Exhaustive Debate on Bill to Abolish Medical Care System for the Elderly (75+) Needed; Otherwise Popular Verdict Must be Sought by Snap General Election

Article by Tada Shigemasa
Photo by Sakai Takeshi

Facing the public anger and opposition to the Medical Care System for the Elderly (75+), the LDP-Komei coalition government is running about in confusion. After the bill to abolish the system was passed in the House of Councilors, the government has left it on the shelf, while trying to avoid the election by only reducing the insurance fee by half for the time being. The government however, refuses to review the core of the system, including the discriminatory remuneration of medical services that puts constraints on the content of treatments, or the principle of beneficiary liability. There will be no change in the automatic increase of insurance fee that accompanies the growth of the population of senior citizens, and the deprivation of insurance cards of those who are in arrears with premium payment.

But what the people want is not revision of the system but its abolition. On December 14, 2008, 5000 people gathered at the “Tokyo Rally for the Abolition of the Medical Care System for the Elderly” held in freezing rain.

“I almost gave up coming here in this rain, but I’m glad to be here”, says Yamada Sachiko (79), a member of Hokuto Medical Cooperative Union of Kita-ku, Tokyo in the continuous rain. She now lives with her mother. Compared with two year ago when she was enrolled in the National Health Insurance, she now has to pay 100,000 yen more per year. Even from her mother’s pension, the insurance fee is checked off. “The government is cruel enough to rip her off from her scanty pension. My mother, who is now 96 years old, is really angry.”

>From December 16 to 19, a sit-in was held by the elderly people in front of the gate of the Ministry of Health, Labour and Welfare. This sit-in action is held every year by the Association of Regional Organizations for the Old-Age Security around the time of the budget-compilation. Their slogan in 2008 is, “Put an end to the Medical Care System for the Elderly!” Sakamoto Kouji (79) of Santama area, who serves as the Secretary of the Old-Age Security Promotion Association of Tokyo says the total amount of Medical Insurance and Nursing Care Insurance of him and his wife has increased by 70,000 to 80,000 yen since last year.

“We have to pay as much as 40,000 yen for two months, so we have to cut on our food expense. Even a pot noodle is a luxury for us. Prime Minister Aso says spending 20,000 to 30,000 yen at a bar or restaurant is ‘cheap’ for him, and thinks that one pot noodle costs ‘about 400 yen or so’. Such a person can never understand our feeling”, Sakamoto says.

Struggle to Show One’s “Way of Life”
In December, it was revealed that the number of applications filed for administrative review on the Medical Care System for the Elderly reached 10,199. Ainoya Yasutaka, Assistant General Secretary of the Central Council for Promotion of Social Security says, “The driving force of such a large number of applications for administrative review is the anger of this generation of people, who feel terribly betrayed by the government, despite their great contribution to the rebuilding of the war-torn Japan.”

In filing the application, applicants can state their views by parol on why they have objections to the current system. Ishikawa Council for Promotion of Social Security compiled their statements in the form of a booklet. During the war, Asatou Yoshimatsu worked at a factory to produce fighter planes “for the sake of the Emperor”, and after the war, he worked hard “for the sake of reconstructing Japan”. He suffered an air raid while working in the factory and narrowly survived, fleeing desperately for his life. In his statement Asatou says, “When this medical system for the elderly started, I remembered the term ‘Hikokumin (anti-Japanese)’ often used during the war to attack those people who did not cooperate with the government in its war effort. The government has now excluded us from the category of Japanese nationals, treating us as ‘Hikokumin’. It no longer has the intention of protecting the health of those over 75 years old. I feel really sad.”

Yamamoto Shigeru says he has “lived through Meiji, Taisho and Showa eras as one of the living witnesses of the rapidly changing century. How can the government treat those of us in such a cruel way?” Mori Akira says firmly, “We have suffered many times by the government policy of abandoning its citizens throughout the pre-war, during war and post-war periods. This Medical System for the Elderly is as good as sending each of us a coffin and encouraging us to die as soon as possible.”

Their deep anger compels them to stand up to prove the value of their lives. Goto Mitio, General Secretary of the Federation of Regional Elderly Citizens Associations stresses, “We are not just opposing the collection of the insurance fee by check-off or high insurance bill. This is the struggle to prove our way of life.”

Making a Breakthrough in the “Structural Reform”
People’s campaigns and struggles, carried out in combination with the struggle to prevent the medical and nursing care system from breakdown and to abolish the measure to abuse the people with disability, are slowing changing the public opinion. One of the core policies of Koizumi’s “Structural Reform” package was to continue to slash the annual natural increase in social security cost, amounting to 220 billion yen. The government is now forced to review this policy, though it still refuses to repeal the Cabinet decision to continue this measure till 2011.

Tosa Kazuo, the then deputy director of the National Health Insurance Division of the Health and Labor Ministry and one of the designers of the Medical Care System for the Elderly (75+) blundered in January 2008 that the purpose of introducing this new system was “for the elderly people over 75 to feel themselves the burden of endlessly-increasing medical expenses”. What he said eloquently reveals the aim of the “Structural Reform”, by which the government has abandoned the responsibility of protecting the health of its peoples but imposes it on them.

But now we are seeing this “Structural Reform” policy stand at the crossroads. Mr. Ainoya states, “The movement to demand the abolition of this medical system is the attempt to make a breakthrough in the ‘Structural Reform’ policy.”

The bill to abolish this medical system was debated for only one day at the extraordinary Diet session last autumn, and it has been carried over to the current ordinary Diet session that started in January. “Our demand to the government is to debate and pass the abolition bill, or seek a popular verdict by a snap General Election”, Yuasa Takeo, Assistant General Secretary of the Japanese Federation of Democratic Medical Institutions (Min-Iren) says.

Mr. Sakamoto, during the sit-in in the cold weather said, “The reaction of the people on the street is very different compared to last year. Today only, more than 10 people spoke to us, saying, ‘Carry on’ some of them even give us donations.”

During the interview, the author witnessed one worker on his way back from work give 3,000 yen as donation to the campaigners. Now is the great opportunity to change the government policy of Japan from one of seeking economic efficiency only to one of giving priority to the life and health of its people.