Opportunity of Broad Collaboration for Revival of Medical Service
Medical Care System for the Elderly (75+) Must be Abolished:
Dialogue with the President of Ibaraki Prefectural Medical Association
“The Medical Care System for the Elderly (75+) must be abolished immediately!” — Ibaraki Prefectural Medical Association was the first to express its opposition among the prefectural level medical associations. Putting up its own campaign posters, the association has promoted a signature drive for this. Min-Iren President Suzuki Atsushi and President Haranaka Katsuyuki talk on this system.
Courageous “First” Opposition
Suzuki: I watched on TV the session of the Health and Labor Commission of the House of Councilors in which you testified as an unsworn witness on the Medical Care System for the Elderly over 75. I was really impressed that you precisely pointed out the problems from the position of the old people and conveyed the feelings of the workers in the field of clinical medical services.
Haranaka: That’s because we doctors face the patients every day. The place where my hospital is located is a farming area, and most of the old people receive only about 40,000 yen per month of pension. If these elderly people over 75 were put in a separate category of health insurance, in Ibaraki, it would inevitably lead to the increase of the insurance fee, and more burden on them. I was worried about it from the very beginning. So we created a poster saying, “The new system would lead to more burden”. We also sent a leaflet to all the medical associations across the country, urging them to join the movement to abolish this system.
Suzuki: Your organization was the first to raise the voice of opposition. It must have required a great courage to do so.
Haranaka: As I was a board member of the Japan Medical Association and also a standing board member of the Political League of Medical Doctors, it indeed required a courage to raise my hand in opposition alone on the rostrum. But as a medical doctor, I just cannot accept this new system.
The notion of “identifying only one major illness” for an elderly patient, as the “medical fee system” says, is impossible to apply to the old people. Symptoms of old age can be a combination of cerebral vascular disturbances, cardiac problems, kidney problems, cancers, and so on. You cannot identify just one “major” illness.
“Family doctor” or “one’s personal doctor” system is necessary, if implemented in its original meaning. Surely it is important to keep one doctor who knows the situation of the patient’s family well, and can give appropriate advice to the patient on the correct usage of similar medicines that he/she receive from different clinics, say, from ophthalmologists and orthopedics. However, the purpose of designating the “Doctor in charge of the elderly” in this new system is different. It is to prevent old patients from going to different doctors.
Suzuki: Recently, the Japan Medical Association also called for medical collaboration among institutions and agencies in local areas by closely exchange information. It is very important to promote collaboration in the community. But this new system goes against such efforts.
Haranaka: Because it was introduced just for the purpose of reducing the medical expenditure of the State. The Health and Labor Ministry often says, “Out of 32 trillion yen of national medical expenditure, 11 million yen is spent for the elderly people. They take a lot of money”, but this argument has no foundation. Ostensibly “for the sake of the elderly”, the government has increased the burden not only of the elderly, but also of younger generations. With the introduction of the new system at issue, we found out that the state contribution to the medical services has decreased by 234 billion yen.
Those now over 75 years old are the ones who have paid the greatest amount of health insurance fees in the universal health care system. Taking the case of Japanese men, the average life expectancy is 79. If 71 years the healthy life expectancy, the period when they may suffer from illnesses or handicaps would be less than 10 years. Why is it not possible for the state to support these people during such a short period of their life? I have to conclude after all that such a system as this is wrong.
Only 6.6% say, “Health insurance premium has decreased”
42% say “Health care
Suzuki: As soon as the new system started, Min-Iren held a nationwide survey on the actual situation of the older people and announced the result in mid-June. Among 6,000 respondents, 40% of them said their insurance premium burden has “increased”. It was only 6.6% whose burden has “decreased” (as shown in the chart). This reality was so distant from the hypothesis of the Health Ministry that the burden would be less for 70% of them. Actually, this kind of survey should have been conducted by the government with the result made public, before the introduction of the new system.
Haranaka: If you collect the people of the age prone to fall ill and create a separate health insurance system for them, it is bound to become a costly one. In the new system, municipality governments are spared of conducting a health check-up for those over 75. As most local governments are in financial difficulties, many of them are likely to discontinue this service. The new medical care system treats those over 75 with discrimination. It is a “granny dumping (Ubasute-yama)” medical care system.
Suzuki: In fact, there is a mountain called “Obasute-yama” in Nagano Prefecture. Just recently, our colleagues and some old people got together at the top of the mountain and held a protest meeting.
Haranaka: Oh, I see.
We wouldn’t oppose if the politics make people happy
Suzuki: I believe that this Medical Care System for the Elderly (75+) is nothing but an “administrative malpractice” scandal of the Ministry of Health, Welfare and Labor. This ministry has introduced a number of wrong measures one after another recently, including the restriction on rehabilitation service and reduction of recuperation beds.
Due to the reduction of hospital beds for recuperation, those patients driven out of the hospital have to rely on emergency hospitals when their conditions suddenly get worse. Now that community hospitals are disappearing in their neighborhood, they have no choice but rely on large-scale emergency hospitals. There, they need to be examined from the beginning, which would cost extra money. So, we must say that the entire design of this medical system is faulty.
Since Prime Minister Koizumi launched the structural reform of the medical system in 2000, and especially after Koizumi achieved a sweeping victory in 2005 over the postal service privatization, he has slashed the medical budget significantly. The plan was to reduce 220 billion yen every year, to reach the aggregated total slash of 33 trillion yen of the medical care service in 5 years. Now, even the Health and labor Commission of the Liberal Democratic Party has said that such a reduction could not be sustained any longer.
