or have to be; actually, I am more fearful of returning to the U.S. where basic health care is not considered a fundamental right of citizens. Here, when my husband broke his toe in a minor accident one night, the ambulance came within fifteen minutes. They took us to a nearby hospital where he received immediate, excellent treatment after hours, including seeing a doctor, getting X-rays, and having a splint put on. All in all, less than $50.00. His follow-up care was personal and complete, inspiring his confidence to go there for all his medical needs in the future. In my case, five years ago I discovered that I was losing vision in my left eye. I went to a university teaching hospital where I had it looked at by a professor and doctor of, it turned out, the highest quality in the country; in the following weeks, I would have surgery on my eye to have a scleral buckle put in to prevent further detachment of my retina and potential blindness if I had not received immediate attention. My care was the best from start to finish, as was follow-up and results: my eye is now better vision-wise than it was before the operation and I have had no problems with it since. I shudder to think how I might have put off the crucial, initial examination of my eye if I had been in the U.S.
Admittedly, as foreigners, we sometimes get special attention or treatment, I think, in Japan, but in comparing my care with my Japanese neighbors and those in the waiting room or my hospital room I always hear and see how they take for granted their nationalized medicine. Consequently, their complaints about having to wait or not being able to make appointments or the like are the complaints of those who are invested in making their system work better, not of those who want to change to a system such as we have in the U.S. Is there anyone from any country who would prefer that? I would find that hard to believe, unless he or she were someone from a country without any health care at all – but then again, in that case, the U.S. can be said to be in effect on a par with a country that offers no health care, even if it has great doctors and facilities. It has health care only for those who can afford it, it seems, in too many cases.
How did we reach this point of such patently unpersuasive, false arguments about “socialized medicine” in violation of our “capitalist” society, thereby losing sight of the democratic aims voiced in the Preamble to the U.S. Constitution, one of those aims being, you will recall, that the government will “promote the General Welfare” on our behalf? What is included under “the General Welfare” if not basic protection and promotion of health care for all citizens? If other countries can do it, why can’t we? Although Europe is in recession just as are we, its citizens feel it less thanks to its safety net systems. Let’s argue about which safety net system, not to have one or not! Universal health care works under capitalism, is not without inconveniences such as waiting and bureaucracy, and it is certainly not “free,” as we can see in Japan. Despite its imperfections, as imperfect as democracy itself as we strive to improve our country for the benefit of all, the universal health care system in Japan offers safety, quality, and security that I would take any day over, well, nothing – which is what the U.S. offers too many of us all the time, or at least at that some point in our lives when we most need it. My deductible two cents.

Mary Knighton
Tokyo, Japan

Thursday, April 9, 2009

Breast Cancer care in Japan

I’ve been living in Japan for 26 years and am on Japanese health care insurance through my husband’s company. Seven years ago, when I was 44, on a routine mammogram, breast cancer was discovered. I had gone for a routine mammogram every year, for about $30 each time. A few times, something was expected, but through needle-point biopsies, nothing was discovered. This time, I was in an early stage of cancer, but needed a lumpectomy. I wasn’t satisfied with the first hospital, so I had two other second opinions and chose the best hospital in Japan, and fortunately, the best surgeon connected to it. The surgery was performed and a 4-day hospital stay in a private room cost us only about $2,800. It would have been more than 10 times that if it had been in the U.S. A friend of mine had the same procedure, and I think it cost her over $50,000 in the U.S. (She didn’t have American insurance.) I went to Tokyo monthly for hormone treatments to stop my periods and had radiation treatments at a local Cancer center for 5 weeks. The treatments including Tamoxifen that I was on for 5 years, cost me only about $100 per month because of the insurance.

Japanese insurance, and the ease of just showing our insurance card with the country taking care of the rest, made it inexpensive and very easy for me to get the treatment I needed. We could not have afforded the treatment that I got, and check-ups I continue to get, AND at one of the best hospitals in the world, if we hadn’t had Japanese insurance.

Vivian Morooka
Chiba, Japan

My first reaction to "socialized" medicine was negative

When I was 11 I moved with my family to France. My first reaction when I heard the phrase "socialized medicine" was negative, since I had heard of socialism only in negative contexts in my US public schools, but I noticed that my parents were thrilled by the affordability of medical care. When we moved on to Africa one of our extended families' main concerns was of course our health, but for expatriats living there, the care at top notch hospitals in Nairobi was excellent and very affordable. I did not have much first hand experience of the healthcare system during my 6 years there, but I visited others and witnessed the care they were given and their satisfaction with the expertise and facilities offered for excellent prices. I found myself thinking that if I ever needed a major surgery when in college in the US, that I would seriously consider a trip back to Africa for the care and service offered by the hospital. Although the flight itself would be pricey, it would surely be a better option overall. The irony of this thought was not lost on my teenage mind.
In the previous 5 years I have mostly lived in Japan, and been covered by the national insurance program for very reasonable fees. Whenever I have been sick I have gone to the doctor and received excellent treatment and follow-up. I am always amazed at the price that I pay when I leave... so low! My only health concerns come when I travel back to the US. I am uninsured there, and I worry what I would do if I had an accident or fell sick. I certainly think twice before I go to the doctor in the US, but I don't hesitate to make a visit when I am sick in Japan. Ever since my first experience with socialized medicine in France I have dreamed of a day when the US put such a priority on keeping all its citizens healthy. I do hope that I will live to see the day that it becomes a reality! There are many good models to follow so we should pick the best of each one to make a great American healthcare system!

