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...

Saturday, March 7, 2009

Long-term Hospital Stay in Spain

I had gotten a call from the daughter "M" of a fellow teacher, who I was helping while she was going to school, "K" is her apartment mate in this true story.

I got a phone call,"I don't know what to do, "K" is unconscious." "M" went to a neighbor and they called for an ambulance.

The next call from "M" was, "I am in the ambulance and we are on our way to Val D'Hebron Hospital." (In Barcelona) I left Sitges and was at the hospital within an hour and worked my way to the emergency room. There was "M" in utter shock and "K" was unconscious and being prepped to be moved to intensive care........

The doctors and nurses wheeled her up to intensive care and "M" and I waited about two hours before a doctor called us in to an office. She asked if we were relatives. We said no.....Fortunately "M" had grabbed "K's" purse. The doctor told us that "K" had suffered a sodium depletion and had aspirated her vomit and that her lungs had become totally infected......"You have to call "K's" mother immediately and get her here, we do not know if she will make it."

"M" and I phoned the mother from the hospital and explained the emergency, but did not mention the possibility that "K" might not make it. (To emphasize the emergency I told "Ks" mother, "I don't care how much you have to spend on the ticket, you have to get here.") I met "K's" mother at the airport the next morning and took her right to the hospital. "K" was on tubes and unconscious.

"K" was unconscious for at least three weeks and remained in intensive care for five weeks. She was then transferred to the General Hospital for a week when she suffered a pulmonary embulism and was put back into intensive care for a week and back to the general hospital for two more weeks.

When she was released, she was ambulanced back to the hospital several times for therapy.....

I was at the hospital every day of the first five weeks to help the mother and to translate with friends of "K"......

"K" Suffered from a sodium depletion, ARDS (Acute Respiratory Disorder Syndrome), Pulmonary Embulism........The only reason she survived was because she was a cross country runner and ran almost every day, she never smoked, and she never did drugs. She was well educated and is working on her PHD today.

She is a U.S. Citizen and was attending a university and working part time..........Tecnically she should not have been covered by the social security system here, but the University got that adjusted.

She was taking extensive amounts of drugs for a long time (Antibiotics, Anticoagulants etc.) She was monitored for about six months and eventually was released from hospital care with her "Alta". Once, after a trip to the U.S., she discovered a blood clot in her leg and learned that she had to inject herself with an anticoagulant prior to any flight...........

What was her bill at the end of all that ? "0" I believe the most she had to pay for any prescriptions after release from the hospital was 2 euros.........

In seven years of living in Spain, I have paid "0" towards my healthcare......I can join the social security system for 48 euros a month , approximately $68. However, even if I am not in the system and in an emergency, they will take care of me and worry about billing later......

Doctors are paid 42,000 to 46,000 Euros, about $54,000 to $59,000 a year (And probably work 20 hours a week for Spain) ........I have a friend who is a doctor. Since he is a capitalist, he has his own private clinic in two separate cities and makes about $125,000 a year total.

If I were President: I would make all licensed doctors participate in an annual national licensing program that they must serve 20 hours of service at a Nationalized Hospital......They would all receive $100,000 for that service.

What hospitals should be nationalized? County and state hospitals and private hospitals that are going out of business or not making it........Remember, Religious Hospitals get wicked tax breaks that private hospitals can not compete with.

Unless the United States takes the burden of healthcare off the American Businesses, Governmental bodies, school districts, wages can not be competitive with the rest of the world?

President Obama claims that, "We must impove the system we have." I disagree you must remove the system we have and build a new one......Yes, "We can rebuild America without greediness and corruption!"

Herbert Chersonsky