“Because it’s good for you.”
Money quote: “A low thigh circumference seems to be associated with an increased risk of developing heart disease or premature death.”
Showing posts with label public health. Show all posts
Showing posts with label public health. Show all posts
Saturday, September 05, 2009
Friday, June 05, 2009
Containing Novel Influenza (A/H1N1): A Success Story Buried under the Rubble
A rare success story for the beleaguered Aso administration has been its response to the Novel Influenza (A/H1N1). When the news of the virus broke, the authorities quickly set up border checkpoints (it helps that entry points are limited, Japan being an archipelago) and bought time with them while they geared up the domestic response mechanism. When they detected the first domestic human-to-human transmission cases, they quickly wound down border control operations and turned the resource savings over to domestic containment tasks. In the meantime, they did a good job at keeping the public well-informed, giving the latter the public to drop their facemasks almost as quickly as they had put them on*. The trickle of new cases continues (4 June, 15 newly confirmed), but it’s a non-story now—which is probably a problem for Aso. Success in this case is a process leading to normalcy. There are few tangible “kills” to highlight, so the story fades out of the headlines.
Don’t feel too sorry for the Aso administration though; there are big elements of luck to this. For one, there is no doubt that the experience both national and international from the SARS and bird flu outbreaks aided the Japanese authorities enormously in setting up the necessary framework, then forming and executing effective plans to contain the virus. They had in effect dress rehearsals. Moreover, the relative mildness of the symptoms helped maintain public order; there was less urgency, and available resources could be stretched more easily.
This leads me to wonder: How prepared is Japan—any nation, actually—to face an onslaught of a more lethal strain of the virus returning later in the year, which is exactly what happened in 1918 with the Spanish flu? Even if the number of cases will turn out be as limited as they have been in the current outbreak, they will require far more resources for isolation and treatment. They are likely to force more and longer closures of schools and other establishments where they are discovered. The impact will go beyond the pathological, as economic activities world-round take a major hit.
Of course the chances of a lethal mutation are as good as one that works in reverse, making the virus more benign. And nothing guarantees that the virus will come back either. That being said, under the bad-case scenario, a serious flu epidemic will be one of the earliest major political tests, if not the earliest, that the post-election government will face. The danger for a DPJ-led administration is that, coming in to confront large parts of the bureaucracy—the Ministry of Health, Labor and Welfare with it its national pension system troubles has been a particularly popular target of DPJ criticism—it may have difficulties changing gear so that it can take control of the situation, lest it works the other way around.
* The facemask is part our national costume. We’ll whip them out at the slightest sign of a cold, much the way we unfurl our umbrellas at the slightest hint of rain.
Don’t feel too sorry for the Aso administration though; there are big elements of luck to this. For one, there is no doubt that the experience both national and international from the SARS and bird flu outbreaks aided the Japanese authorities enormously in setting up the necessary framework, then forming and executing effective plans to contain the virus. They had in effect dress rehearsals. Moreover, the relative mildness of the symptoms helped maintain public order; there was less urgency, and available resources could be stretched more easily.
This leads me to wonder: How prepared is Japan—any nation, actually—to face an onslaught of a more lethal strain of the virus returning later in the year, which is exactly what happened in 1918 with the Spanish flu? Even if the number of cases will turn out be as limited as they have been in the current outbreak, they will require far more resources for isolation and treatment. They are likely to force more and longer closures of schools and other establishments where they are discovered. The impact will go beyond the pathological, as economic activities world-round take a major hit.
Of course the chances of a lethal mutation are as good as one that works in reverse, making the virus more benign. And nothing guarantees that the virus will come back either. That being said, under the bad-case scenario, a serious flu epidemic will be one of the earliest major political tests, if not the earliest, that the post-election government will face. The danger for a DPJ-led administration is that, coming in to confront large parts of the bureaucracy—the Ministry of Health, Labor and Welfare with it its national pension system troubles has been a particularly popular target of DPJ criticism—it may have difficulties changing gear so that it can take control of the situation, lest it works the other way around.
* The facemask is part our national costume. We’ll whip them out at the slightest sign of a cold, much the way we unfurl our umbrellas at the slightest hint of rain.
