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Preface
- Johns Hopkins University Press
- Chapter
- Additional Information
I grew up and currently live in Japan, but I lived in the United States for about eight years. When I was at the Johns Hopkins University studying for my doctoral degree, I played softball on the political science team. Once, while running to catch a ball, I felt a sharp pain in my knee. It turned out that I had hurt a kneeligamentandhadtoseeadoctor.Atthattime,Iknewalmostnothingabout the American health insurance system. At the outpatient reception desk, a lady in front of me became upset and left the hospital, apparently due to a problem with her health insurance. In Japan, the first question a person is usually asked is, “Is there anything wrong with you today?” Only later would you be asked, “Could I have your insurance card?” In contrast, in the United States, one of the firstquestionsposedis,“Whatkind ofhealth insurancedoyouhave?” In Japan, there are many public health insurance programs. But no matter what health insurance program we belong to, we can basically get medical treatment by any doctor and in any hospital. In the United States, on the other hand,thehealthinsuranceyouhavedecideswhereyoucangoformedicaltreatment . As a Japanese man, I was puzzled by this. Patients do not have the freedom to choose their doctors and hospitals in the United States, where I assumed such freedom was guaranteed. Is American health care bad? Many Japanese friends who came to study at the Johns Hopkins University medical school have told me that it is not. American medical technology is the choice not only of scholars and professionals in the field of medicine but also of patients, including many affluent people and members of royalty all over the world. My wonderment at the American health care only deepened. My experiences in America provided me with a potential book topic: Why did Japan and the United States adopt the health care systems they have? I began to pay attention to one of the core elements of the health care system: healthinsurance. Preface x preface I belong to the school of American Political Development, which I would describe as comparative studies in the field of American politics. APD compares not only periods in U.S. history to one another but also the United States to other countries. Alexis de Tocqueville, who compared European countries, including his own country, France, and the United States, is often named as one ofthefirstAPDscholars.APDstudentsusecomparisontoseewhatcannotusually be seen. This approach inspired me, as a Japanese scholar, to study the development of health insurance in the United States by comparing it with the practice in Japan. As I wrote this book, Japan and the United States were both facing a considerable degree of pressure to reform their health care systems. Because of Japan ’s high longevity rate and low health care expenditures, some have singled out the Japanese health care system as a model of effectiveness and efficiency. But the situation is not so straightforward. In recent years there have been many reports on the lack of doctors at hospitals, particularly in the areas of obstetrics /gynecology and pediatrics. In August 2006, a pregnant woman in Nara Prefecture who had suffered a brain hemorrhage died in the ambulance after being rejected by nineteen hospitals.1 While such cases are still occurring, manyhospitalshavecloseddownbecauseoffinancialdifficultiesandtheshortage of doctors.2 The government is now facing pressure to deal with health care reform, particularly the shortage of doctors and low doctors’ fees. In his first policy speech on June 11, 2010, Prime Minister Kan Naoto said that his administration “will work to rebuild the medical system, and to secure medical care that inspires confidence.”3 On the other side of the Pacific Ocean, the United States also suffers from health care problems. While the United States has very high health care expenditures and perhaps the most developed medical technology, many Americans do not have access to quality medical treatment simply because they cannot afford it. Moreover, in the past few decades, even those with private health insurance have difficulties receiving the requisite care. Health care reform was one of the most important issues in the 2008 presidential election. OnFebruary4,2009,asoneofhisfirstlegislativeactsaspresident,BarackH. Obama signed a bill to add nearly $33 billion over five years to the State Children ’s Health Insurance Programs (SCHIP). He had followed through on his promises from the electoral campaign, suggesting that the legislation would be the first step toward universal coverage. Then, on January 27, 2010, in his State of the Union speech held in...