Friday, April 3, 2009

We can't understand a developed country without universal coverage

Healthcare in The Netherlands keeps getting toyed with at the national level, so this is up-to-now. It isn't completely free unless you're below a certain income, and above that, or if you're self-employed, how much you pay depends on what kind of policy you buy. Everyone is insured. With an above average income, my insurance (worldwide medical, dental, physio, repatriation, medicines, basically whatever I need) with €150/$200 annual deductable (I chose that limit) costs €1700/$2300 a year, with my employer paying half, and me getting a group discount on the rest, so that works out to something like €50/$67 a month. That's it. This includes doctor's visits, medications, physiotherapy, even things like visits to a nutritionist or a problem overseas.

But as an American, the things you always worry about are also the larger incidents. The ones I've had would have cost more than my house in the US. About 15 yesrs ago I was travelling for work in Africa and had to be taken by ambulance to a hospital, admitted overnight, tested, followed up intensively (my insurer offered to fly me home, but I took my regular flight) . The Namibian hospital phoned my Dutch insurer, and everything was arranged between them. I never even saw a bill. I saved receipts from the private doctor I saw for the rest of my stay, and was refunded that amount when I got home.

A few years later, I was visiting in Texas and had a different problem, also involving hospitals and so on. That time the hospital had a hard time processing my foreign insurance and I did see the bills (ouch), but again was able to pass them directly to my insurance company.

Then (gee, I sound like a physical wreck) a few years after that I survived a brainstem stroke. In The Netherlands. The doctor's house call, the ambulance, the time on the Stroke unit, medications, an MRI, aftercare, excellent neurologists and nursing staff -- all paid by my insurance.

The Michael Moore movie 'Sicko' is incomprehensible here. People complain about the annual fiddling with our coverage, but they can't understand a developed country without universal coverage. They go to the doctor when they're sick. They go to physios if they need them. They see the dentist routinely. They fill prescriptions.

Linda McPhee
The Netherlands

Wednesday, April 1, 2009

Chiropractor visit costs $5

In the US, going to see a chiropractor or doctor would cost a minimum of $25 per visit, but in Japan seeing a chiropractor costs me about 500 yen (approx. $5). Seeing a doctor, well, it depends on if he or she's a specialist or not. But in general these visits are cheaper than the ones I had in the States. Also, the fact that I had a pre-existing condition doesn't seem to affect anything here in Japan.

I'm a little afraid to go back to the US, as I don't have insurance there and, if something happens, things could get complicated. In the US, my family has always had to fight with the insurance company to get coverage on anything more than a co-pay ($25)--and this was the insurance provided by the city. In Japan, there hasn't been any fighting for me thus far, and I can see any doctor I want. I don't have to check to see if he's "on my plan." My family in the US has had trouble getting the medical care they need because the doctor who specializes in such-and-such area doesn't isn't on their insurance plan.

I hope the US will give its citizens and legal residents better health care in the near future.


Tuesday, March 17, 2009

No rationing, no deductibles, everything is covered

In Japan you can go to the doctor whenever you need to without worrying about the cost. When I came to Japan it took me several years to become accustomed to this. For several years before I came to Japan I was under insured. My insurance was as comprehensive as American insurance policies get. However in order to make it affordable I had a very high deductible. This meant that I always had to pay out of pocket and I developed the habit of self rationing health care. Often I would suffer though things like allergies or sinus infections without going to the doctor. After coming to Japan gradually I realized that I do not have to do this. The co-payment for a doctor's visit is less than $10 and for a prescription it is rarely more than $10. Now I go to the doctor when symptoms first appear. I suffer less and almost never miss work.

My medical insurance in the states cost $180 a month for just me and never paid out a cent. The only time the company paid out was when I was hit by a car while riding my bicycle, and even then, they recovered what they paid when I settled with the motorist's auto insurance. But that did not stop them from rationing my care. They would not pay for all the physical therapy my doctor prescribed, so I was not able to receive all of it.

In Japan we don't have this kind of problem. There is no rationing, there are no deductibles, and everything is covered. You don't have to wait in line for an appointment or get a referral for a specialist. Your doctor does not have to get authorization from an insurance company to treat you. If you want a second opinion you just go get one as my wife did when she needed one. And the cost? My wife and I pay about $240 a month for the two of us and this will not increase when we have children. It will change if our income changes but then we will be able to afford it. I'm very happy with this system.

Michael Rector
Nagoya, Japan

I love going to the chiropractor in Japan

I love going to the chiropractor in Japan. He usually starts me off with about five minutes on a massage bed. Then, he briefly massages my upper body to help me relax before finally "adjusting" my neck and back. And if I'm in need of extra care, I can also have other treatments such as acupuncture and electrotherapy. All for a whopping 500 yen! You gotta love Japan.

Jeremy Berg

Sunday, March 15, 2009

Maternity stay in U.S. reimbursed

Although I live in Japan with my Japanese husband, I gave birth to my first child in the United States (Montana) and had some intervention. I had saved all of my hospital receipts and after returning to Japan, I was able to submit all of the bills (approximately $3200) to the Japanese Health Care system. In Japan, at that time, all births were covered up to 300,000 yen ($3000). We only had to pay out of pocket about $200. It would have cost more had I stayed in the hospital with my new baby for more than one night. In Japan, it is common for new mothers and babies to stay one week. Depending on the hospital, the price can vary, but in general, the cost runs around the reimbursement amount of 300,000 yen. I am not sure what amount American insurance covers in childbirth, but I felt we were pretty lucky to get the $3000 back!

Yamaki, Japan

Punitive system of no Medicare coverage for citizens abroad bad economic policy

As US citizens who have worked and lived many years abroad, our greatest problem related to health care is the total lack of any overseas Medicare coverage following our retirement.

Even though we paid for Medicare coverage all the years of our employment, there is no coverage provided for those living outside the US. This puts us at a great disadvantage as well as in danger of not being able to afford necessary treatment, especially in the case of health emergencies. There is also the additional cost of returning to the US for treatment or going without adequate coverage for health care while abroad.