Sunday, May 24, 2009
Visa Exemption to Resume for Mexicans
A brief follow-up to this post: In case you were wondering, here is the MOFA notice announcing the resumption of the visa requirement waiver for Mexicans as of 22 May. With the growing number of cases of contagion within Japan, the thrust of the effort to contain the H1Ni virus has shifted to the domestic front. The resumption of the visa waivers is part of the transition.
Saturday, May 09, 2009
A Public Service Notice on the N1H1 Influenza Virus for People Who Are Thinking of Buying a Mask…
This essay by Patrick Smith, one of my favorite writers, brings a welcome perspective to the issue. If only our political leaders could speak with this degree of sanity.
To American conservatives: Yes, it’s Salon, but that doesn’t mean Smith doesn’t make sense.
To American conservatives: Yes, it’s Salon, but that doesn’t mean Smith doesn’t make sense.
Wednesday, April 29, 2009
The Swine Flu Pan(dem)ic?
According to Mexican sources, as of Wednesday evening Japan Time, the number of suspected deaths from swine flu reached 149 (152?) out of 1,600 cases reported. Meanwhile, in the United States, 42 cases had been reported, only one of which required hospitalization. Other cases have been reported in Latin Ameerica, Canada, New Zealand, and Europe, most notably in Spain, but story remains the same: no deaths outside of Mexico.
You wonder if God has anything against Mexicans. It just doesn’t make sense to me. I can think of four plausible causes:
a) Serious underreporting of nonlethal cases in Mexico.
b) Poor treatment in Mexico.
c) Misattribution of deaths to swine flu in Mexico.
d) Misattribution of illnesses to swine flu outside of Mexico.
There must be other, equally sensible if less probable explanations. What do you think? In the meantime, if you are interested, read this. And this.
You wonder if God has anything against Mexicans. It just doesn’t make sense to me. I can think of four plausible causes:
a) Serious underreporting of nonlethal cases in Mexico.
b) Poor treatment in Mexico.
c) Misattribution of deaths to swine flu in Mexico.
d) Misattribution of illnesses to swine flu outside of Mexico.
There must be other, equally sensible if less probable explanations. What do you think? In the meantime, if you are interested, read this. And this.
Wednesday, August 06, 2008
Sankei Dumps on… What else?
Sankei slams the Fukuda administration for covering up for the Chinese until the Beijing Olympics are over.
Meanwhile, Asahi does minimum follow-up, and Yomiuri says that the government claims to be hauling ass on the case.
Meanwhile, Asahi does minimum follow-up, and Yomiuri says that the government claims to be hauling ass on the case.
The Difficulties of Staying on Message on the Poisoned Dumplings
Sankei picks up a revealing follow-up story by Kyodo Tsushin entitled Chinese Foreign Ministry Admits Domestic Dumpling Poisoning.
According to the report, the Chinese Foreign Ministry responded to a written question from Kyodo with the admission that “poisoning cases had occurred in China in the middle of June” and that “the Chinese government takes the case very seriously. The Security Ministry is conducting the investigation with all its power.”
Unfortunately, the message did not reach the domestics. To quote from the same article:
National Directorate-General of Quality Oversight, Inspection and Quarantine, Public Communications Division: We have learned of it for the first time from Japanese media reports. We are confirming the facts.
Hubei Province, Sanitary Agency, Sanitary Oversight Bureau: Any gyoza that had been made with the same wrapping dough were all destroyed.
Everybody of course is protecting his ass. For the Foreign Ministry, it means don’t let anything rain on the Olympics. The domestic Beijing authorities are stalling for time. The local authorities are denying any responsibility. It all makes sense. Me? Remember, this happened more than four months after the breakout in Japan; it’s a great reminder to clean out the stegosaurus filet and coelacanth tofu from the back of my freezer.
According to the report, the Chinese Foreign Ministry responded to a written question from Kyodo with the admission that “poisoning cases had occurred in China in the middle of June” and that “the Chinese government takes the case very seriously. The Security Ministry is conducting the investigation with all its power.”
Unfortunately, the message did not reach the domestics. To quote from the same article:
National Directorate-General of Quality Oversight, Inspection and Quarantine, Public Communications Division: We have learned of it for the first time from Japanese media reports. We are confirming the facts.
Hubei Province, Sanitary Agency, Sanitary Oversight Bureau: Any gyoza that had been made with the same wrapping dough were all destroyed.