Haranaka: The ultimate aim of the politics that our Liberal Democratic Party should be, whether in building roads or dams, revitalizing economy, or in building defense capability, to achieve a safe and secure life of the people. No one would oppose to the politics that make people happy.
Mr. Koizumi went so far as to privatize the postal administration. But even in the U.S., where the privatization of government services is advanced, post offices are still run by the government. In Europe, we are witnessing the current of renationalization of once-privatized services.
Revenue earmarked for road construction should be spent for the people
Suzuki: Both postal service and national railways had been created by the vast amount of taxpayers’ money, the asset of the people, since the Meiji Era. Such social infrastructure should not to be broken up or privatized easily.
Now we are facing the crisis of the “collapse of medical service”. There are less and less public hospitals, due to closure or privatization. A severe shortage of doctors is found everywhere.
Haranaka: Nurses and careworkers are seriously understaffed, let alone doctors. The government has capped the increase of medical expenses for 20 years, despite the increase of commodity prices by 1.8 times and that of average salary by 2.1 times during the same period. As many hospitals cannot pay decent salaries to their workers, less and less students choose to go to schools of nursing or careworkers.
Social security has been neglected by the successive governments, based only on market principles. This has led to the current crisis of medical services.
Suzuki: The Japanese government regards welfare as something that those in power would give to the people in charity. But in Sweden, the original meaning of the word “omsorg (social welfare)” is to “share sorrow”. It implies that the problems that everyone would experience, such as illnesses, handicaps, nursing care of family members or poverty, should be shared by the members of the society as a whole. This calls into question how the State resources should be duly spent in our country.
Looking to the revision of nursing-care fees next year, an outrageous proposal is being discussed to exclude those who require a light level of nursing care out of the system.
Haranaka: Such measures are proposed with the precondition to reduce medical expenditure or social security cost every year. In 1995, the government expected that the national medical expenditure in 2025, a peak year of the aging in Japan, would be 141 trillion yen, and aggressively spread propaganda, saying that the medical service would ruin the nation. Now, the government projection has gone down to 46 trillion yen., which shows how sloppy their projection was. But even if this figure were correct, the financial contribution of the government to this 46 trillion yen would be mere 2 or 3 trillion yen. Is the government really not able to bear this amount?
We have special earmarked revenues such as for road construction. These funds do not belong to bureaucrats, but to the people. We can find a way to make use of such resources.
Suzuki: That’s right. We also spend fabulous amount of money on military. Recently, a treaty to ban cluster bombs was concluded. I was surprised to learn that Japan has spent 200 billion yen for such bombs.
“Medical Service Revival plan” should be used as reference for discussion
Haranaka: It was rather good that the people have come out publicly with strong anger over the Medical Care System for the Elderly. It may be a good opportunity for us to review the system as a whole, so that we can build a country where we carefully check national revenue and expenditure and make sure the people can lead a secure and safe life until the end.
Suzuki: I totally agree. The Ibaraki Medical Association and other local medical associations have taken the lead in the opposition campaign, involving many members of local assemblies. I have always wished that those in the medical-services community would share the pain and anger of the people and work together with the people to increase social security budget and expand the base for funding it. Min-Iren recently issued the “Revival Plan of the Medical and Nursing-Care Systems”, which also discusses how to secure the fund. I hope this plan will be made good use of in discussing these matters.
For example, Japanese corporations contribute less to social security than those in other countries. Taking the fund for national health insurance alone, they bear only 2.4% of the GDP, as opposed to 11% in France. Financial community wants to lower this share even further, by raising the consumption tax. I really want to question if those business people or academics assembled in the Council on Fiscal and Economic Policy or others are qualified to make decisions on the course of the country.
Haranaka: Indeed. When I was summoned as an unsworn witness to the Diet, I, too, said, “Why is it that those who were not elected by the people have more power than Diet members?” Even when these councils discuss a question of medical service, no doctors are included as council members. They discuss the matters only from the economic point of view. This would impact very adversely for the people.
Suzuki: Of course, there are some wasteful expenses in medical services. Especially, we are made to buy pharmaceutical products, medical equipments and supplies from the U.S. at very high prices.
Haranaka: The most important elements in the medical services are the people who work there. While the prices for the goods like medical supplies should be lowered to the international standard, decent remuneration must be paid to the medical skill and technology, which are at the top-level in the world. Japan supposedly has a universal health insurance coverage and is proud of the highest longevity in the world. However, the doctor’s fee for patient’s second or further visits is set at only 10% of that in the U.S. Such a poor evaluation on the doctor’s skill is really deplorable.
“Medical Care System for the Elderly (+75) should be abolished once and for all
Suzuki: Medical service is an important and large-scale industry, which protects life and health of the people. A healthy operation of this service itself will lead to the revitalization of Japan.
Haranaka: The economic ripple effect from the medical and nursing service is greater than that of public work projects. So, even if medical care for the old people over 65 is made free of charge, this country would never go bankrupt.
Suzuki: We must remove the wrong notion that there is no future for medical or nursing services because Japan has a vast amount of debts. People from a broad range of fields should lay heads together at the same table and jointly create a country where people can live without anxiety.
The bill to repeal the Medical Care System for the Elderly (+75) was carried in the House of Councilors in the last session, and at the House of Representatives, it was carried over to the next session. What do you think would happen, Mr. Haranaka?
Haranaka: The government is expected to strongly resist the repeal of the system. But the fact that they themselves repeatedly submitted draft revisions in the last Diet session shows that the government has admitted the fault of the system. They should have the good grace to freeze or abolish the system.
Suzuki: We must continue our campaign over to the autumn Diet session, and force the abolishment of the system through debates at the House of Representatives, too.
Thank you very much Mr. Haranaka for joining us today.