Thursday, April 10, 2008

The Nose Knows: My Take on the Politics of the Late-Term Elderly Medical Care Insurance System Rollout

Anonymous said...

If you can pull your nose out of the comics for a minute, I would be grateful if you would comment on the possible political effects of the new changes in Japan's health care payment regime.
My understanding is that the elderly now have to pay more and their families have to shoulder more of the burden of taking care of their aging family members.


Mon Chére Anonyme:

There is too little media attention to determine the political impact. If anything, the lack of attention means that the impact will be small. To make it count in the next House of Representatives election, the DPJ must place it in the context of a larger program for healthcare reform that addresses the long-term solvency of the system. That in turn requires a full-bore challenge against the ruling coalition over the future of public finances and ultimately the future of the nation. The Fukuda administration has set the stage for just such a showdown after the summer holidays, but is saddled with the ruling coalition and the vested interests behind it. Here, the DPJ has much greater room to maneuver, due to its opposition status and the relatively ideology-free nature of domestic policy.

As it is, the DPJ appears to think that grabbing anything that they can get their hands on and worrying about the consequences later is good campaign strategy; I don’t. As the pattern emerges, the media buys into the notion of an unprincipled opposition party whose sole interest lies in pushing the ruling coalition over the brink. As this narrative takes root in the public’s mind, the political benefits from the failings of the ruling coalition - and they are many, both procedural and substantive - accrue only to None of the Above. I expect the media to be similarly unsympathetic, indifferent at best, to the latest DPJ gambit to connect the public pension scandals to a cancellation of the new Late-Term Elderly Medical Care Insurance System, as it is called.

This reminds me to give you some of what I believe are the reasons for the relative media indifference.

First of all, the Late-Term Elderly Medical Care Insurance System was enacted as part of the 2006 overhaul of the public healthcare system, and only now has gone into effect, as of April 1, after two years of preparations. Without a new context, it is yesterday’s story. The media cares little unless there is widespread confusion or negative outcry at the rollout. My guess - I am admittedly reaching here - is that the public will get over it relatively easily, albeit with minor grumbling. Some individuals for whom very small pensions are their sole or main source of discretionary spending money can feel a very, very sharp pain, but the provincial governments, which have the primary responsibility to administer the system, should, as a rule, be instituting measures to subsidize those most unfortunate souls*.

Moreover, it does not appear to have been a make or break issue for the DPJ in the first place. The DPJ did resist it as well as the other parts of the package; but, as was the case with its more consequential challenges against the ruling coalition - extension counterterrorism operations in the Indian Ocean and the Gulf, and the gasoline tax surcharge retention - it did not bother to put the matter in its Policy Manifesto for the 2007 House of Councilors election. This is striking in light of the attention that the Manifesto gives to the related but separate Long-Term Healthcare Insurance System. Have I missed something here?

Finally, there is the issue’s enormous complexity and interconnectedness. Publicly-funded healthcare is the most arcane and geeky part of the bureaucracy. (It budgeted two years of preparations for the implementation of its latest innovation!) It is unreasonable to expect a mainstream journalist on a one or two year tour of duty at the Ministry of Health, Welfare and Labor to master much more than the talking points that the bureaucracy and its opponents feed them. The media need something that they can understand before they go back and spend time with what is after all a two-year old story. Now let the elderly keep their pension is admittedly an uncomplicated battle cry. But the media by now has a larger, unflattering narrative for the DPJ that would supersede it. And when the matter is swept up into a broader opposition outcry for scrapping the system in the first place, the media would, if anything, rightfully ask, yes, but what then?

I have placed the issue within my own frame of reference, namely: The DPJ under Ichirō Ozawa is following a make-it-up-as-we-go-along-bribe-‘em-with-their-money strategy, so the LDP is losing but the DPJ is not winning. This is broadly similar to the Economist’s most recent take*, but I’m aware that there are people out there who do not agree with it.

* Regional disparities have been given some attention but they have always existed. I suspect that there is a noticeable, negative correlation between the level of insurance premiums and the average age of the local population. Incidentally, that’s useful to keep in mind when talking about devolution of power. Elective officials in marginal and other aging communities will be strongly incented to feed the present by starving the future.

**In fact, I have some grounds to believe that I actually influenced it. Not only are the broad contours similar, but the Economist piece also features a reference to the Manifest. I’m not aware of anyone else in the blogs, media or the DPJ who has the habit of checking the DPJ’s claims off its Manifesto.

There you are, Mon Cherie.


MTC said...

Okumura-san -

Was not the imposition of the elder care system delayed one year, I believe with the encouragement of the New Komeitō, in order to prevent the program from becoming an issue in the July 2007 House of Councillors election?

Or am I thinking of another program?

Jun Okumura said...

You must be right, MTC. Make that one year. Can't get anything past you, can I?

In any case, it's been two years. We'll see if anyone at the kisha club remembers enough to see past the spin.

Anonymous said...

Mon Dieu!
C’est mon cher ou ma chére.
C’est ma chérie.

Jun Okumura said...

I am verie sorrie, ma chérie.

Anonymous said...

You might have lost a comic book, maybe left it at your stop in Kabukicho, as you do wax on about it. Ah, but another excuse to return.

On the topic of Manifestos it is interesting to note that Kan Naoto's DPJ Manifesto lists as pleges:

Five Pledges
■ Completely abolish the “tied grants” distributed by central government within four years.
■ Ensure complete disclosure of political donations.
■ Abolish the Japan Public Highway Corporation within three years and make all motorways
outside of major urban areas toll-free.
■ Reduce the number of Diet members and civil service labour costs by at least 10% within
four years.
■ Cancel unnecessary public works projects, and immediately stop work on the Kawabegawa
dam, the Isahaya Bay land reclamation project and the Yoshinogawa moveable dam.

Now, Ozawa's Manifesto is just a list of vague platitudes. Maybe we should look at the first Manifesto.

On the issue of pensions and health care it says:

We will create a reliable pension system that can be trusted by both current and future generations,
by using such means as transforming the basic pension into a tax-based system. We will protect
our nation’s elderly by constructing more group homes that will form the focal point of community
nursing care. We will reduce the portion of child medical expenses borne by the individual to 10%
until graduation from elementary school, require the release of medical records if requested by the
patient, and increase the transparency of the consultation fee revision process.

I am not sure what I am more surprised by: the lack of depth or substance in Ozawa's manifesto or the "success" of the Kan one.


Jun Okumura said...

Actually, I'm quite impressed with the full DPJ Manifest under Mr. Ozawa. But the party had to choose items to highlight that it (Mr. Ozawa?) thought would be most appealing to voters in the 2007 House of Councilors election. Perhaps the choices could have been improved on, maybe something was lost in translation. But you certainly have a point. Compared to the snappy, to-the-point straight talk from Mr. Kan and his younger DPJ colleagues, Mr. Ozawa's pontifications are often vague and meandering.

My main beef with the DPJ is, and I never pass up a chance to say it, that the DPJ went away from its manifest to chase after the issue of the day. I think that because of this, they've been backsliding as far as political credibility goes, even as the ruling coalition and the Fukuda administration reels from a series of policy failures and public communication mishaps.