Everybody of course is protecting his ass. For the Foreign Ministry, it means don’t let anything rain on the Olympics. The domestic Beijing authorities are stalling for time. The local authorities are denying any responsibility. It all makes sense. Me? Remember, this happened more than four months after the breakout in Japan; it’s a great reminder to clean out the stegosaurus filet and coelacanth tofu from the back of my freezer.
Chinese Dumplings Story, on the Eve of the Beijing Olympics... Go Figure
The headline for the Yomiuri scoop, page one top of course, reads: Tianyang Chinese Dumpling: Poisoning in China (天洋餃子 中国で中毒).
A brief reminder:
Tianyang Foods is the Chinese food processing company whose gyoza (Japanese word for chaozu, the Chinese dumplings that resemble overweight raviolis) imported to Japan by JT—motto: It may be detrimental to your health…—turned out to be contaminated with methamidophos, a chemical so deadly that it has never been allowed to be used in Japan as a pesticide, agricultural or otherwise. China itself had banned it since 2007 January 1. This January, 10 people in Japan became ill, one of them falling into a temporary coma, after eating the dumplings. The Chinese authorities were highly defensive, insinuating that the contamination had occurred in Japan. After a flurry of widely reported pronouncements, the matter had subsided—not without wreaking havoc on Chinese exports of agricultural and products and processed food to Japan—until now. My thoughts on the matter at the time remain the same, but this new twist in the events is worth noting for its own sake.
The salient facts:
In early July, just before the Hokkaido G8 Summit, the Chinese authorities had informed Japan through diplomatic routes that some of the dumplings that Tianyang had recalled were later consumed in China, causing symptoms of methamidophos poisoning.
The August 6 hardcopy Yomiuri cites August 5 revelations from 関係筋 (related sources) ”.
The rest of the major dailies follow suit on their websites (and late morning? and evening editions), claiming: Asahi—it became known on the 6th through administration sources (６日、政府関係者の話で分かった); Mainichi—it became known (わかった); Nikkei—it became known on the 6th (6日、分かった); and Sankei—multiple related sources revealed on the 6th (複数の関係筋が６日、明らかにした).
Asahi, the last one to come online at 11:14AM, is the only one to give a reason for the delay in disclosure. “High government officials (政府高官)” told Asahi that was still under investigation in China. Nikkei files the report from Beijing and later in the article cites “diplomatic sources (外交筋)”.
The Beijing Olympics begin in just two days, on August 8.
Now, some comments:
In a conversation the other day with the proprietor of Shisaku, we agreed that the journalese phrase “it became known on date x (X日にわかった)” is more often than not “we wuz scooped” in journalese.
Of all the scoopees, the usually anti-government Asashi is the only one that bothered to wait for the authorities’ explanation before posting the news.
Did I already mention that the Beijing Olympics begin in just two days?*
* Technically, the games start today, when the female soccer teams play the first games in their group league stage. Go, Nadeshiko! Kick Kiwi ass! Soccer begins before the August 8 opening ceremonies because soccer players need more time than other athletes—except marathon and other long-distance runners—to recover between events, or games.
A brief reminder:
Tianyang Foods is the Chinese food processing company whose gyoza (Japanese word for chaozu, the Chinese dumplings that resemble overweight raviolis) imported to Japan by JT—motto: It may be detrimental to your health…—turned out to be contaminated with methamidophos, a chemical so deadly that it has never been allowed to be used in Japan as a pesticide, agricultural or otherwise. China itself had banned it since 2007 January 1. This January, 10 people in Japan became ill, one of them falling into a temporary coma, after eating the dumplings. The Chinese authorities were highly defensive, insinuating that the contamination had occurred in Japan. After a flurry of widely reported pronouncements, the matter had subsided—not without wreaking havoc on Chinese exports of agricultural and products and processed food to Japan—until now. My thoughts on the matter at the time remain the same, but this new twist in the events is worth noting for its own sake.
The salient facts:
In early July, just before the Hokkaido G8 Summit, the Chinese authorities had informed Japan through diplomatic routes that some of the dumplings that Tianyang had recalled were later consumed in China, causing symptoms of methamidophos poisoning.
The August 6 hardcopy Yomiuri cites August 5 revelations from 関係筋 (related sources) ”.
