Discussion in the Diet is beginning over how to reform the health-care system. Japanese society, in case you’ve just emerged from two decades in a cave and haven’t seen this topic beaten to death yet, is aging. The cost structures of the social welfare programs need to be changed, but as with everything else, there are a lot of people who make out well by the current system and will resist changing it. Many of them are powerful middle-aged bureaucrats who are themselves approaching old age rapidly.

The [Koizumi] government, in a cabinet session on the morning of 10 February, approved a health care system reform bill the primary goal of which is to hold down health care costs, which have been increasing as society ages. The bill will be submitted to the Diet within the day. The bill incorporates such proposals as a phased-in increase, to begin in October, in the health care fees paid by the elderly and the restructuring of [national] health insurance.

If the bill is enacted, cash register payments [that is, the amount you pay on the way out of the doctor’s office, assessed as a percentage of the total tab] for high-income persons of at least 70 years of age will increase. You’re designated high-income if your annual household income is over about US $55000. Of course, the bill doesn’t seem to address systemic inefficiencies that encourage over-subscription–notably the practice of drawing out treatment for a relatively simple problem over several visits, after the fashion of a novel published serially. Or the effects of overweening bureaucracy.

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