War and Health Insurance Policy in Japan and the United States: World War II to Postwar Reconstruction by Takakazu Yamagishi (review)

Judging from the political debates in developed countries in the last generation, policymakers now think the welfare state has become something to be reexamined or even challenged, rather than something to be maintained. This change of attitude is due to many factors: the aging of the population, slower economic growth, the soaring cost of medicine, and recurring economic crises that now seem almost structural. Academic discussion on welfare policies has accordingly flourished and is now a large industry, which political science, economics, history, philosophy, and many other disciplines have joined. Historical investigation and international comparative analysis are two major approaches among the forces in the field, and Takakazu Yamagishi’s War and Health Insurance Policy in Japan and the United States has combined those two methodologies to produce a sharply focused, beautifully constructed, and clearly argued explanation of the historical making of the systems of medical insurance in Japan and the United States. In so doing, the author has emphasized the importance of World War II to both countries and the different meanings of the “total war” to their health insurance policies.

Generally speaking, history matters to the present of health care systems, and international comparison highlights the similarities and differences in medical policies. Yamagishi’s choice of Japan and the United States during World War II is clever because they share the same temporal framework in the making of health insurance policy but differed sharply in what they achieved. For both Japan and the United States, World War II was a crucial period: their health care systems were rapidly expanded and transformed into very different shapes between 1937 and 1945. Before the war, both nations were latecomers in terms of medical insurance compared to European countries. While England had achieved a fairly wide coverage of its population through medical insurance (43.1 per cent) by 1937, the corresponding figure was 9.3 per cent for the United States and 5.4 per cent for Japan. During the war period, both countries quickly developed their medical insurance systems, Japan reaching about 70 per cent coverage in 1944 and the United States about 30 per cent in the same year and growing to around 70 per cent in 1952. Japan and the United States built starkly different and almost opposite medical insurance systems, despite their development over the same period: Japan constructed a public health insurance system, while the United States opted for private health insurance. They continued to differ after postwar reconstruction, which is remarkable given that Japan was occupied by the United States for seven years after the war. This book analyzes how the war influenced the health insurance systems in Japan and the United States in an almost irreversible fashion.

The total war is thus the focus of Yamagishi’s book. Total war increased the power of the government in terms of medical policies, tilting the balance of power between the government and medical practitioners toward the former. Associations of medical practitioners, such as the Japan Medical Association and the American Medical Association, which had resisted the introduction of insurance systems as damaging the autonomy of medicine, temporarily withdrew their resistance during the war because medicine (and every aspect of the nation’s life) was turned into a matter of the defense of the nation. Securing people’s health through increasing access to medical care was crucial for healthy soldiers, productive workers, and numerous births. Such concerns should be prioritized—the wartime public maintained—over doctors’ interest in professional autonomy or, worse still, in their own profi t: as an article in a Japanese newspaper expressed in 1939, “[medicine] belongs not to doctors but to the public” (p. 66).

Both Japan and the United States thus went through a period of rapid growth of the medical insurance system during the war. They shared one crucial factor...