The rest of the major dailies follow suit on their websites (and late morning? and evening editions), claiming: Asahi—it became known on the 6th through administration sources (６日、政府関係者の話で分かった); Mainichi—it became known (わかった); Nikkei—it became known on the 6th (6日、分かった); and Sankei—multiple related sources revealed on the 6th (複数の関係筋が６日、明らかにした).
Asahi, the last one to come online at 11:14AM, is the only one to give a reason for the delay in disclosure. “High government officials (政府高官)” told Asahi that was still under investigation in China. Nikkei files the report from Beijing and later in the article cites “diplomatic sources (外交筋)”.
The Beijing Olympics begin in just two days, on August 8.
Now, some comments:
In a conversation the other day with the proprietor of Shisaku, we agreed that the journalese phrase “it became known on date x (X日にわかった)” is more often than not “we wuz scooped” in journalese.
Of all the scoopees, the usually anti-government Asashi is the only one that bothered to wait for the authorities’ explanation before posting the news.
Did I already mention that the Beijing Olympics begin in just two days?*
* Technically, the games start today, when the female soccer teams play the first games in their group league stage. Go, Nadeshiko! Kick Kiwi ass! Soccer begins before the August 8 opening ceremonies because soccer players need more time than other athletes—except marathon and other long-distance runners—to recover between events, or games.
Tuesday, April 22, 2008
Post Mortem on the Late-Term Elderly Medical Care Insurance Rollout
I’ll have to alter my assessment of the political impact slightly, now that we’re seeing some serious coverage. I don’t see the deduction issue having a serious impact, but more broadly, the rollout reports feed into the now-familiar incompetence issue adding to the image of a bumbling, indecisive administration. However, that’s an already well-established trope, and these latest troubles are a temporary blip compared to the other far more serious problems of the coalition and more specifically the Fukuda administration.
--Me
MK kindly reminds me that even after I altered my assessment of the impact of the Late-Term Elderly Medical Care Insurance System, I still didn’t see the deduction issue having a serious impact. So true. I guess that’s why I’m not a political strategist. And speaking of political strategist, where was the LDP strategist who failed to make the following points and push them relentlessly through the media before the rollout?
1) The new insurance system is designed to ensure the viability of the national healthcare system.
2) On average, low income households will pay a little less, while high income households will pay a little more.
3) We’re leveling costs across municipalities, so some households will see their bills go up, while others go down. We’re taking measures to alleviate the hit.
4) We’re deducting the monthly payments from pension payments for your convenience and to cut costs.
5) Our local and national offices will be on call to answer any questions and solve any problems that you may encounter.
6) For details of the makeover, here’s the url, or call or visit our representatives at…
The message should have preceded the rollout, initiated by a series of informal talkfests-by-invitation (complete with box lunches/cake-and-coffee and dog-and-pony shows) between matched members of the administration (Prime Minister; the Minister of Health, Welfare and Labor; and top MHWL bureaucrats) and the media (editorial writers and reporters on the MHWL beat, i.e. MHWL kisha club members), accompanied by a print-and-broadcast PR blitz that emphasized these points. That way, they could have formed the basic contours of the narrative, which would have put the grumbling and bumbling in context. In the event, the grumbling and bumbling became the context.
A well-designed and well-executed might not have stopped losses altogether, but it certainly would have stemmed the tide. Most importantly, it would have given the Fukuda administration a boost in the competence department, where its biggest deficits lie. The DPJ is not making much headway here either, indicating that the political battle here is not so much over substance as over form.
I am not making it up. This is how it’s done. The government typically has six months to one year to design and implement the public relations campaign between the Diet vote and the actual rollout. The Koizumi-Abe-Fukuda administrations had two years to prepare after the Diet voted to do the makeover. So what happened?
I really don’t know. I’ve written before about problems in the kantei, and it certainly was the job of people in the Prime Minister’s Office to keep tabs on this issue (among many others) and coordinate public communication efforts. But the MHWL should have been doing it on their own initiative in the first place. Incompetence? Loss of will? Both? Your guess is as good as mine.
So much for Monday morning quarterbacking. Now, back to work.
--Me
MK kindly reminds me that even after I altered my assessment of the impact of the Late-Term Elderly Medical Care Insurance System, I still didn’t see the deduction issue having a serious impact. So true. I guess that’s why I’m not a political strategist. And speaking of political strategist, where was the LDP strategist who failed to make the following points and push them relentlessly through the media before the rollout?
