How They Are Doing: Akira Nagatsuma

Now, one of my big misses:

I predicted that he would be a headline generator for the Hatoyama administration. And he was. For a while. For the most trivial of reasons, as well as a more serious flap over the Late-term Elderly Medical Care Insurance. But the news cycle quickly shifted to meatier issues such as Futenma threatening to cast a pall on Japan-U.S. relations, the campaign promises that threaten to break the bank, and, of course, the laborious process of setting up operations (including the inevitable Ozawa questions), leaving Nagatsuma to toil away in relative quiet.

That said, Nagatsuma’s own actions have helped deflect media attention keep the spotlight off his turf. He has genuinely recognized his shortcomings—basically, a lack of any experience in the field except his admittedly substantial investigative efforts—and made a conscious decision to reach into the bureaucracy to learn the explore the territory before striking out on his own.

Nagatsuma showed good judgment on the Late-term Elderly Medical Care Insurance System as well. As the DPJ looked to ways to fulfill its campaign promise to scotch Late-term Elderly Medical Care Insurance, the local governments threatened to revolt over yet another makeover only a couple of years into the new system. In the first place, the unpopularity of the Late-term Elderly Medical Care Insurance had stemmed not from any major flaws in its substance but from trivial complaints* that a bad rollout plan (or lack thereof) had been magnified in the media glare against a background of resentment and mistrust toward the Ministry of Health, Labor and Welfare. As an effective anti-MHLW crusader for the DPJ—his pursuit of the missing pension accounts scandal was arguably the single most important factor in the DPJ takedown of the LDP-Komeito regime—he carried none of the political baggage of his LDP predecessors. Thus, when he quickly backed away from the situation and tabled the matter for future action—most likely as part of a more thoroughgoing reform of the national healthcare insurance system—there remained no substantial vested interests to demand a return to the old system and hence little media attention to the issue. The long-term issues remain, but, at a minimum, he’ll have the rest of this Hatoyama administration’s term to work out a plan—with the cooperation of the bureaucracy.

Of course Nagatsuma’s portfolio is only one lethal genetic mutation away from being overwhelmed with a swine flu pandemic. Which brings me to another point: He is likely to have his hands on the MHLW portfolio for the next 3-4 years—more than enough time for health-related catastrophes large and small to occur. His leadership and communications skills will be tested, when everything will turn on his command of his troops. The much-maligned MHLW has, in the public eye, performed with few miscues on swine flu up till now, so it is to his credit that he has worked to play down his reputation as an MHLW nemesis.

* 1) The name “Late-term Elderly (後期高齢者)” was deemed callous and disrespectful.
2) Deducting the premiums from their public pension checks was deemed callous and disrespectful. But this actually affects only the cases where a) someone else (the oldest son?) other than the beneficiary is paying the premium and b) that someone decides to take the opportunity of the switchover to stop doing so.
3) There were complaints over higher premiums. But they actually fell on average, though they did rise in some municipalities because local subsidies were dropped in the switchover to management at prefectural levels.
4) The new system caps the transfer from the rest of the national healthcare insurance system. This means that the (currently very low) copayments will rise for the elderly as the population ages. This figured less in the public outcry than the trivia, though, most likely since otherwise the DPJ and the media would have had to present alternatives.