Dr. Tomohiko Murakami

Here is this week’s Media Mix, which is about the government’s difficulties in cutting medical expenses. Before anyone starts citing the column as proof that universal health care doesn’t work, keep in mind that, strictly speaking, Japan’s national health insurance system isn’t universal. Yes, everyone has to participate, but everybody has to pay taxes, too, and the insurance system is set up more as a tax, meaning you pay into the system what you can afford to pay. And because people pay in this way, they think they should get as much out of the system as they can, meaning treatment for even the smallest infirmity. That’s why everyone goes to the doctor when they have a sniffle. The government has been trying to discourage this kind of situation, especially among old people who look upon the medical system as some kind of social club, but whenever they game the system to penalize people for using it indiscriminately the media takes the side of the public and says the government is trying to kill people. Doctors couldn’t be happier, because that’s how they make money.

In the column, I also mention that more conscientious doctors believe the health care system as it’s operated in Japan also discourages preventive care, since the focus is on treatment of existing ailments. In a way, this problem manifests itself in the inordinate number of old people who are bedridden. The media, strangely, has never questioned this phenomenon, and act as if it’s normal for people to spend their waking hours prone after they turn 75. Active people in their 80s are celebrated as being superhuman, which is even odder considering that Japan’s longevity rates are the envy of the world. This approach to illness as something that happens out of the blue undermines the efforts of health maintenance professionals who try to convince the public that they will be not only healthier but happier if they take care of themselves.

This media mindset was illustrated in an interesting way in Dr. Tomohiko Murakami’s book, which I mention in the column. Murakami was the head of the city hospital in Yubari, and became infamous in June 2010 when the national press blasted him for refusing an ambulance’s request to bring a man to his hospital. At the time, such stories were being reported all over Japan, the result of cutbacks and other fiscal difficulties, but the media treated them all the same: monolithic medical institutions couldn’t be bothered with treating some people, even when they required emergency help. The reports implied that the Yubari man died of cardiac failure because he wasn’t treated, but as Murakami explains in the book, the man, a suicide, was already dead. The ambulance simply needed a doctor to declare him deceased, but at the time Murakami had his hands full with living patients since he was the only doctor on duty.