1) The new insurance system is designed to ensure the viability of the national healthcare system.
2) On average, low income households will pay a little less, while high income households will pay a little more.
3) We’re leveling costs across municipalities, so some households will see their bills go up, while others go down. We’re taking measures to alleviate the hit.
4) We’re deducting the monthly payments from pension payments for your convenience and to cut costs.
5) Our local and national offices will be on call to answer any questions and solve any problems that you may encounter.
6) For details of the makeover, here’s the url, or call or visit our representatives at…
The message should have preceded the rollout, initiated by a series of informal talkfests-by-invitation (complete with box lunches/cake-and-coffee and dog-and-pony shows) between matched members of the administration (Prime Minister; the Minister of Health, Welfare and Labor; and top MHWL bureaucrats) and the media (editorial writers and reporters on the MHWL beat, i.e. MHWL kisha club members), accompanied by a print-and-broadcast PR blitz that emphasized these points. That way, they could have formed the basic contours of the narrative, which would have put the grumbling and bumbling in context. In the event, the grumbling and bumbling became the context.
A well-designed and well-executed might not have stopped losses altogether, but it certainly would have stemmed the tide. Most importantly, it would have given the Fukuda administration a boost in the competence department, where its biggest deficits lie. The DPJ is not making much headway here either, indicating that the political battle here is not so much over substance as over form.
I am not making it up. This is how it’s done. The government typically has six months to one year to design and implement the public relations campaign between the Diet vote and the actual rollout. The Koizumi-Abe-Fukuda administrations had two years to prepare after the Diet voted to do the makeover. So what happened?
I really don’t know. I’ve written before about problems in the kantei, and it certainly was the job of people in the Prime Minister’s Office to keep tabs on this issue (among many others) and coordinate public communication efforts. But the MHWL should have been doing it on their own initiative in the first place. Incompetence? Loss of will? Both? Your guess is as good as mine.
So much for Monday morning quarterbacking. Now, back to work.
Saturday, April 19, 2008
Japanese Healthcare Revisited
I received the following comment for this post. The answer became fairly long, and I did promise to revisit the issue, so I’m uploading it as a separate post on its own. I find it amusing that it retains the feel of a comment.
What if you are critically ill and in an ambulance and the crew cannot find a hospital that will accept you? Perhaps they are busy, or think you might have a contagious disease. And you die. Then what?
That's just one of the puzzling questions I had after watching the Old Japan Hand. I have more when I read the newspapers or see how my mother-in-law was treated when she had a serious illness and required long-term hospitalization. Well, the cost was low to us at first, so I guess that's all that is important.
I'm sorry to hear about your mother-in-law, Dan. She apparently got much worse treatment than my grandfather, who spent his last years in a hospital.
Cost is, of course, always important, and in the long run, you end up getting what you pay for, and vice versa. So you have to strike the balance somewhere. This means that every public healthcare system will fall short of the ideal and only the wealthy will get everything they ask for, at their own cost.
One way to cut costs is queuing. That’s why you see those piles of months-old magazines and used comic books in waiting rooms. Some queues can be much longer, and systemic. For example, some national healthcare systems keep you waiting for months for surgery, which could result in serious harm to the health of the patient.
Another way is to cut services altogether. It’s clear from the video that many hospitals are facing financial difficulties, and one of the consequences beyond the purview of the documentary appears to be a deterioration of emergency services in some areas. I don’t know how pervasive this problem is (not in my neighborhood, if personal experience is any gauge － which admittedly may merely highlight the dangers of the anecdotal approach － particularly with the extra money the local government has put been putting into its medical services in recent years), since I haven’t followed the issue closely enough to see any statistics. I also do not know how much of the problem is due to local budgetary constraints (which would give added urgency to the promised reassignment of gasoline tax revenues to general purpose funds) or management issues (for someone has to coordinate the system, and governments, local and national, can be slow-moving and unimaginative, to put it gently, which means that your relatives on your wife’s side should vote early and vote often － I mean, every chance they have).
Doctors and medical institutions game the system on the revenue side too. I think that the documentary mentioned the high proportion of money going to medication. That’s one price you pay, pardon the expression, for a fairly rigid pricing system. Then there’s the sagaku beddo, where the hospitalized patient pays extra for an accommodation upgrade.
