Thursday, March 12, 2009

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

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