In order to have coverage for Medicare Part B, etc,.there are mandatory reductions from our Social Security. And even though we are paying these amounts on top of what was deducted from our salaries over the years, no coverage is provided unless we are able to return to the US for such treatment.

In most, if not all cases, the costs of equivalent health services are less overseas than in the US. This is another reason why the punitive system of not providing Medicare coverage for US citizens abroad is a poor choice in terms of economic policy.

Please put this issue at the forefront in seeking improvement to the health care of US citizens residing abroad.


George W. Gish, Jr.
Tokyo, Japan

Injured in America, Treated in Japan

About a year and a half ago, I was in the United States, visiting New York City.
Coming out of a store, I stepped off a curb without looking.
This careless move resulted in a complex fracture of my right wrist, and an avulsion fracture of my right ankle.
I was told this when I went to the emergency room there.
That 3-hour visit cost almost three thousand dollars.

I was also told I would need immediate surgery, or I could expect to have a deformed hand -- a hand I may not be able to use again (I am right-handed).
I turned to my husband and said, "Take me home."

"Home" is Japan.
My local national (public) hospital is 10 minutes from my house.
I felt better the minute I got there. The young woman at the information desk is my neighbor's daughter, the orthopedic nurse is the mother of my son's former classmate, in the outpatient clinic we saw a farmer from the village where we used to live -- he tried to give us 'consolation' money ...)
X-rays confirmed that I had a Smith's fracture of the hand, and would need surgery as soon as possible.
I was admitted to the hospital on the spot -- the 3-hour surgery took place two days later.

I was ready to go home after a week, but as I could neither walk nor use my hand, I was kept in the hospital for three weeks.
The doctors said it was for my own "comfort and convenience." They asked me to "please relax, and let the nurses take care of you."
I assured them that I could function in our house without having to go to the second floor.
But they said it would be too difficult for me to get around, get food etc. while my husband was at work every day.
When an American friend asked how did they know that, I told her: "They asked me. They wanted to know where the toilets in my house were located, if there were stairs, would I be able to sleep on the first floor, and if there was another person to be with me throughout the day."

After being released from the hospital, I continued in rehabilitation for almost six months.
Twice a week, I worked with an occupational therapist for one hour on my hand, and one hour with a physical therapist for my leg.
I am happy to report both my hand and leg are back in fine working order!

The bill for all this (3-hour surgery, 3-week hospital stay, 6 months rehab) was about $2000 -- or, less than a few hours in the emergency room in NY.

Karen Hill Anton
Shizuoka, Japan

It's satisfactory and affordable

The public citizens' health insurance offered to Japanese citizens is what I/we use. It's satisfactory and affordable.

I wish Obama would consider single payer health care

I have a couple good health care stories since I first came to Japan 4 years ago but the one that sticks in my mind the most was 2 years ago at Christmastime.

(For reference I am under the Japanese National Health Care System which is a single payer system that takes a fixed percentage of my salary every month)

Two days before Christmas 2 years ago I had developed a extremely sore throat and was worried so I decided to go to my local hospital in Chofu. When I arrived I had a severe fever and I could barely swallow. I walked into the hospital and was seen by a bi-lingual physician almost immediately (maybe a 5 minute wait after showing my National Health Care Card) who examined my throat, asked when it had began and took my temperature. He decided that a throat culture was necessary and it was sent to the lab. In the meantime he prescribed a painkiller and antibiotic and asked me to come back in 2 days. While the painkiller certainly helped my throat pain, it seemed that the antibiotic was having no effect. When I went back to the hospital they informed me that I had a severe case of Strep throat and I needed a much stronger antibiotic, which was prescribed immediately.

After 1 and 1/2 weeks of antibiotics I was healthy and able to enjoy the New Years celebration (unfortunately no alcohol)!

The total cost of this treatment including prescribed drugs and lab work?

Roughly 7000 yen ($70.00)

I honestly can't imagine if the same thing happened to me in the states, nor how much it would have cost as I usually never could get affordable coverage back home. I am a firm believer in the Single Payer Health Care System, and I wish it was on the table for the upcoming Health Care Initiative that President Obama will be working on.

Michael Hoctor

I can go to any dentist of my choice

I currently live in Tokyo, Japan. I am a citizen born abroad--born in Japan. I lived in the States for 15 years, but my family stayed in Japan.

When I was in nursing school about 7 years ago, my tooth started hurting.
I had dental insurance, but when I called to make an appointment, not one dentist in the area would accept my insurance. They all said that my insurance "never paid" so they stopped accepting it.
After calling over 20 dentists, I finally gave up and got seen, self-pay. I was told that I needed to see a specialist to get a root canal. However, again, no one would take my insurance, and I could not afford the $1000 + that the procedure would cost. If I need a crown placed, I would have to pay much more.

The dentist told me that the only other option I had was to go to the Emergency Room where my tooth would be pulled.
I was in my 20s! I REFUSED to get my tooth pulled! All I needed was a root canal!

So what did I do?

I saved up my student loan money, waited for 4 months until Christmas break and flew back to Japan where my family lived--and where I still was covered under the National Health Insurance.

The morning after I arrived in Japan, I went to a dentist and got a root canal. Just like that. I think it cost me, mmm, like $30.

My tooth was in such bad shape--my face was swollen, I couldn't chew because my gums were so swollen that it lifted up my infected tooth, and I was in so much pain. My dentist told me that if I had waited just a little longer, the infection would have spread to my bone--a very dangerous situation. He couldn't believe or understand why I was unable to get care.

