Health Care Reform

I do not claim to know all the ins and outs of the Health Care Reform debate, and I don't think anyone on any side can predict accurately what the outcome will be of any plan other than the current one. I do know what I think today, based on a fair amount of reading on the topic, and I have the bully pulpit, so here's my two cents.

To be clear from the start, I am very much in favor of a public option. To make sure we are thinking of the same thing, this is where the government starts a non-profit organization that competes with private insurance companies without anything being subsidized by the government. This seems like a straight up good idea - there are no subsidies, so it doesn't cost the tax payer as much as real socialized medicine (I'm sure it will still cost plenty to get started, though), and it only provides honest competition to private companies - it doesn't have an unfair edge (namely being able to offer services cheaper because Uncle Sam is paying for part of it). Of course, a public option non-profit company is only concerned with staying viable - not with making people at the top rich, so that gives it an edge, but then again, it would likely end up being a bureaucracy with its own inefficiencies so that private companies could still find ways to give better service but still make money doing it.

It has been interesting comparing the American system to the Japanese system (something I am still learning about but have had contact with recently).

In Japan there is social health care. There is a national insurance provided by the government to anyone who wants it. In fact, signing up takes less than an hour and because it is subsidized by the government, it's quite cheap. It does not cover 100%, but I think it covers 70% of medical expenses which would probably keep most people from going broke, even if they did have a huge emergency. I'm sure I am oversimplifying things, but lets go with that for now.

In Japan, there are also many private companies. They offer different kinds of coverage. Some offer cheaper monthly costs but don't pay anything until you reach a certain pre-set amount. Many of my colleagues opt for plans like this because they don't expect to get sick and they don't want to sink too much into health care at this stage in their life. Another common private insurance is a gold-premium style of option. Its super expensive, but it covers everything. If you can afford it, you never have to worry about any medical issues.

It is also illegal to live in Japan without insurance. I assume there are ways to get help paying for insurance if you truly can't afford it.

From what I can tell, most hospitals run on a first come, first served basis. This is probably not the case if you are doing a yearly physical, but as you may remember from earlier posts, most people get their yearly physical done at work once a year. For those with medical issues that crop up unexpectedly, you go to the hospital, take a number, and wait your turn. If you go in the morning, you may only wait a few minutes. I can only imagine that dire emergencies skip the wait. From what I hear, you are always seen the same day. Plus, if you know you need a specialist, you go to the specialist. No getting a referral from your doctor. We like that rule. Our dermatologist is like a friend of ours. We drop in all the time.

The cost of our dermatologist visits are also surprisingly inexpensive. Again, we don't make appointments, we literally just drop in when we feel like it. We have never waited more than 15 minutes (though that must be different in other branches of medicine) and we don't pay so much. I have national insurance here in Japan and I usually pay the equivalent of $7 or $8 per visit. Russell is insured through work, but has to send all receipts to the U.S. and be reimbursed, so he sees the full cost of the treatment - usually about $30-$40. I'm not sure what keeps the cost of treatment down. I assume it is in part related to malpractice suits (or lack thereof), but there are probably many forces at work.

The cost of my national insurance (and it may be cheaper this year because it is the first year I am on it - I'm not quite sure how all of this works yet - is about $50/month. Way less than is taken out of Russell's paycheck, and way, way, way less than Russell and his employer together pay.

I realize that this is a more socialized system, and not what the U.S. Democrats are proposing, but I find it interesting that the main complaints I hear from people against a public option are that 1) it would put private companies out of business (not even a socialized system has managed to do that in Japan) 2) it will reduce the quality of care (but we get treated faster and by clearly qualified doctors) 3)all of the government bureaucracies will get between you and your doctor (but in spite of very clear bureaucracy here, I got insurance fast, pay on the spot, and am in and out in less than 30 minutes). I'm not sure that a public option in the style the Democrats are proposing can do as much as a Socialized system, but it seems like a step closer to good quality, affordable health care while still promoting responsible competition from private companies.

Another thing that's interesting to me is that whenever I mention the U.S. health care debate to Japanese people, they are shocked that the U.S. doesn't have any form of government run health care. They are even more shocked to hear that a significant chunk of Americans live without any health care. The first thing most people say is, "How is that possible? The United States is one of the most advanced countries in the world!" When probed about the Japanese system, of course there is belly-aching and stories of abusing the system or slow bureaucracies - but no one ever says they wish there were no national insurance plan. And no, Japanese people are no more trusting of their government to run anything, much less health care. In fact, they are probably less confident in their government than we in the U.S., overall. The need for some sort of universal health care just isn't up for debate, though.

I am curious to hear other opinions. If you have my email, feel free to send me your thoughts. Posting in 'comments' is also good.