So Japan, like most countries, winds up with an imperfect (from a Bill Gates or Sumner Redstone perspective anyway) system. T.R. Reid finds the Japanese public satisfied (define satisfied, yeah, of course), and that conforms to his personal experience from his Tokyo days as WaPo Bureau Chief. I think that I can say the same for myself as well as that of my immediate family.
Of course, all is not well with the system, and the documentary touches on those points as well. But it just might be that T.R. Reid has accentuated the positive more than other foreign correspondents in Japan do. If so, that may owe something to his sunny and positive outlook. Still, it’s good to have someone let the world know that we’re not all a bunch of whale-killing, kangaroo-slaughtering, right-wing, walking vending machines.
ADD April 20: The “walking vending machines” is a reference to this all-time low in NYT Japan-Is-Weird stories. I say “low” not because of the subject of the story but because the gullible writer apparently missed the joke.
What if you are critically ill and in an ambulance and the crew cannot find a hospital that will accept you? Perhaps they are busy, or think you might have a contagious disease. And you die. Then what?
That's just one of the puzzling questions I had after watching the Old Japan Hand. I have more when I read the newspapers or see how my mother-in-law was treated when she had a serious illness and required long-term hospitalization. Well, the cost was low to us at first, so I guess that's all that is important.
I'm sorry to hear about your mother-in-law, Dan. She apparently got much worse treatment than my grandfather, who spent his last years in a hospital.
Cost is, of course, always important, and in the long run, you end up getting what you pay for, and vice versa. So you have to strike the balance somewhere. This means that every public healthcare system will fall short of the ideal and only the wealthy will get everything they ask for, at their own cost.
One way to cut costs is queuing. That’s why you see those piles of months-old magazines and used comic books in waiting rooms. Some queues can be much longer, and systemic. For example, some national healthcare systems keep you waiting for months for surgery, which could result in serious harm to the health of the patient.
Another way is to cut services altogether. It’s clear from the video that many hospitals are facing financial difficulties, and one of the consequences beyond the purview of the documentary appears to be a deterioration of emergency services in some areas. I don’t know how pervasive this problem is (not in my neighborhood, if personal experience is any gauge － which admittedly may merely highlight the dangers of the anecdotal approach － particularly with the extra money the local government has put been putting into its medical services in recent years), since I haven’t followed the issue closely enough to see any statistics. I also do not know how much of the problem is due to local budgetary constraints (which would give added urgency to the promised reassignment of gasoline tax revenues to general purpose funds) or management issues (for someone has to coordinate the system, and governments, local and national, can be slow-moving and unimaginative, to put it gently, which means that your relatives on your wife’s side should vote early and vote often － I mean, every chance they have).
Doctors and medical institutions game the system on the revenue side too. I think that the documentary mentioned the high proportion of money going to medication. That’s one price you pay, pardon the expression, for a fairly rigid pricing system. Then there’s the sagaku beddo, where the hospitalized patient pays extra for an accommodation upgrade.
So Japan, like most countries, winds up with an imperfect (from a Bill Gates or Sumner Redstone perspective anyway) system. T.R. Reid finds the Japanese public satisfied (define satisfied, yeah, of course), and that conforms to his personal experience from his Tokyo days as WaPo Bureau Chief. I think that I can say the same for myself as well as that of my immediate family.
Of course, all is not well with the system, and the documentary touches on those points as well. But it just might be that T.R. Reid has accentuated the positive more than other foreign correspondents in Japan do. If so, that may owe something to his sunny and positive outlook. Still, it’s good to have someone let the world know that we’re not all a bunch of whale-killing, kangaroo-slaughtering, right-wing, walking vending machines.
ADD April 20: The “walking vending machines” is a reference to this all-time low in NYT Japan-Is-Weird stories. I say “low” not because of the subject of the story but because the gullible writer apparently missed the joke.
Wednesday, April 16, 2008
T.R. Reid on Healthcare (Japan Included)
Old Japan hand T.R. Reid was last seen reporting from Colorado on the Kobe Bryant rape charge as the first, only, and probably last WaPo Rocky Mountain Bureau correspondent. (There was a video clip on the WaPo website back in the day, when it was hip to say back in the day (or so we thought).) Now, he has taken time out from writing his book on healthcare to star in a documentary on… what else? Healthcare. Enjoy.