The airfare cost about $800. The root canal cost about $30. So, it was CHEAPER for me to fly for 17 hours over the Pacific to the other side of the planet, than to walk down the street to a dentist in my neighborhood in the US, to get a simple root canal.
Plus, I got to see my family and friends and enjoy good sushi as well. What a bargain ;)

Oh, and now that I LIVE in Japan and don't have to take a plane to see a dentist, I only have to pay $30. And, I can go to any dentist of my choice. Whenever I want.

Saturday, March 14, 2009

I am thankful to live in a place with national single-payer health insurance

On Saturday I noticed that my husband's face looked strange - one side was droopy. Since he had been injured in a car accident at the end of the year and has been suffering from whiplash, we thought it was related.

He had lost feeling by Monday morning, so he went to the general practioner who serves as our family doctor at 9:30 a.m.

No appointment necessary, waiting time 15 minutes, cost out of pocket (30% of total) $11

The doctor told him to get to a general hospital immediately and wrote a letter of introduction.

I accompanied my husband to the osteopathic doctor who is treating him for the whiplash.

No appointment necessary, waiting time 25 minutes, cost out of pocket would have been $5.70 (cost was charged to insurance company of person who caused car accident.)

This doctor concurred with the other doctor and told my husband to go to the nearby university hospital.

The university hospital is a 5-minute drive from our home. The lobby was overflowing with people waiting for outpatient care. It was my husband's first visit to that hospital, so he had to register.

Wait time to register: 20 minutes

We were sent upstairs to the dermatology department. Here the wait was longer, about 40 minutes to see a nurse who took down the medical report. We were told that it would be quite a long wait to see the doctor. However, we overheard another nurse who had picked up a phone to say that there would be a patient for immediate admission and guessed that it was my husband. I left to handle matters at the business we run together.

My husband was seen by a doctor at 1:45 p.m. The doctor diagnosed facial paralysis (probably Bell's palsy) and ordered immediate admittance for treatment. When I returned at 2:30 p.m., my husband had completed paperwork for admission and was being pushed in a wheelchair by a nurse to the dermatology ward.

Because he had requested a private room, he was asked to leave a deposit of $3000. This would not be necessary for a bed in the 6-8 person rooms. We have a private insurance policy which will cover the cost of the private room.

Because the treatment of facial paralysis involves the aggressive use of steriods which lower the immune system, my husband was told to expect a hospital stay of two to three weeks. He is on an IV drip 3 to 6 hours a day. He is not allowed out of the hospital ward because of the danger of infection from the lowered immunity.

In the meantime, he is being examined for underlying causes. A heart problem has been detected. At the moment he is being examined by four different departments at the hospital: the orthopedic department for the whiplash, the otolaryngology department for the facial paralysis, the cardiology department for the heart problem, and the internal medicine department for a weight problem. All test results and explanations are given by the doctor in the otolaryngology department whom he sees at least once a day. A nurse checks his vital signs several times a day. All his exams are scheduled ahead of time so he never waits more than 10 minutes for a test or consultation.

So far, tests include CTscan, MRI, full set of spine X-rays, several blood and urine tests, stress tests for heart, various ear and eye tests for causes of facial paralysis - just about every test possible for his condition. The main doctor usually disusses the results the same day as the exam.

We are on the national health insurance plan (kokumin kenko hoken) as a family. We pay the top rate for the premiums for our family of 5, approximately $6000 a year. We pay 30% of medical and prescription costs up to about $750 total in a month. Other than the cost for the private room, we will not pay more than approximately $750 plus a small charge for the hospital food for the calendar month. Also, we will be able to deduct medical costs over about $1500 from our total income for income tax purposes.

Of course, we have both checked medical information on the Internet in both Japanese and English about the various conditions and concerning the diagnoses and advice we have received so far. All information we have gathered matches up with the treatment my husband has received so far. My sister has also checked on information available in Thailand. The biggest difference in treatment that we can detect is that the US relies on oral medication more while most of Asia relies on IV drip to adminster medication. Also, as far as I can tell, my husband would be treated as an outpatient in the US (and with the exhorbitant cost of hospital care in the US, that would be preferable.)

However, we are very glad that my husband is hospitalized because the amount of running around and time that would be required if he were an outpatient (not to mention the risk of exposure to infection) would play havoc with my work schedule as well. As it is, my college-age son has come home to help out during spring break.

Right now, our biggest concern is my husband's condition. We wonder how his health condition will affect our work and our family. The one major concern we don't have right now is how we will pay for the excellent care we are receiving.

If, God fobid, my husband is unable to continue work and has to close the business, I can enroll him and the children on the insurance plan that I will be on from April when I take a full-time job as a university professor. I will be enrolled in the private university and school plan, which, of course, is tied to the other government schemes.

The biggest drawback that I can see to the various national health insurance schemes here is that, without a private plan to pay for a private room, my husband would be in the 6 to 8-person ward. Those wards do look crowded. Otherwise, the treatment for the patients is all the same.

At times like this, I am particularly thankful to live in a place where national single-payer health insurance is available. I hope that, sometime in the near future, all my fellow Americans too are able to have access to medical care.
M. P. O.

It isn't perfect, but I recommend the Japanese system of health care

I have lived in Japan for nearly 20 years and have enjoyed the health system that they have for most people here. When I first started, it had a 10% deductible and that began changing about 10 years ago. It was increased to 20% and then to 30% and it has remained at this point for at least 5 years. As long it doesn't go above this, it should be OK. I believe that my Japanese Mother and Father-in-law have a 10% deductible.

This system works for most medical attention, including optometry as well as dentistry. It does not cover the cost of making glasses, and I have no experiences with dentures... However, it covers most medication that I have had to utilize.

Also something interesting is that some cities subsidize medication as well as doctor visits for children under certain ages. I know my daughter received certain vaccinations for free by the city of Sapporo. Also there are free checkups for children in Elementary schools which are contracted out to a physician who's practice is located near the school.

