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Introduction
- Johns Hopkins University Press
- Chapter
- Additional Information
Approximately fifty million people died in World War II. Yet, despite this massive devastation, the war was also responsible for policies that would improve the health of people. World War II forced nations like Japan and the United Statestorealizethathealthysoldiers,workers,mothers,andchildrenwerevital for their survival. Health insurance, which assured people’s access to medical care, became a means of building up national strength in wartime. Whereas before the war, Japan and the United States lagged behind major European countries in terms of health insurance coverage, by the end of the postwar reconstruction both had become much closer to being the forerunners. That relationship , between total war and health insurance in Japan and the United States, is the focus of this book. Thetermtotalwardescribestheconditioninwhicheveryaspectofthecountry comes under the influence of the war. In such circumstances, governments pursue comprehensive economic and social policies for war mobilization. Before the twentieth century, it was mainly the professional soldiers who fought wars, while the rest of the population remained relatively untouched by the government’s mobilization activities. With the advent of total war, such as in World War II, military conflict had a profound effect on nearly all parts of the economy, society, and politics. The question this book explores is: How did World War II shape the health insurance systems of Japan and the United States? Both countries increased their health insurance coverage during the war and in the postwar reconstruction . In the total war of World War II, wider human resources and materials Introduction 2 war and health insurance policy in japan and the united states were mobilized, and health insurance was connected with national security in both countries.1 The government found health insurance useful for enhancing war mobilization, and the war allowed the government to have more power to expand health insurance coverage. The wartime political, policy, and ideological changes were so great that they also affected the development of health insurance during the postwar reconstruction. While both Japan and the United States expanded their health insurance coverage, they adopted different health insurance systems.2 This discrepancy resulted from the variations within the total war and the postwar reconstruction . In 1952, when the U.S. military occupation of Japan ended, Japan had a health insurance system that was predominantly public and was composed of multipleprograms.Incontrast,whenPresidentHarrySTrumandecidednotto campaign for reelection in 1952, the United States had a health insurance system that relied greatly on private health insurance. I claim that these different outcomes resulted largely from the dissimilarities between the two countries’ war experiences, such as the duration and depth of mobilization, the sequence of the war, and the result of the war. All these factors greatly influenced what kind of health insurance system developed in each country.3 It was during the period under study that Japan and the United States consolidated the developmental path of their health insurance, public-dominant in the one and private-majority in the other. After the American occupation ended, Japan achieved universal coverage in 1961. The basis of its health insurance system has remained the same up to the present day. The central government directly administered a program for workers in small companies, which targeted 27.7% of the population in 2006. About 3,400 insurers, including municipalities (1,835) and firm- or occupation-based mutual associations (1,561), provided public health insurance coverage for other citizens.4 The Ministry of Health, Labor, and Welfare (formerly the Ministry of Health and Welfare and the Ministry of Labor) plays a role in supervising these programs. On the other hand, among OECD countries, the United States is the only industrialized country in which the government does not guarantee universal health insurance coverage for its people and in which a significant segment of the population relies on private health insurance. Although two major public health insurance programs, Medicaid and Medicare, were created in 1965 for the poor (12.9% of the population in 2006) and the aged and the disabled (13.6%), respectively, private health insurance is the main component of the American health insurance system. In 2006, 67.9% of Americans were enrolled in private health insurance programs. But there is a large segment of the [18.212.102.174] Project MUSE (2024-03-28 23:49 GMT) introduction 3 population that neither public nor private health insurance covers: about 47 million people (15.8%) remain uninsured.5 What happened from World War II to postwar reconstruction influenced what...