Surprising for a Nihongo-phone like T.R. Reid, the video erroneously says that there’s no wait in Japanese hospitals. So very not so, sir. Otherwise, it’s to the point. Also, fair and balanced. No kidding.
Actually, I’ve been giving some thought to Japanese healthcare, and I’ve come to the conclusion that queues are essential to an affordable, effective and, yes, efficient universal healthcare system. I think that I’ve also come across some other features of the Japanese healthcare system that make more sense when you stop depending on conventional wisdom and outdated news reports to make your case.
ADD April 18: I've noticed that my last comment could be misconstrued as an attack on Tom. Not so, I am criticizing commentary that is diametrically opposed to his take. The Japanese healthcare system has many shortcomings, but so much of conventional wisdom does not take into account the fact that they are so often the result of unavoidable choices when the government is compelled to directly intervene in a market that is not a natural monopoly.
Stay tuned.
Surprising for a Nihongo-phone like T.R. Reid, the video erroneously says that there’s no wait in Japanese hospitals. So very not so, sir. Otherwise, it’s to the point. Also, fair and balanced. No kidding.
Actually, I’ve been giving some thought to Japanese healthcare, and I’ve come to the conclusion that queues are essential to an affordable, effective and, yes, efficient universal healthcare system. I think that I’ve also come across some other features of the Japanese healthcare system that make more sense when you stop depending on conventional wisdom and outdated news reports to make your case.
ADD April 18: I've noticed that my last comment could be misconstrued as an attack on Tom. Not so, I am criticizing commentary that is diametrically opposed to his take. The Japanese healthcare system has many shortcomings, but so much of conventional wisdom does not take into account the fact that they are so often the result of unavoidable choices when the government is compelled to directly intervene in a market that is not a natural monopoly.
Stay tuned.
Thursday, April 10, 2008
The Nose Knows: My Take on the Politics of the Late-Term Elderly Medical Care Insurance System Rollout
Anonymous said...
Sir,
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.
Lyons
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.
Sir,
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.
Lyons
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.
Wednesday, December 05, 2007
Chinese Authorities Have a Cow with Japanese Beef
Actually, I wrote this post only because I couldn't pass up the title. I’ve also used a footnote to get rid of something that has been festering in my brain for a long time.
The five teppanyaki restaurants and two steakhouses in the new Tokyo Michelin serve as a good reminder that, for the gaijin foodie, Japan is the MBL of beef*. And it’s no different for the nouveau richein China.
Unfortunately, in one of the greatest of ironies**, Japanese beef has been banned in China since 2001, after Bovine Spongiform Encephalopathy was discovered in Japan. So Chinese Customs are frequently catching smugglers posing as tourists trying to smuggle in large amounts of Japanese beef, according to this Sankei report.
* I understand that Kobe beef is quite popular at expensive weddings and bar mitzvahs in the U.S. Which raises the question: Where do they find kosher Kobe beef? And yes, that’s where Kobe Bryant’s name comes from. Only a quirk of fate saved him from being named Fugu Bryant, or Matsutake Mushroom Bryant. Which in turn raises yet another question: Could Torii Hunter just as easily have been named Minaret Hunter?
** In fact, this is a double irony. Can you spot them both?
The five teppanyaki restaurants and two steakhouses in the new Tokyo Michelin serve as a good reminder that, for the gaijin foodie, Japan is the MBL of beef*. And it’s no different for the nouveau richein China.
Unfortunately, in one of the greatest of ironies**, Japanese beef has been banned in China since 2001, after Bovine Spongiform Encephalopathy was discovered in Japan. So Chinese Customs are frequently catching smugglers posing as tourists trying to smuggle in large amounts of Japanese beef, according to this Sankei report.
* I understand that Kobe beef is quite popular at expensive weddings and bar mitzvahs in the U.S. Which raises the question: Where do they find kosher Kobe beef? And yes, that’s where Kobe Bryant’s name comes from. Only a quirk of fate saved him from being named Fugu Bryant, or Matsutake Mushroom Bryant. Which in turn raises yet another question: Could Torii Hunter just as easily have been named Minaret Hunter?
** In fact, this is a double irony. Can you spot them both?
Subscribe to:
Posts (Atom)