Hospitalization is also covered. I have had a couple of instances in which I needed tests to be run and was hospitalized. One time in a room with six other patients and another time in a private room. The private rooms in 2000 were only 8,000 yen a day (a little more than $80). Less than the price of a hotel room, so I opted for the private room rather than the six patient room. I do not know what the price was for that room, but the difference was so small than I could not fathom staying in the group room.

The good (or bad side) depending on how you look at it, is that here in Japan people go to many different doctors, perhaps a different one each time. I have always tried to pick my doctors and stay with them, however, many people do not do this. Up to now, this has probably allowed people to get multiple prescriptions for the same ailment unnecessarily. However, with the new electronic medical record system which will be mandatory soon here in Japan, this may be more easily controlled.

For the most part, I can say that the Japanese medical system has been very good. I hear other ex-pats here who claim that this is a very bad place to receive medical treatment. I agree that the Hygiene at some hospitals here in Japan is severely lacking. However, if one takes the time to carefully pick their hospitals and get referrals from medical care workers that they trust, then this system is quite a good one. I highly recommend the Japanese Medical System as long as it is properly managed "by the people, for the people".

I am not sure if this was of any help as I and my family are healthy for the most part, but I do endorse the Japanese model.

If you have specific questions, feel free to contact me.

Very Sincerely Yours,

Brian Dishman

Thursday, March 12, 2009

Overnight stay in hospital after accident

I was out with a friend in Kyushu, he got a little
too inebriated and fell down a flight a stairs, putting a huge gash in
his head. He was unconscious for a minute or so but he woke up and we
eventually got him to a hospital. We brought him in, showed the front
desk his Japanese health card that was in his wallet. Soon after, two
nurses came out right away and took him to the back and got him
stitched, (about ten stitches) cleaned up and gave him a place to rest
for the night on the hospital bed. He told me he got a bill a bit
later for a little over 10,000 yen, or a little over a hundred

I wonder how much this would have cost back in the states?


Appendicitis surgery

It was early February a couple years ago and I had just finished
eating dinner with my host family in Kobe. I went to bed with a bit
of a stomachache, but nothing too serious. I woke up a few hours
later with severe stomach pains and, well, I spent a fair amount of
time that night hovering over the toilet bowl. I finally got to bed a
couple hours later and woke up feeling much better. Just a case of
food poisoning I thought.

I had a glass of water and in an instant, as if it was the catalyst
for a complete bodily meltdown, I was back repeating the same scenario
during the night before but feeling even worse. My Japanese host
mother drove me to the hospital down the street. When we arrived, the
nurses helped me on to a stretcher and I waited about twenty minutes
or so before they started taking my MRI and a few tests, I don't
remember too well. I remember there was a massive machine that
injected a giant syringe of warm fluid into my blood stream so they
could take pictures of my abdomen. A little bit after, the doctor
looked at the results and decided I had appendicitis.

Unfortunately, they couldn't do surgery on me because they were
already busy through to the next day. "So this is how it all ends" I
remember thinking for a few moments.

But the doctor came back to me a few minutes later and told me an
ambulance was waiting outside to take me to a nearby hospital that
could do the surgery right away. I arrived at the hospital, the
nurses brought me in, the anesthesiologist anesthetized me, and I woke
up in a bewildered state sometime later. The doctor came into my room
and said that it had burst so he had to disinfect the entire stomach.

Thus, instead of the normal quick twenty minute or so surgery that it
normally takes for an appendectomy, mine lasted about two hours. "It
was a little difficult," the doctor told me that night.

In Japan it seems they like to keep you around in the hospital for a
bit longer than the states, so I was kept for ten days, just to make
sure I was all well and ready to enter back into society. It wasn't a
wonderful experience, but the nurses were nice, and the doctor came in
to give me exceptional explanations of the procedure, with plastic
models of the body and everything. I ended up paying about $1,900


National Health Insurance paid all but 30% of cancer treatment

My friend Sally Chaney got pancreatic cancer, perhaps in 2005, in Kyoto, and only had 'Global' health care, from America. With chemotherapy and radiation therapy coming up in one week, she went to the Sakyo Ku ward office, where they signed her up for National Health Insurance, no charge. The National Health Insurance paid all but 30%. 'Global' picked up the 30%. Six months later she had to have a stomach operation, to repair a hole made by the radiation therapy. The National Health Insurance paid, but 'Global' refused to pay the 30% "because they only pay one time for any one illness." Sally died of it a year later.
Linda Crawford
New Hampshire

The French system is better than the Japanese

Friends --

This is painful, but I feel I should contribute to the discussion of the health-care issue. My story is that of the sudden and unexpected death of my late wife, Hatsue, last May 5th.

My wife was of Japanese origin, but she had lived in the US for some 36 years, was an American citizen, and a proud and active Democrat.

We retired to Chiba city in mid-2006, and built a new home on a plot of family land. The objective was to take care of Hatsue's elderly mother, whom she felt she had neglected by staying so long abroad. She wrote in the wet concrete outside the front door, "For my mother---with love."

I should note that Hatsue was an independent-minded person who paid close attention to her health. She had a trim figure, ate well, and exercised.

We are only a few hundred meters from the Chiba Medical Center, formerly a "national" hospital that has been privatized. It is a major facility, with all the usual services.

My wife complained to an internist in June of 2007 of stomach pains. She was given an endoscopy, which proved negative. Later in the year, she complained of violent shoulder pain. She was given scans of her neck and shoulders, all of which were negative. She was transferred to a female psychologist, on the theory that the stress of moving back to a by now unfamiliar environment and building a house had caused stress that was responsible for her pain. I accepted this diagnosis, because there had indeed been a great deal of stress.

