Single Payer Health Insurance: My Japanese Experience

( – promoted by buhdydharma )

As the debate about Health Care continues to heat up with the usual suspects from the Health Insurance industry begining their campaign to convince Americans that Universal Health insurance is against their best interests, would decrease quality of care, limit options, increase wait time (as if those under the current system don`t have similar issues)and all the other usual lies they spout hoping to scare a large enough portion of the electorate to dash the hopes of us who want Health Care reform.

I would like to share with you MY experience under a single payer system which we have here in Japan. It is called National Health Care Service or for those of you who can read Japanese: (grrrr..why cant I post Japanese characters? Every time I try here I get this error message:java.sql.SQLException: Incorrect string value: ‘xE5x9BxBDxE6xB0x91…’ for column ‘mainText’ at row 1)

Of course first I should tell you how it`s paid for before I go into the details of how it works.

Every month a certain percentage is deducted from my pay check which includes both my National Health Care and my National Pension. This amount is matched by my employer. While I don`t wish to discuss my finances in detail, I can tell you every month they deduct roughly 40,000 yen (around $385 dollars) by comparison my wife who is a stay at home mom pays roughly 7000 yen (around $65) for her coverage. All children under 15 are covered for free.  

Once you are in the National Health Care system you are given a National Health card. It looks like this:

With this card you can go to ANY doctor, hospital, or clinic.

Now when you do need care you go to the provider of your choice and give them your card. After seeing the doctor and getting your treatment and/or prescription drugs you will have to pay a small co-pay. This is 30% of service cost 70% of which is paid by your National Health insurance.

Those are the dry facts, now I would like to get into my experiences in this system.

When I first came to Japan I was reluctant to use the system. I had come from America where generally I would suffer on my own before daring to go to the doctor, knowing how much the visit would end up costing me. This attitude followed me to Japan so it was 2 years before I actually went to a Japanese hospital. Here was my first experience:

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 ($65.00)

I was amazed! This was incredible affordable quality of care.

Since then I have been to the doctor for regular check-ups and never hesitate because of fear of cost.

Seems great right, so while I was planning this blog post I decided to interview my acupuncturist/chiropractor whom I see regularly to treat my back pain and tension which are remnant of an old sports injury (yes THAT is covered too. Once 30 minute visit costs me around $14).

I explained the current situation in the US and the current debate and asked if he wouldnt mind I ask some questions. He smilingly agreed.


This is ProgressiveTokyo and Hiroshi-san.

I explained how things normally work in the states, and asked as a provider how he felt about the Japanese system. He replied that it is very simple and no hassle. His secretary files his claims to the NHS and the NHS transfers the reimbursement. When I told him about doctors negotiating with HMOs and insurance companies he was shocked and said he always treats his patients with the care he feels is best and would never want to negotiate with a company telling him (the provider) what he should and should not treat. I replied “As it should be”.

I now firmly believe that the reason the Insurance companies and HMOs are fighting this with their propaganda and lies is simple.

They know that once Americans see the amazing quality of care, service, lack of hassle for both patients and doctors is they will NEVER go back. And that scares them.

Crossposted at the Big Orange


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  1. For National Health Care NOW!

    • RiaD on May 23, 2009 at 15:56


  2. if only the public could see/hear this instead of the monied smear machine that is currently in force.

  3. an actual patient and doctor about another system. All I ever hear is how horrible it is in places where they have ‘socialized’ medicine. I really like that you can choose to a treatment like acupuncture. I go to a Chinese doctor who because she does not have a medical degree here is not even allowed to call herself a doctor. She is both an herbalist and an acupuncturist. I have no insurance as we own a small(I mean small) business. Insurance would make us unable to eat.  

    Last year I had an ear infection from hell and I don’t know what she gave me but within a week it was gone. Last time I went to the ER, I had a horrible infection on my ankle bone. I was treated by a nurse practitioner. I told her about my doctor and that I felt I needed western medicine in this case as they are good at killing stuff. She laughed and said that Dr. Wong probably had something in her back room that would have sucked it right out.

    I resent the fact that the only treatment you can get under our official system is dictated by the for profit entities and that you are not allowed to decide or participate in your own health.  Every time I cross into the nightmare of our system I usually end up worse off and broke. BTW when I said to the NP I have to find a good doctor who’s western , she replied If you do give me their name. I need one too.      

  4. If memory serves correctly, both Japan and Germany were required by the Allies (including the United States) to develop universal health care systems after World War II. According to the most recent ranking of countries in the world by quality of health care, the rankings in 2000 (the most recent year available) were as follows:

    Japan – 10th

    Germany – 25th

    U. S. – 37th

    I’ve worked in a professional capacity for more than 30 years in a governmental agency. I work in a union shop environment. Union membership is “voluntary”, however, if you don’t join, you don’t get to work. We enjoy relatively decent pay and benefits, which I doubt our employer would merely offer if their employees had no leverage to negotiate.

    During contract renewal negotiations, which occur during every even numbered year, our input is sought regarding tradeoffs between maintaining our health care coverage as is, cost of living increases, and/or a combination of the two.

    The combined contributions of my employer and myself toward health care ($623/month) and my defined benefit pension ($671) is $1294/month. My employer pays considerably more than one-half of this amount.

    By comparison, it appears that you are paying $450/month to cover you and your family for health care and pension.

    The adoption of a single payer system in this country could mandate that employers redirect net savings (realized by converting to such a system) for healthcare benefits and pension into increased employee compensation, provided that this portion of one’s increased income was exempt from income, social security and medicare tax.

    Under a conversion to a single payer system, I would conceivably enjoy improved health care, and have considerably more money to spend to stimulate the economy in the bargain.

    For anyone interested in crunching numbers, here is the link to the tables for the 2008 Annual Report from the World Health Organization —

    Here are a few comparisons:

    Life Expectancy (Healthy LE)-2006 – Germany – 80 (72)

                                                        Japan – 83 (75)

                                                        U. S. – 78 (69)

    Infant Mortality (per 1000) – 2006 – Germany – 4

                                                       Japan – 3

                                                       U. S. – 7

    Adult Mortality from 15-60 yr. – 2006 – Germany – 81

                                                            Japan – 67

                                                            U. S. – 109

    Maternal Mortality (per 1000) – 2005 – Germany – 4

                                                           Japan – 6

                                                           U. S. – 11

    Access to improved drinking water (pop. %)- Germany – 100

                                                                      Japan – 100

                                                                      U. S. – 99

    % of GDP for Healthcare – 2005 – Germany – 10.7%

                                                     Japan – 6.2%

                                                     U. S. – 15.2%

    Per Capita Expenditure for H.C. (US $) – Germany – $3628

                                                               Japan – $2936

                                                               U. S. – $6350

    A few comments, in addition to the obvious differences…

    Of 1000 15-year old adolescents alive today, 45 years from now, there would be 42 people alive in Japan who would not be in the U.S.

    Maternal mortality in the U. S. is nearly double that of Japan and nearly triple that of Germany.

    There are approximately 3,000,000 people in this country who do not have access to improved drinking water sources.

    If the United States adopted the system employed in Japan, all else being equal, we could save more than $3400 for every man, woman and child in this country, and enjoy greatly improved healthcare for all in the bargain. Count the number of people in your household and multiply by $3414. Think of what you could do with that money, once you get over the guilt of not creating even more billionaires in our for-profit healthcare industry.

  5. …Now lets all get this out to those who think 2 of the nastiest 7 words are “socialized” and “nationalized.”

  6. Please don’t delete.

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