The White Peril 白禍

Here we go. This is hardly the beginning--there's been news like it at regular intervals for years--but the Ministry of Health, Labour, and Welfare (note the British u in that fourth word--this is a class-act, civilized country, you know) bean crunchers and number counters have estimated that total health expenditures in 2025 will be more than double what they are now: 69 trillion yen (about US $630 billion). That includes out-of-pocket payments by users but, naturally, mostly consists of Social Insurance premiums and taxes. The most quickly increasing sector is geriatric care, of course; it's projected to be half the total by then.

When people ask me what the health care system is really like over here, I never quite know what to say. Care for minor stuff is great; so is care for catastrophic illness. I've had friends who had heart bypasses and treatments for cancer that were, to judge from the results, first-rate. No, it isn't the Nirvana a lot of collectivists in America think it is: care for things that are significant but not life-threatening is seriously hit-or-miss. You have to work hard to find a good dentist. It's common to tell a GP that you've already tried aspirin for your fever and still walk out of his office with powdered acetaminophen. Treatments are often drawn out into short segments given over weeks or months. Part of this is because the traditional Asian view of how to restore health involves slowly and naturally prodding the life processes back into normal alignment.

But part of it is also that more visits help maximize revenue from patients who don't have many other options. Despite the long average life span here, the lack of transparency in operations (and deemphasis on personal responsibility and initiative) that create drag on the Japanese domestic economy are bad for the health care system, too. This article is out-of-date, but it compiles several of the cases that got the most publicity in the first few years I lived here. Since then, you get similar stories regularly: a sociopathic nurse in Sendai killed his patients by giving them heavy doses of muscle relaxant. Even though the frequency with which his patients worsened was such that his colleagues called him "Nosedive Mori," and he was using unprescribed doses of muscle relaxant that were missing from inventory, he seems to have kept this up for years. And then there's the "thank-you money" that people routinely give their surgeons in addition to the set fee.

None of this is to be interpreted as meaning that people are lying or incorrect when they say that Japan has good health care. It's just that you can't point to Japan and say that having a national health care system improves things over private insurance by ensuring better control and an orientation toward service rather than profit. Everyone knows that as the population ages, caps on care will change; it will be unpleasantly interesting to see how the revised MHLW rules play out as they move through the medical system in real time and on real terms.

I didn't know whether there'd be more to report about this: アルカイダ幹部が新潟に１年以上潜伏 (Key al Qaeda Member Hid Undetected in Niigata for Over a Year), but it looks as if for now, that's about what they know. He's Algerian-French and named Lionel du Mont; he was in Niigata from the end of 2002 through 2003 with his German wife. He went in and out three times (at least once on a false passport); he had a tourist visa, so he probably wanted to avoid crossing paths with the law by overstaying. His business was used cars, but it looks as if they suspect him of moving equipment and funding for al Qaeda.

I can't imagine how the government is all that surprised. Yes, the man was wanted, apparently, in connection with an attempted bombing at the G7 Summit in Lyons in 1996 (that's background in the article, not my encyclopedic knowledge of current events talking). InterPol was looking for him. But still, his passport was French, and people pass through Japan's international airports from Europe and Malaysia in droves every day. It looks as if they think he was helping to establish part of the network here. Lovely. He was apparently arrested in Germany at the end of last year, so I hope they're getting some information out of him.

So just how badly off are all those welfare states in which wage-earning citizens sacrifice their crass individual goals for the good and harmony of the collective? You'll have to find out about Sweden from someone else; the situation here in Japan is enough to make anyone my age (32) consider keeping his nest egg as a shoebox full of gold nuggets. It's not enough that the population is aging. It's not enough that money paid into the Social Insurancephalopod is mismanaged. (At least it isn't diverted into a thinly-disguised government slush fund, the way savings accounts through the Postal Service are. Actually, come to think of it, maybe it is. I'm probably better off not knowing). We also have pervasive non-payment of premiums (link to Japanese article as usual--sorry if you're not Amritas).

Those of us who work for corporations have the money taken directly out of our wages (like FICA), but the self-employed and students of at least twenty years old have to pay in themselves. Now, of course, most people do work for corporations, so in the grand scheme of things, the amount of money that's being lost is not as great as the "Non-payment of Social Insurance Pension Premiums Still Near Worst-Ever Level of 37%" headlines make it sound. Even so, I agree with the media that it's an indication of how little people have come to trust the pension system, for all the hot air about reform.

I have today off, so I went out last night and flirted shamelessly while getting schnockered enough to be hung over this morning. Mark you, there was nothing self-indulgent about this: I was preparing for a round of bureaucratic errands (reregister domicile in new ward of city, reregister name seal in new ward of city, renew passport at embassy, change address at banks and credit card offices) that began at 9 a.m. sharp. The hangover was necessary to dull my irritation at the inevitable snags that come up in a full day of filling out forms at government agencies. The shameless flirting was necessary to practice the people skills you need to deal smoothly with functionaries. The woman behind the passport counter did not, it is true, lean in and ask, "So, dude, is the rest of you as hairy as those forearms you've got there?" But let me tell you, I'd've been ready to answer with aplomb if she had.

Speaking of functionaries: as much as anyone else, I go in for orgies of complaining about them when they're surly or clueless. But I have to say that everyone I dealt with at the embassy today was just great. The man at the next window had what sounded like a legitimate gripe about the way his passport renewal was being processed. He made his displeasure clear, but he was polite about it and didn't blame the guy behind the counter. The guy behind the counter, for his part, apologized profusely and made sure the poor man knew exactly what needed to happen for his passport to be done as quickly as possible. There's a lot that I value about Japanese politeness; as long as you act like a civilized person, you don't really have to mean it, and that understanding can make difficult situations much easier. You deal with what people say and do and don't get worked up over what you assume they're thinking. But as an American, I have to say that it's a beautiful thing to see forthright goodwill in trying circumstances. It made the rest of the day much easier to deal with--how many times can you write your address in six hours before cracking, after all?--even after the hangover wore off.