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(119,622 posts)
Tue Sep 19, 2017, 06:50 PM Sep 2017

Want a Better Health Care System? Check Out Japan

The country's public-private hybrid gets good results at lower cost.

By Noah Smith



So how is Japan doing it? What’s the secret of their success?

Japan has a hybrid system. The government pays 70 percent of the cost of all health procedures, unless you’re a low-income elderly resident, in which case it pays as much as 90 percent. The remaining 30 percent is covered by private health insurance -- either employer-sponsored or privately purchased. Spending on private health insurance to cover the 30 percent co-pay is partially tax-deductible. Benefits are the same for everyone, and -- unlike many U.S. health plans -- include dental and mental-health care. For catastrophic care, poor people, and people with disabilities or certain chronic conditions, the government pays more.

This is not that different from what Medicare already does. It has deductibles (unlike Japan) and fixed co-pays, for which many patients purchase supplemental “Medigap” insurance. Simply extending this policy to cover all Americans would leave the U.S. with a system not too different from what Japan has. The private insurance industry would continue to exist, and would supplement rather than compete with the government.

A single-payer system with substantial co-pays has several advantages. Most importantly, the government’s dominant position would allow it to push down the country’s anomalously high prices. In Japan, fees for health services are capped by a government committee, but this isn’t necessary -- simply having the Medicare system use its bargaining power to negotiate cheaper services could solve a lot of the country’s cost problem. The government can also use its bargaining power judiciously, allowing high prices for innovative treatments in order to encourage their development.

The high co-pays of a Japan-style system provide the government with a fiscal escape route. If high taxes prove to be too much of a burden on the economy, the co-pays could be increased, preserving the government’s negotiating power while reducing the amount of taxation required. Also, high co-pays would ensure a role for private insurance, preserving the knowledge and expertise of some fraction of the millions who currently work in that industry.


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Eliot Rosewater

(31,268 posts)
1. I dont like for-profit to be involved at all unless heavily regulated and then what is the
Tue Sep 19, 2017, 06:54 PM
Sep 2017

point in having them at all.

But this is surely better than what we have now, I suppose.

quite frankly Medicare needs to be revised so supplements from for-profit is not necessary nor should Part D be necessary.


(4,533 posts)
6. Japan has price controls
Tue Sep 19, 2017, 07:32 PM
Sep 2017

Doctors have a big book with the cost for services. Stitching up a cut up to 5 inches is X yen. 5 to 11 inches is Y yen etc. the cost for various medical scans is about ten percent of our cost. And all these costs are set to provide a fair profit. The Japanese use more hi tech treatment than we do. I think they go to the doctor more often. The average doctor meeting lasts 4 minutes. You can usually see your doctor today or tomorrow.

Almost every country has a mix of govt and private health care. In Canada they have private insurance for stuff their govt paid coverage omits, like our Medicare supplement policies.

Since a mix of govt and private works well in all major countries, Canada, UK, Japan, Germany etc I see no reason to automatically ban all private providers.

Eliot Rosewater

(31,268 posts)
7. Could be you are right. The less for-profit is involved the better.
Tue Sep 19, 2017, 07:34 PM
Sep 2017

I dont see why they have to be at all, but baby steps I guess.


(12,425 posts)
2. Way toooo easy and less money that can be graft to the corrupt
Tue Sep 19, 2017, 06:55 PM
Sep 2017

Will not happen in the USA because we like our corruption...


(51,846 posts)
3. Our country is NOT "progressive" as far as I see it!
Tue Sep 19, 2017, 06:59 PM
Sep 2017

If we were we would have had universal health care, equal rights, etc 50 years ago! No woman president, no women crafting the healthcare bills, people of color getting killed and the police who did it get a pat on the back, healthcare and college for the rich, etc. This country sucks!!!! Reagan and Fux News were the beginning of the end.
Yes, I am mad as hell and should be. ALL true patriots should be...but hell no, half do not even vote!


(18,675 posts)
4. I've tried the Japanese health system.
Tue Sep 19, 2017, 07:01 PM
Sep 2017

You always have a very long wait to see a doctor.
Also they don't give out pills.
They give you powders in a small envelope. You dump it in your mouth and then drink water quickly, hopefully before you taste the medicine.
Just my experience.


(90,444 posts)
9. There's long waits to see a doctor here!! I don't see why long waits is an issue any place on Earth
Tue Sep 19, 2017, 08:23 PM
Sep 2017

... other than a PCP which still takes me a couple of days at least.

Don't know about the powder medicine but if it does the same job and its 223423 the price of what we pay here I'd take the powder any day.

We need adequate right now, not good or perfect.

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