Hatsue received permission to go to a "pain clinic," where she received shots of what must have been very powerful palliatives. She was finishing a month's series of these shots and felt that she had made enough progress that she was about to schedule "rehabilitation," when she collapsed in late April.

We took here to the Medical Center, where we were told that she could not be hospitalized because of a lack of beds. I insisted on a blood test, and the results--a total lack of sodium in her system was one-- led to her hospitalization on a Sunday afternoon. Sh was given extensive tests and we were informed on Tuesday that she metastasized cancer in "at least" eight organs, including a large growth in her brain, and we were shown the x-ray pictures. She was placed on morphine (we had always agreed between us that we would not authorize desperate measures if our partner was to be in just this sort of situation).

Hatsue passed away peacefully the next Monday (Children's Day), seven days after entering the hospital. The death certificate read "lung cancer."

The cancer specialist at the Medical Center told us that a simple chest x-ray would have revealed the cancer at any point in the previous year.

I hasten to say, however, that Hatsue never evinced any of the symptoms of lung cancer. She was able to move around more or less normally, walking to her pain clinic visits for a round trip of two kilometers even during her final month.

I have consulted with American specialists and talked to academic experts on Japanese health care to try to make sense of this tragedy. The Americans refuse to speculate on failures in diagnosis, but point out that Hatsue probably had the most vicious form of cancer: small cell. If you Google "small cell cancer," you will see that the only suggestion is to try to get yourself into a trial of some new treatment. The academic experts on Japanese medicine defend the Japanese health-care system as making only the average number of diagnostic errors and note that there are no limits to test ordering that restrict Japanese physicians from testing broadly.

But those of us who live in Japan know that there are serious problems with the Japanese health-care system. I am told that a Japanese doctor see more than 6000 patients each year on average, versus an average for an American doctor of just over 2000. I

f you have gone to a Japanese doctor, you know what this means. You are granted no more than two or three minutes with an obviously impatient physician who gives you an extremely compressed "bottom line" diagnosis and treatment in a peremptory tone that brooks no questions. The ignorant patient is granted no role in his or her own health-care. To use the famous analogy, the patient is presumed to be too dumb to help to determine if the hoof beats are those of a horse or a zebra.

I am told there is no system for ongoing education for medical professionals in Japan, and that there are no specialty groups (the "academies" and the "boards" in America) that set standards and qualifications for practice in specialized fields.

This overloading of the average Japanese doctor must trace back to restrictions on entry that probably mirror the cartel-like practices that infect so many other professions in Japan.

My own conclusion after some forty years of involvement with the Japanese health-care industry is that the Japanese people owe their high longevity figures to a diet that is steadily being corrupted by American (or is it Western?) influences and to the exercise that even middle class persons get by use of the public transportation system, with its walks to the stations and the stairs that they must climb and descend on a daily basis. (The latter, of course, are being replaced by elevators and escalators.)

I understand that the French system is much more promising as a source for ideas for American health-care reform than the Japanese. The French exercise a great deal of control over medical education, and I am told that unless their model is followed, there is not much hope for American success.

Rod Armstrong

The quality of medicine is very high

I think the best story I could give, and one that is particularly personal for me, is the cost and

quality of having a child in Japan. My wife and I just had our first child and we were both (maybe me

more as she’s Japanese) amazed at the quality and cost to having a child in the country. First,

Japan has one of the lowest mortality rates in the world because the quality of medicine is very high.

I would certainly say this was the case with our childbirth. Second, the net cost to us was only about

200,000 to 300,000 yen ($2-3K). Although I’m sure location plays a part (we live in Tokyo), it is our understanding

that all Japanese can get the same cost almost anywhere in Japan. I would say the process here

is very easy and certainly a relief when you hear of the big costs that can occur with having a child in the U.S.

We were very impressed with the entire process.

Aaron Lloyd

I appreciate the psychological security of being covered

When I enrolled in Japan's National Health Insurance program, I used to protest and complain that I had to pay for all of the people who went to the doctor for every little ailment or just hung out at hospitals to see their friends and because they had nothing better to do. However, I realized that in whatever circumstance I'm in - illness, accident, emergency - I am covered for medical treatment. Of course, the coverage is basic, but it covers dental and that really helps. I can go about my life not worrying about how I will be able to pay for medical treatment because the Japanese government will take care of most of my basic needs.

I switched to shiokyosai insurance for educators, but I now really appreciate the psychological security of being covered.

Edwin Aloiau (orginally from Honolulu, Hawaii)
Tokyo, Japan

Our health has improved since being in Japan

My family of 5 live in Japan. We have coverage from the US. I never joined the national health care because I felt that we were covered under our own insurance from the US and that seemed suitable at the time.

However, we have been to the hospital twice since living here. I was bitten by an animal shelter dog at a fundraiser once. The jagged bite mark on my leg was bleeding and the nurse suggested I go to the hospital immediately for injection and a check up. I checked in at the Red Cross Hospital in Hiroo and waited 45 mins to see a doctor. I saw the doctor first, not a nurse, or technician or aid but the Doctor. He cleaned my wound, inspected it, applied antibiotic ointment and dressed it. I received a dose of antibiotic and a prescription for 3 pills a day for 10 days. The bill for the hospital was 7000 yen and the prescription was some similarly small amount.

