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Reviewed by:
  • Health Care Issues in the United States and Japan
  • John Creighton Campbell (bio) and Naoki Ikegami (bio)
Health Care Issues in the United States and Japan. Edited by David A. Wise and Naohiro Yashiro. University of Chicago Press, Chicago, 2006. ix, 258 pages. $65.00.

The American health-policy expert William Glaser once remarked that the United States has the best health economists in the world but the worst health care system; the question is, which caused which? Japan has few health economists and one of the best health care systems in the world, making it a good subject for comparative study.

Health Care Issues in the United States and Japan begins promisingly. The introduction by David Wise makes the familiar points that Japan spends only half of what America spends on health care but Japanese are considerably healthier by most measures. These points "raise all kinds of questions about how the health care systems operate differently in the two countries, and how these operational differences relate to health care quality, costs, and outcomes." In particular, "in both countries, the rising cost of health care presents important financial challenges. Indeed, aging populations and rising health care costs are motivating health system reform throughout the world" (p. 2).

A book that addressed these questions via concrete U.S.-Japan comparisons would be a landmark contribution. As well as being interesting aca-demically, such a book could offer lessons for Americans interested in how their country might provide universal and equitable access to high-quality medical care and save money at the same time, as Japan has done. Unfortunately, this is not that book. The authors seem more interested in what Japanese health policymakers might learn from the United States. For example, there is this from Wise's introduction: "The major reform proposals include standardization of medical treatments, partial replacement of public health insurance with private health insurance, introduction of a partial managed care system, and introduction of for-profit hospitals to stimulate competition" (p. 3).

These have indeed been suggested in Japan, and they are all familiar in the American health economics literature. More broadly, these proposals are a component of the reform campaign that has dominated Japanese policy discourse ever since the "administrative reform" era of the early 1980s. Economic regulation, corporate management, labor relations, public administration, and practically everything else are all dominated by the same narrative: the situation in Japan is a social and economic crisis; the problem is old-fashioned Japanese ways; the solution is "the market"; the exemplar is America; and the people to listen to are neoclassical economists. [End Page 133]

The question is, does this view—whether it is appropriate for other issues—make sense in the realm of health policy? Health economists in both the United States and Japan tend to say yes, based on their principles and theories. We look at the record and say no.

We can illustrate the disagreement by commenting on the key chapter in the book, "Evaluating Japan's Health Care Reform of the 1990s and Its Efforts to Cope with Population Aging," by Naohiro Yashiro, Reiko Suzuki, and Wataru Suzuki. Yashiro has been a leading reformist critic since leaving the Economic Planning Agency in 1992. He has written widely on edu-cation, labor, regulation, pensions, and so forth as well as on health care, consistently calling for market-based reform. Today he is one of the most influential economists in Japan as a member of Prime Minister Abe Shinzo¯'s key policy body, the Council on Economic and Fiscal Policy.

The first move for Yashiro and his coauthors is to proclaim a crisis: "it is obvious that the current health care system cannot cope with a rapidly aging society" (p. 17), and "medical expenditures as a share of national income in Japan rose from 5.9 percent in 1990 to 7.9 percent in 2000, despite the economic stagnation" (p. 25). Both statements are off base. First, the current health system has already shown it can cope with a rapidly aging society. From 1980 to 2003, the elderly (over age 65) share of the population grew from 9 to 19 per cent. Total...

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