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News of the Day ... In Perspective

1/15/2007

Japanese cancer patients decry limits of "universal" system

According to legislator Takashi Yamamoto, who was just diagnosed with cancer, “abandoned cancer refugees are roaming the Japanese archipelago.” Patients are told they’ll never get better, even when treatments exist, and many are not even informed of their diagnosis.

Japanese public television showed the stark contrast. In the U.S., multiple specialists meet to discuss a cancer patient’s care. In Japan, a single doctor usually makes the diagnosis and carries out treatment with minimal consultation.

Galvanized by a speech by Yamamoto, the parliament passed a bill calling for more cancer specialists and a permanent role for patients in policymaking.

But while patients want American-style treatment, policymakers are alarmed. With a huge national debt and corporations worried about higher taxes, they say Japan can’t afford to pour money into treatments that can’t extend lifespan by very much.

“America did too much of this and that’s why their medical costs have grown,” said Masaharu Nakajima, a surgeon and former director of the Health Bureau at the Ministry of Health, Labor and Welfare.

Since Japan enacted universal health insurance in the early 1960s, the emphasis has been on a minimum standard of care for all. People must pay a monthly health-insurance fee, and large companies pay also. Coverage decisions, doctors’ pay, and other rules are largely set by the central government.

Medical spending in Japan is around 9% of the GDP, compared with 16% for the U.S., and is lower than in most Western European countries and Canada.

The average physician’s income in Japan is about half as much as in the U.S., and last year was cut by 1.36%, on top of a similar cut in 2002. Japanese doctors complain that they have no time to spend with patients. The experience of seeing a popular doctor is summarized as “a three-hour wait for a three-minute visit.”

Cancer mortality rates in Japan have been steadily climbing and are now more than 250 per 100,000, while U.S. rates are declining and are now around 180 per 100,000.

“Our rights as individuals are not being recognized,” stated lung cancer patient Hidesuke Hashimoto. Mr. Hashimoto, a former math teacher, undertook to study his options on his own, moving along to a different hospital when told there was nothing more that could be done, and sometimes paying out of pocket (Peter Landers, Wall Street Journal 1/11/07).

Commenting on the Wall Street Journal article, Craig Cantoni, a columnist in Scottsdale, Ariz., writes: “Like nationalized health care in other countries, the Japanese system is based on the premise that the state owns your body.” Therefore, “the state can dictate what medical care can be withheld from you, either by policy or by making you wait so long for care that you die in the meantime.”

A dysfunctional American market is not a justification for the change in ownership. “Nor is [it] justified by the fact that Japan spends about half as much per capita on health care as the United States, or by the fact that the Japanese have a longer life expectancy.”

Cantoni warns that if rights are taken away for reasons of efficiency or cost, “no right is safe from do-gooders and busybodies, from politicians and bureaucrats, and from the tyranny of the majority.”

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