My second trip to the same hospital was when my son fell 10 ft to the ground while playing on the playground. He landed on his hip and was shaking and cold and couldn't walk. We feared a fracture on the hip and took him to the hospital. They informed us that since we didn't have an appointment we couldn't be seen. We asked again, nicely, and they agreed to see us after the other patients had been seen. We anticipated a long wait. My son, however, was called back for a consult with the doctor in 30 short minutes. He did a check up and put Isaac through a full range of motion. He sent us for xrays. Xrays indicated that my son had not broken any bones. He applied an adhesive medicated bandage to my son's hip area to keep the pain from bruising down. He sent us home with a prescription for medicated bandages which I was able to fill for 1500 yen. The entire visit took about 1 hour and cost me 15,000 yen. ($140 USD)

Service has always been wonderful and polite. I feel good when I visit the doctors here. My husband and I have received medication for blood sugar and anxiety. He paid an equivalent of $45 for glucophage and I have paid the equivalent of $28 for lorazapam for anxiety spells. This is without any aid from my US insurance drug plan. This is just the cost of medication over the counter from the doctor's prescription. I was shocked the first time I ever had to have medicines here. Without any drug plan at all medication costs here are so much lower than the US. I didn't offer any national health card to cover the medicines. I assume it's because the greediness of pharmaceutical corporations isn't as rampant in Japan as it is in the US. Affordable medicines are the norm.

Since we have lived here we have enjoyed the walking and trains and bike riding. We have enjoyed the abundant healthy vegetables. We have each lost 60 lbs and no longer require medications for blood sugar or anxiety.

Our health has improved greatly since being in Japan and the times we've needed help with our healthcare it has been a pleasurable and thrifty experience.

We return to the US in June. I am more than a bit afraid to move back to the US. I fear the slovenly, sedate, lazy lifestyle that is so common in the US. And the strain that kind of lifestyle puts on the entire system in the US. There are no accessible bike lanes in many cities in the US. The people in their gas guzzling vehicles feel they own the road and would never deign to ride their bike to the grocery when they can drive the 2 miles from home to the store instead.

Americans have a lot to learn from other parts of the world with regard to health care and every other aspect of their daily living. But that's a whole other rant you didn't ask for.

W - in Tokyo

Health care is not a commodity

It is clear that the United States needs universal healthcare for everyone.

In the U.S., you cannot have healthcare without a fulltime job. This is very limiting to people like myself who want to work in specialized fields as teachers, freelance writers, etc., that don't always have fulltime positions with benefits.

I've lived in Japan on and off for the past 10 years. Here I've been able to get affordable health insurance through the government under $400 per month, which can be less or more pending my annual income. If I were to get full coverage for my family in the United States even at a lower income than what I make in Japan, it would cost close to $600 a month with employee subsidized insurance and over $1000 if I were to pay it on my own.

Once when in the U.S., my health insurance costs went up 20 percent from one year to the next, while my wages did not increase at all. This great of an increase can only be explained by the insurance industry's desire to exponentially increase the return to their stockholders, as well as by the absurdly high salaries they pay some of their workers. I feel healthcare is not a commodity, but the right of every person.

It makes sense that people who make more should pay more in taxes to help subsidize the cost of services for all. Most people are hard workers, and there is only so much a person can do in one day no matter if they are billionaires or making under $20,000 a year. Both deserve the same right to live. If both were lost in a snowstorm climbing a mountain together, we'd send the same rescue team and put them both on the same helicopter, wouldn't we?

We are all climbing the same mountain.


Adam H.

An Opposing View

I do so as a twenty one year resident of Japan and also as someone who has had and continues to have extensive medical problems including asthma, slipped disc in back, pinched nerve in neck, herniated esophagus , hernia, gout and a disease of the liver. In spite of all these problems I manage to lead a very active life as a university lecturer and owner of a small business.

I think it is impossible to talk about health care in Japan without talking about health in general in Japan. The Japanese are the longest lived people in the world (in spite of their smoking habits) and I attribute this largely to the fact that these people eat a healthier diet than Americans, eat LESS than Americans, Weigh less than Americans, and are far more physically active than Americans. Can you really just talk about their national health care system without talking about the fact that Japanese have access to the best mass transit system in the world? What does that mean? It means that millions of Japanese walk to their train stations, walk up the stairs to the platform, down from the platform and walk to work. I don't know the national statistics but I do know that I walk an average one hour a day just getting to and from work and doing my shopping and daily errands. Consider how much slimmer and healthier New Yorkers (subways!) are than people in Mississippi (take the car to the mailbox). I would say more than half of Japanese use the mass transit system which goes some way to account for their fitness. Do we have decent mass transit in America?

Certainly Japanese have acquired bad eating habits from the West (especially America) but they still have a measure of portion control unheard of in the U.S.. The reason American housewives are the size of sumo wrestlers is because they (and their husbands and kids) eat as much as sumo wrestlers. I have been with Japanese friends in America who thought the portion they were served was actually for everyone at the table (four people). America, take the fork out of your mouth!

America does have the edge where smoking is concerned, but the Japanese are catching up rapidly. Smoking is definitely losing it's cachet with the young.

So what I want to say here is that the reason the Japanese are healthy is because of their lifestyles, not because of their health care system which is deeply, deeply flawed. True, everyone is eligible, but WHAT are you eligible for? You cannot talk about health care in Japan without actually talking about the quality of that care. Access alone is not the only issue. It is access to QUALITY health care that matters and the Japanese do NOT have it. In twenty one years of living here and using Japanese doctors (not to mention teaching doctors English at the University level) I have been consistently shocked at the almost total lack of accountability within the system. Doctors are a pampered elite here who are never questioned and never , never contradict each other. The system is such that if you do ask for a second opinion you are banished forever from the clinic where the first doctor made his diagnosis. Malpractice is common...and deadly, I have two close friends who were very seriously injured by malpractice here...both of whom had to return to the U.S. to have their problems taken care of. People die here because of the very, very serious problems in the system. They die (and are maimed or suffer) because the system
is a failure. The system here fails from top to bottom. Medical schools regularly accept the sons of doctors as a matter of course whether or not these people are qualified to be in medical schools or not. Medicine is a family business here. PLEASE do not even begin to think that the admissions system is honest (I am on the faculties of FIVE Japanese Universities and should know). Doctors graduate medical school with poor training and an even poorer idea of their responsibilities to their patients and communities. This pattern continues throughout their careers.

