The Healthcare Debate And What We Can Learn From Japan

Aside from all things Japan and Apple products, reading about and discussing politics are a few of my favorite pastime activities. I am passionate about politics but I am not the type to turn an ear away simply because you affiliate yourself with a specific party. I have my opinions of course, but generally speaking, I am very open-minded when it comes to political discussions. So with that, think of this as an open-minded discussion as you are welcome to comment on the issue as well, but please, be respectful.

Healthcare is one of the hot topics in U.S. politics these days. Is it constitutional? This is the number question being asked right now. While I agree this is an important question, I think an equally important question that is not being asked is: How will a universal healthcare system fit into a country that takes pride in its individuality? The healthcare debate in the U.S. is much more about social issues than it is political, for the foundational arguments on both sides of the fence boil down to: how do Americans want their healthcare managed: as a collective mass, or as individuals.

Japan chose the universal healthcare track in 1961 and hasn't turned back since. While the system has its issues, like any healthcare system, it seems to work about as well as anything the rest of world's developed nations (which is not all the good, but that's whole other topic) have to offer to date. In fact, when the Japan's system is stacked up against other systems around the world it is by far the least costly system. But why does it work? Is it because of the system itself, or is it deeper than that? Canada and Switzerland have universal healthcare and their costs are lower than the U.S. but they are much higher than Japan. I believe it is much more foundational than a few lawyers and a few thousand pages of law, that's for sure. Universal healthcare works, for the most part, in Japan as a result of social practices, not because of the ideology behind the system that many supporters believe in.

Ever since Chie Nakane defined the Japanese society in her 1970 authoritative piece titled, Japanese Society, the West has often referred to the Japanese as collective in nature. While this has been argued by many critics as generalizing, I don't think it was Nakane's intent to label every Japanese. And there are variations within her theory of course, but generally speaking most Japanese operate with a collective mentality in Japanese society. The extent of my studies into the Japanese culture is nothing to brag about but I do know more about the Japanese mind than the average westerner, and I can tell you, collectivism runs deep in Japanese society. Living here has only further proven this theory in my mind. This is not to say Japanese are void of individualism, it's just that they tend to place other's needs and wants ahead of their own in many situations just as unconsciously as Americans tend to place emphasis on their own needs and wants. There's no right or wrong in either way of thinking for they both work quite well within their respective environments. But how does this have to do with healthcare you ask? It has everything and more. First, a look at Japan.

I have three major reasons, all related to cultural practices, why universal healthcare works in Japan. Firstly, the Japanese are the healthiest people in the world with the longest average lifespan. They are healthy not only because of their primarily rice and fish diet (among other things of course) but also because health is seen as a national objective rather than a single individual's New Year's resolution. All the way from elementary school where school-wide athletic events (運動会) are held yearly, to the business place where adults in many professions to this very day, although not to the degree it used to be, still perform company-wide daily exercises. Another less appealing factor that contributes to the general health of the country is the pressure of a good public image in Japan. In other words, if you are considered over-weight society has its passive aggressive means of letting you know you are. Naturally, the more healthy population you have the less of a burden it places on the healthcare system, as hospital visits are less frequent per citizen, and ultimately diseases are reduced on a whole. Secondly, going to the doctor is not only an arduous task for the average male like it is in the U.S., but also an act disliked by all in Japan. Not simply because they hate going to the doctor, but because if you do your doctor is likely to lecture you, or worse, scold you for being in the condition that caused you to go to the doctor in the first place. These are two very powerful cultural practices/taboos that serve to relieve pressure on the universal healthcare system.

(Thanks to a diligent reader, I want to make a few things more clear with regard to this "taboo" I am speaking of. The healthcare system in Japan requires you to get regular health checks on a yearly basis, even more frequent as you age. To my knowledge these types of hospital visits are viewed as a necessity to one's health and probably don't fall into the category of "taboo". However, a visit to the doctor on your own volition is often viewed as "taboo", especially to those who were not born into the universal healthcare system (elderly). But with the younger generations, this is changing. Those that were born into the system expect it to be an open system and doctors are also changing their attitudes towards patients. As a result this "taboo" is likely to dissipate as more people come to expect an open system.)

Lastly, and probably the greatest factor as to why universal healthcare appears to work in Japan is the concept of elderly care. It is very common for children to house their parents and take care of their needs when they grow up and buy a house of their own. This is a cultural practice that has been going on for thousands of years as a result of reinforced societal obligations. While I don't have any official figures, there's no doubt in my mind that this practice significantly reduces the burden of the elderly, the most frequent users of healthcare, on the system. These are all factors that contribute to the marginal success that universal healthcare is in Japan. Let's take a look at the U.S.

Currently, the U.S. does not have a universal healthcare system. There is a Government run healthcare option available to the elderly and the poor (Medicare and Medicaid), but it is not mandatory. This government system is in serious trouble of complete collapse due to inefficient funding. In fact, it is the single largest contributor to U.S. debt. This is the closest system we have in the U.S. that mimics the universal healthcare system in Japan, and it is failing, fast. There are a number of economical and political reasons for why it is failing, but as I have shown with the Japanese and their system, social factors seem to play a much more influential role in the success of a universal healthcare system. A universal healthcare system requires a population that is united in its efforts to be healthy and stay healthy in order for it to be considered even marginally successful, otherwise you have an overburdened system run amuck with a generally unhealthy population that requires expensive treatments.

If we take a look at the U.S. we find that being healthy is not at all a national matter, it is rather a highly subjective matter. There are still cultural norms that prefer the slim to the round, this is apparent in media of course, but even this isn't compelling enough as the U.S. has some of the worst obesity rates in the developed world. There are movements, organizations, companies, and events that promote health in the U.S. but these are all generally aimed at tapping into the individual athlete. I would argue that there is no single entity in the U.S. that has been as successful as the Japanese as a nation have been in promoting a healthily lifestyle. Why is that? There is a simple, yet powerful answer to this question: because the motivation to be healthy in the U.S. does not exist within culture practices, like it does in Japan, rather it exists in each individual. One of the founding principles of the U.S. is individual or personal liberty. In other words, the concept of individualism, not collectivism, runs thick in American culture. This is why, in the U.S., a person who is medically obese, smokes cigarettes, and drinks like a college freshman on the weekends can convince them self that they are healthy. Moreover, it’s also why this same individual could care less about what the media portrays as the ultimate healthy human being. Its what makes America the "U.S. of A.”; individual liberty. Not to mention, many of the elderly in the U.S. are not shelter by their children as they generally are in Japan. This practice doesn't exists for a variety of reasons in the U.S., mostly personal reasons, so I won't go into it, but the fact is there are fewer elderly folks who rely on their children for many costly healthcare matters in the U.S., which would result in their ultimate dependence on the would be universal healthcare system. This only serves to increase the burden of responsibility on the system.

So, if there is no common cultural practice that acts as a binding force to impel people as a nation to be healthy, then how can a universal healthcare system work? That's a good question, and if Obamacare passes the constitutionality test, only time can offer an answer. Maybe it is possible for Americans to maintain a certain amount of personal responsibility that will benefit the nation's health overall, again, only time will tell. But we can definitely learn something from the Japanese: whether it is achieved through a collective effort or sense of personal responsibility, if we expect universal healthcare to be a success in the U.S. there must be an overall improvement in the health of the average American otherwise we will find ourselves in yet another sinking healthcare ship.