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.