Let me provide just one example of how bad the system is. As far back as the 18th century Tobias Smollet (a medical doctor himself) was decrying the practice of doctors owning dispensaries. There is a clear conflict of interest if the doctor profits from prescribing medicines he sells. That is exactly what happens here. Medicines are (dangerously and expensively) over prescribed. The best evidence of this I know is that doctors regularly prescribe a stomach medicine to alleviate the symptoms caused by taking too much medicine! For a simple cold I was once prescribed ELEVEN different medications (remember the tax payer foots the bill so patients have little incentive to complain). Yet, the medicines prescribed are often
ineffective because the dosage of active ingredients is much lower than that sold in the U.S. (and this is where Japanese drug companies help themselves at the public trough).

I would argue that one thing that keeps the Japanese so healthy is the certain knowledge that if they get sick they will have to go see an incompetent doctor.

One of the aspects of our system Americans love to hate is the fact that lawyers drive up the cost of health care through their lawsuits. Try living in a society where a doctor can maim, cripple or kill you and there are no lawyers to help you find redress. Oh, there are good lawyers in Japan, (quite the opposite of their medical brethren), but they have very ,very little success challenging the medical system.

What I conclude from my twenty one years of experience here is NOT that national health care is a bad idea or that we should not try it, but that we need to look at GOOD models (France and maybe Germany?) not failed models (definitely Japan). We need to learn from the mistakes of others not simply assume these mistakes are inevitable.

But if you ask me whether I think America should change it's health care system to be more like Japan's, all I can say is
you should call the suicide hotline and have them talk you out of it.

Jeffrey Tarlofsky

The Japanese system is easy to use and transparent

Eye infection

I was on vacation last summer and left my contact lense in a little bit too long. My eye became red and stayed pretty red even after the lense had been removed for a couple of days.

When I returned to Japan, the redness persisted so I decided to visit an eye specialist. Japan's Universal Health Care system allows participants to go to any doctor at any clinic/hospital, many of which are private; there are no 'health care networks' here like there are in the US. You simply go where ever you'd like to go (freedom!). In my case, it was an eye clinic 2 minutes' walk from my office.

I presented my health care card (monthly premiums are deducted directly from my pay in the same manner as social security in the US) to the receptionist and was seen by the doctor after a 20 minute wait.

The doctor gave me an eye exam and two different types of eyedrop medication. The cost for the visit & medication was $20. The entire ordeal took less than an hour and my eye returned to normal about 4 days later.

I like the Japanese system a lot. It's easy-to-use and transparent. As both a user & business person, I find it highly affordable and hassle-free. I would recommend a similar system to anyone.

Mike Stensrud
Tokyo (via Oregon)

Over 70? don't worry about paying for hospital fees

As a young American woman in Japan 30 years ago I remember
commenting to my husband, an M.D., on the reason for the longevity of
women in Japan. At the time, the life expectancy was 83 for women and
79 for men. Japanese women outlived, not only Japnesse men, but as a
national group had the longest life expectancy in the world. I said
that it must be due to the diet. He corrected me immediately saying
that it was the health care system.

Recently I was even better able to understand the meaning of
this. My friend and former Japanese language teacher who had not been
feeling well was hospitalized for tests. They did a 24 hour
electrocardiogram on her saying that the usual 15 minute one was not
enough. She was told that during the night her heart had stopped
beating for six seconds and that had this happened during the day while
she was up and around rather than lying in bed, it would have been a
massive heart attack.

She had to have open heart surgery. In order to do this they had
to open up the chest cavity by forcing her ribs to open. Then they
took the heart out and inserted a mechanical valve inside one of the
main arteries. There were three surgeons in attendance and it took
more than four hours. She had to stay in hospital for a whole month.
And of course she had visits to the doctor afterwards. She's fine now.
The doctors said she went through it well because, although she was 71
years old, all her other internal organs were in good health. They
also commented on her positive outlook as a factor in her recovery.

The total cost of all of this was 1,800,000 yen, which comes out
to almost $17,000. In Japan all people under six and over seventy have
100% medical coverage. We have a national health care system
here. This means that in old age you don't have to worry about where
the hospital expenses are going to be coming from.

Dorothy A. Dufour

Many countries, many health care systems

I think it is an unfortunate situation that there are many people in
the United States who do not have adequate health care coverage, and I
think many other countries I have lived in do much better in this

In Austria, for more than 3 decades, I was covered by state health
insurance, which was quite complete coverage, and the system seems to
work well. You could have supplementary health insurance in
addition, but it did not really seem necessary. When I had
appendicitis in Austria in 1981, the hospital dealt with it well, and
I didn't have to pay anything at all - it was covered by state health
insurance, and almost nothing in the way of paperwork either..

In Japan the state health insurance provides basic health care
whenever I have a visa to stay in Japan for a year or more. But,
there may be some "loopholes" - it may be better to have some
supplementary - and I have not always found a solution that I am
really satisfied with. Short-term OK, but long-term still not really solved for me.

In the Netherlands, where I lived for 3 years, I didn't understand the
situation very well really, but I think it was better than in the US,
even now. Since they thought I was "well-paid", my employer said I
should buy into "private health insurance", required, which was
considered "adequate", I suppose.

Jimmy Macnaughton

Dates: I have not resided in the US since 1971.

Netherlands: 1971-1974

Austria: since 1974 except for time living in Japan

2001-2004 1/2 time in Japan
up to end of 2004, no problem with state health insurance in Austria

2005- present 9 months a year in Japan...