Let me start with the conclusion: I get treated medically same day (literally – sometimes same hour) for barely no fees in Japan with a speed I have never seen anywhere else on the planet. All hospitals in Tokyo treat me like a prince when I walk in, they all welcome me with a smile and polite greetings, and take care of me with the kind of service and attention you barely would expect when you walk into a high class French luxury restaurant in an expensive hotel in a big city. All for the equivalent of a couple of dollars.
I can hear the NY Times journalists and other quack economists shouting already, yes but the weather in Asia is different!, in Japan surely central planners ban profits!, it is thanks to the fact that government controls and limits doctor fees! it is the health ministry which fix prices! Complete and total non sense. Japan’s healthcare is privatized. End of the story.
And not privatized like the complete and appalling mess they have in the US, where tremendous and outrageous government regulations unfairly help keep poor patients completely captive of rich doctors (and/or of too big to ever fail insurance companies).
Here is the way it works in Japan, 30% of the medical fees (for people my age, for older people it is kept at 20%) will come out of the patient’s pocket on the day of the visit (think of it as a co-payment for the visit), while 70% of the fees are billed to the patient through taxes (i.e. the doctor bills 70% to the government who then bills 70% – plus the government’s commission of course – to the patient back through taxes). Said differently “30% is private and 70% is public”. The co-payment is so cheap (10$? 20$?) that nobody even notices. Sure, with 70% of the activity managed by the central planning government, you still get a lot of irregularities here and there in the system, you will hear stories about paramedics being in slightly insufficient number one day in some remote hospital, or you may hear about how high and useless government regulations for OBGYN making pregnancy a somewhat costly experience. Every country has its challenge and its bureaucracy.
But in reality the whole system in Japan works surprisingly well and the patients are in full control of the industry. All doctors in all hospitals are exactly where they should be. 30% of co-payment is all it takes. In fact, even 5% of co-payment, perhaps 1% of co-payment would suffice plenty enough to give the right economical “signal”, and feed with a correct “indicator” as to where to assign which doctor when and to what department. Allocation of capital is optimized and as a result not a single building or department or nurse, in fact not a single seat is where it is without a real purpose. All resources (human, tools, etc) are all precisely where they need to be, hospitals seldom overbuy big machinery for nothing, in fact if anything hospitals seem to all manage to do very well with all of the very finest and latest equipment in all departments. And all of them somewhat manage to turn in profits. And listen to this, Japan has a system that costs half as much and often achieves better medical outcomes than its American counterpart, even though Japanese patients visit doctors on average 15 times a year (versus 3 for Americans). Japanese have nearly twice as many scans as Americans do. Japanese insurers are also a lot more accommodating than their American counterparts, in fact I still have to see or hear them deny a claim – they all have to be quite careful with their reputation.
In Japan the healthcare fees are so cheap – I could most surely pay for my friend’s fees if I wanted to. In fact, I probably could even pay for healthcare for the homeless, if I made an effort.
Also, for those who still doubt, by the numbers:
- Japan life expectancy: 83 years
- Japan total health spending as a percentage of GDP: 8%
Instead of forcing patients to pay through taxes, patients have the right to (at least up to 30%) freely choose their doctors and pick their favourite hospital.
This in return:
- Forces Japanese doctors to keep prices very low (on all services and on all drugs as well)
- Invites all Japanese people to pay some attention to what they eat (or how much they walk every day, etc)
- Creates a strong incentive for all in the country to be somewhat careful with money, and not burn all of life’s early savings immediately on a useless noisy SUV or on endless greasy burgers.
Also, the math is amazing, for even if Japan has one of the biggest aging population around the world, it holds the lowest per capita health care costs among the advanced nations of the world, and its population is thought by many to be the healthiest.
Let’s talk about Canada for a second. I hear (correct me if I’m wrong) it takes today something like 2 to 4 months just to get to see a basic doctor in Canada – unless of course, “you know someone who knows someone”. If you know what I mean. You do not. Let me rephrase this last bit then. Unless you are “rich”, and you have “rich” friends, who are friends enough with “rich doctors” to ask for favors. Two… months for poor people with no “personal” connections to see a doctor?!? Waiting even just “one single day” to get to see a doctor in any civilized country makes no sense to start with.
What is this. The Soviet Union? The Third World?
People need… months? Not weeks. Months? And as in, like… “many & several” months? Rumor also has it that when you walk into a hospital in Canada it sometimes feels as if you have to wait several minutes before someone will start greeting you, or you may have to wait for a bit inside the waiting room until you get to first chat with the doctor, and that it sometimes feels as if not a single paper registration procedure has been optimized for decades. People should be on their knees begging for an improvement.
Central planned government managed socialized tax based national healthcare medicine services (call it what you will) maybe worked once or twice in some movie somewhere in the past, but in real life it just cannot function, mathematically it is impossible, it did not work in the USSR in 1950, it is not working in Canada today (at some point people will need to start facing it), and it would not work if you were to try it in Africa in the year 3,050.
The Fatal Conceit of Single Payer is on life support – time to pull the plug.