Americans Abroad Know About National Health Care

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

2009-09-25T04:33:00.000-07:00

"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

Write Your Elected Leaders a Letter

2009-09-06T20:47:00.000-07:00

Even if you have never been politically active before, if you want health care reform back home, write a letter today! Below is a sample letter you can use, or incorporate some of the ideas recommended by the Million Letters for Health Care Campaign).

SAMPLE LETTER

Dear Senator,
I am your constituent, but I am unique in that I am currently living in Japan, a country with an excellent public health care system that covers everyone. Therefore, I speak from experience when I urge you to support only a bill that includes a public option—Medicare for anyone wanting to choose that option would be ideal.

The health care debate so far has focused on buzzwords like “Socialized medicine, death panels, and the government deciding care?” Those are diversionary tactics by opponents when they have no substantive arguments to defend their position. For example, here are the facts about the public health care system that anyone in Japan experiences:

ß The Japanese health care system covers everybody—old, young, rich, poor;
ß Costs are half those in the United States for individuals, families, businesses, society, and even for the government, and their growth is strictly controlled;
ß People have complete freedom to choose their doctors and hospitals;
ß Doctors determine how to treat patients, and they do not need to check with an insurance company first.
ß The Japanese population is the healthiest in the world.

In contrast, the American system:

ß Excludes up to 47 million American citizens—our friends, families, neighbors, and your constituents;
ß Costs are the highest in the world and continue to rise much more quickly than inflation;
ß Insurance companies can limit which doctors and hospitals you can choose for treatment;
ß Insurance companies come between doctors and their patients by determining which treatments they will approve.
ß Americans are not healthy compared to other advanced nations, and they are not well served by the health care system.

Certainly the Japanese system is not perfect, and I understand the US needs a health care system appropriate to our own characteristics. However, public health care systems from Japan and other advanced nations show every day that opponents are dead wrong; public health care can be effective and efficient, and it can help improve quality and access while holding down costs.

Republicans know, unequivocally, what is at stake here; if Democrats do not pass a health care reform bill, then Democrats and Obama will be vulnerable in upcoming elections. I urge you again, as a constituent and as an American who cares about my fellow countrymen, to support and push for health care reform that includes a public option.

Sincerely,

==== SUGGESTION: select one of these to write or use as an idea for what you write ====

September 2009

People in other free-market countries wonder why we have not implemented low-cost high-quality health care for all like they did. It's time for us to act!

We know from President Obama's position in 2003 that he will sign if people communicate in every Congressional District. We are now communicating!

People need to automatically have full health care for their entire lives to improve the quality of life and help people have good preventive care.

People need to automatically have full health care for their entire lives to improve the quality of life without having any major medical bills.

We want this one action that will save families up to $8,000 per year in addition to possibly saving up to $2,500 per year with additional actions.
==============================

STEPS TO PRINT AND SEND YOUR LETTER

http://www.medicareforall.org/pages/Print_Your_Letter#printsteps

The last step links to "extras": additional actions to consider.

INVITE YOUR FRIENDS

http://www.medicareforall.org/invite.php

VISUALIZE SUCCESS TO HELP MAKE IT HAPPEN

http://www.medicareforall.org/pages/Vision

Thanks: thanks very much for using the Invite Your Friends feature. It's been helping increase the number of participants ... now at 1,000. Please help increase that number to 10,000 by the October 1 by spreading the word.

All the best for your health and health care,

Bob Haiducek on behalf of the many people across the U.S. who are working hard to halt the number of hardships due to our current inefficient, uncaring way to pay for health care.

==============================

P.S. For Your Reference in Conversations --------

If you are among fellow activists, please consider bringing up the subject of the contents of this "Help Get Care" document:
http://www.medicareforall.org/files/helpgetcare.pdf
or its corresponding web page.

If you are among people who are supportive of single-payer and would like to know more, please consider these documents:
http://www.medicareforall.org/files/benefits.pdf
or its corresponding web page
and
http://www.medicareforall.org/files/twochoices.pdf
or its corresponding web page.

The Japanese Receptionist Apologized for the High Costs

2009-08-15T02:14:00.000-07:00

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!

Joe
Tennessee
Japan

Americans Who Can't Go Home Because of Health Care

2009-08-15T02:09:00.000-07:00

Can't Go Home from Turtlebox Productions on Vimeo.

Cost for care in Scotland was zero

2009-08-15T01:51:00.000-07:00

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.

John
Scotland
New York

Some Comments on French Health Care System

2009-07-01T02:36:00.000-07:00

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.

Christine
France

Don't Believe What You are Told by Republicans

2009-07-01T02:01:00.000-07:00

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
http://www.ireport.com/docs/DOC-268771

Blog posted by Linda
Video by Sally in Paris

Prostate Laser Surgery for the Equivalent of $1500

2009-05-29T06:03:00.000-07:00

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
Tokyo
New York

In case you don't believe Americans living abroad, will you believe Canadians?

2009-05-28T00:27:00.000-07:00

More at The Real News

Why Make Life Worse for High Risk People

2009-05-19T06:40:00.000-07:00

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
Japan/Austria

Moving Abroad for Treatment of Genetic Illness

2009-05-19T05:35:00.000-07:00

Several years ago, a reporter told my story in the WSJ (http://online.wsj.com/article/SB119515792495794643.html) 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
Belgium

We Urge the US Government to Implement Universal Health Insurance

2009-04-14T03:37:00.000-07:00

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
Japan
Orange County, California

My daughter's ER care was free

2009-04-14T03:32:00.000-07:00

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
Japan
Minnesota

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

2009-04-14T03:21:00.000-07:00

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?

S.S.
Japan.

Lining up for Great Care in Japan

2009-04-14T03:15:00.000-07:00

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.

Althea
Japan
California

Some reasons why national health care is necessary

2009-04-14T03:04:00.000-07:00

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:
http://49.blogspot.com/2004/12/ka-ching-put-it-on-my-tab-updated.html
to get really upset at costs check out her 5 month cost listing
http://49.blogspot.com/2005/03/ka-ching-revisited.html

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

The benefits of social health care outweigh the costs

2009-04-11T06:06:00.000-07:00

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
Japan
Minnesota

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

2009-04-11T05:52:00.000-07:00

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

2009-04-11T05:45:00.000-07:00

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
California

Breast Cancer care in Japan

2009-04-09T23:13:00.000-07:00

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

2009-04-09T23:07:00.000-07:00

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!
Keely
Kanazawa
Kentucky

We can't understand a developed country without universal coverage

2009-04-03T04:33:00.000-07:00

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

Chiropractor visit costs $5

2009-04-01T22:36:00.000-07:00

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.

Amanda
Japan
Texas

No rationing, no deductibles, everything is covered

2009-03-17T05:55:00.000-07:00

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
California

I love going to the chiropractor in Japan

2009-03-17T05:29:00.000-07:00

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
Miyazaki-ken
California