War and Health Insurance Policy in Japan and the United States: World War II to Postwar Reconstruction

3 Creating a Public Health Insurance System: Japan, 1937–1945

In July 1937, the Marco Polo Bridge Incident opened the battle between Japan and China. Subsequently, by its attack on Pearl Harbor in December 1941, Japan started a war against the Allied Powers. In Japan, the periods before and after Pearl Harbor have often been considered separately; the former is often called the (Second) Sino-Japanese War, and the latter is called the Pacific War. While this book sees the difference between these two phases in terms of the degree of war mobilization, it recognizes the continuity of these two wars and calls them together World War II. Some scholars also argue that not the Sino-Japanese War but rather the Manchurian Incident of 1931 was the beginning of Japan’s World War II. After this event, the Japanese military invaded Manchuria, the northeastern part of China, and established a puppet government. Scholars who take this view call the series of the wars that eventually ended in 1945 the “fifteen-year war.”1 They assume that although the Tanngu Truce of May 1933 resolved the Manchurian Incident, Japan did not end its aggressiveness and combat readiness. Although this book does not completely disagree with the viewpoint that there was continuity before and after the Marco Polo Bridge Incident in terms of the government’s war preparation, this book takes the position that it was not until the Marco Polo Bridge Incident that the Japanese government took seriously the possibility of a full-scale war against China. This chapter begins to demonstrate how the Marco Polo Bridge Incident opened a window of opportunity for health insurance legislation. Creating a Public Health Insurance System Japan, 1937–1945 chapter three 54 health security as national security achieving moderate reform, september 1937–june 1940 When the Japanese government began the preparation for a future war with China in the mid-1930s, reform bureaucrats (kakushin kanryo) and military officers started to call for the expansion of public health insurance to improve the healthofthepeople.Then,in1937,theSino-JapaneseWaroccurred,andthegovernment gained the ability to turn its policy preference into actual policy. Although the war with China opened a window of opportunity for the government tointroducenewhealthinsurancepolicies,thepolicieswerenotradicalbutmoderate measures. That was largely because the Japanese government projected thatthewarwithChinadidnotrequireasubstantialchangeinhealthinsurance. The Empowered Government in Health Care The Manchurian Incident and the establishment of the puppet Manchukuo government isolated Japan from the international community. In 1932, in response to the Republic of China’s appeal, the League of Nations dispatched the Lytton Commission, led by Victor Bulwer-Lytton, 2nd Earl of Lytton, to Manchuria . In October 1932, the Commission released the Report of the Commission of Enquiry into the Sino-Japanese Dispute, in short, the Lytton Report. Although this report admitted some of Japan’s rights and legitimacy to be in Manchuria,itsuggestedthatManchuriashouldbemadeanautonomousregion under the sovereignty of the Republic of China. Because Japan hoped to make the State of Manchukuo internationally recognized as an independent country, Japancouldnotacceptthereport.InFebruary1933,MinisterofForeignAffairs MatsuokaYosukewalkedoutoftheassemblyhalloftheLeagueofNationsafter opposing a resolution condemning Japan. In March 1933, Japan made a formal announcement to withdraw from the League of Nations. In addition, Japan’s withdrawalfromtheLondonNavalTreaty,whichregulatednavalshipbuilding, furthered Japan’s international isolation and reflected its serious intention to expand its military capacity. While Japan’s international isolation continued in the mid-1930s, the government became more serious about preparing for a possible large-scale military conflict with China. Some bureaucrats and military officers began to focus more on human resource problems because the war with China would require enlisting more recruits for the military. During this war preparation period, health care and war mobilization were connected. creating a public health insurance system 55 As an example of this connection, there emerged a movement for a new ministryforintegratinghealth careadministration andimprovingthehealth ofthe people. The Ministry of War was one of the first groups that advocated the creation of this new ministry. In the mid-1930s, the Ministry of War developed an interest in the health care issue, particularly after it confronted the shocking results of preliminary conscription physical examinations: more men had failed the exam than in the previous decade.2 Figure 3.1 shows that the proportion of men who were unfit for military service remained above 35%. Moreover, an event in the mid-1930s sent an early warning to the Army, which had dispatched two divisions to Manchuria. Of these, one battalion of about five hundred soldiers had to be sent back to...