avatarJeffrey Goodman

Summary

The article discusses the disparity in healthcare systems between the United States and Japan, emphasizing the benefits of preventative care and the ethical and economic implications of prioritizing early detection and treatment.

Abstract

The article delves into the cultural and economic differences between American and Japanese healthcare systems, highlighting America's tendency to avoid preventative care due to high costs and the risk of surprise medical bills. In contrast, Japan's healthcare system emphasizes regular check-ups and early intervention, leading to better health outcomes and lower costs. The author argues that the U.S. healthcare model, which is heavily skewed towards emergency and late-stage illness treatment, is not only more expensive but also ethically questionable, as it may prioritize corporate profits over patient well-being. The article suggests that the frequent use of healthcare services in Japan, perceived as unusual in the U.S., is a key factor in Japan's higher life expectancy and lower healthcare costs. The author calls for a reevaluation of the U.S. healthcare system, proposing that a shift towards a model that incentivizes early detection and preventative care could lead to significant improvements in health and reductions in cost.

Opinions

  • The author believes that the American healthcare system's focus on emergency care rather than preventative care is a significant flaw, leading to higher costs and poorer health outcomes.
  • It is the author's opinion that the trust relationship built between patients and primary care physicians in systems like Japan's contributes to earlier detection of medical issues.
  • The article conveys the opinion that the U.S. healthcare system's high costs are partly due to the profit motives of various sectors within the healthcare industry, which may benefit from treating more severe and costly medical conditions.
  • The author suggests that the Japanese healthcare system's affordability and effectiveness are due to the government's control over healthcare costs, preventing the kind of price inflation seen in the U.S.
  • There is a clear stance that the U.S. healthcare system's structure, which includes for-profit health insurance companies, hospitals, and pharmaceutical companies, inherently discourages early intervention and preventative care.
  • The author implies that the U.S. healthcare system's complexity and expense are not justified by the quality of care, challenging the notion that it is the "best healthcare system in the world."
  • The article expresses the view that mainstream media in the U.S. does not adequately cover the shortcomings and potential improvements of the American healthcare system.

Is this the Dirty Little Secret Why Americans See the Doctor Less Often Than Japanese?

Photo by CDC on Unsplash

Related and recent articles

Has U.S. Healthcare Really Become a Mob Protection Racket?My Health Insurance Company Asked for Feedback on My Specialist. I Blew My Top. • How Can U.S. and Japanese Healthcare Costs Be So Insanely Different?A Friend Texted to Ask “Who I Favored” for 2024 and Hated My Answer • Quick and Easy Way to Convert from Japanese Yen to U.S. DollarsHow Best to Describe the U.S. Healthcare System to a Young Japanese Woman?

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Earlier today, @tickleheart left a comment that caught my eye on the very first article I wrote on Medium — Life Expectancy vs. Healthcare Costs in the U.S.

In response to my comment that “America’s healthcare hellscape is something that we should be pounding the table on every day until we fix it,” she replied:

“Amen. One huge difference that I see in America-vs-Canada (I have family there) is that preventive healthcare is by far a factor in our life expectancy. Thank you for a very informative article.”

Preventative/primary care vs. emergency care

When you look at spending on (1) primary and preventative care vs. (2) emergency care after something has become an emergency and you then compare percent of overall spending, there is a huge difference between (1) the U.S. and (2) most other countries, including Canada (as @tickleheart mentioned) and Japan (in my own experience.)

American healthcare is more heavily weighted toward emergency care or care after a person has become sick in a problematic way.

But in other developed countries — like Japan, for example — there is a much larger emphasis on preventative care and catching medical problems as early as possible.

Benefit #1: Catching medical problems early is a huge money-saver and risk-reducer

For reasons that include the crazy costs and risks of surprise bills, Americans have been thoroughly trained over the last few decades to avoid going to the doctor unless they are already really sick.

The problem is, if you wait until something is showing serious symptoms, then it’s probably gotten more difficult and expensive to treat than if it had been caught early.

Something like cancer is an obvious example of this. It’s going to be far less expensive and far less risky to treat cancer if you catch it in Stage 1 than if you catch it at Stage 3 or Stage 4.

Benefit #2: Building more of a trust relationship with your doctor also helps catch problems earlier

Also, when you go to the doctor more often, you build more of a trust relationship with your primary care physician. You get to know them, and they get to know you. You get to be more comfortable sharing issues and symptoms with them. And this also makes it much more likely that they are going to catch a problem much earlier than would be the case in the U.S.

If you’re not already familiar with how the National Healthcare System works in Japan, check out this short 7-minute video. It is an excellent overview of how the system works. In particular, Paolo starts off the video with a short story, the transcript of which is immediately below the embedded video.

Benefit #3: You save more lives. You improve the quality of the lives of your people by improving their health and physical wellbeing. You make it clear that people are valued over corporate profits.

And let me call this out CLEARLY — there is a moral and ethical case to be made here, not only an economic one.

When you catch problems earlier, you are more likely to save a person’s life in the case of a serious illness or injury or disease.

When you don’t create a healthcare system or allow one to evolve where profit is the primary motive, you are truly “taking the high road” ethically and morally.

[The short transcript below is from the first 40 seconds of the above video.]

…So the other day, my wife, Maiko told me she had to go to the doctor because she had a cold. I asked her, “Didn’t you just go like a few days ago?”

She said, “Yeah, but that was for a skin rash.”

And then I asked, “Didn’t you go a week before that?”

And she said, “Yeah, but that’s different. That was for a stomach ache.”

For me — someone that grew up in the States — that’s kind of a lot of doctor visits. I might go for a severe skin rash but not for a cold or a stomach ache. Which got me to thinking about Japanese healthcare in general and why people in Japan go to the doctor so much compared to other countries like the US….

photo taken by author, December 2022

Last December (2022) when I was in Tokyo, I spent a few days working out of several WeWork locations in the city.

On one of those days I talked with a woman who was working there, and I happened to think back to this video and what Paolo had been describing.

She seemed like she was probably in her mid-30s and had grown up in Tokyo, and I was curious what her life experience was in terms of how frequently she would go to see her doctor.

So I asked.

Her initial answer was that “she really didn’t go to see her doctor very often,” but she didn’t get specific.

I told her that I was aware that in general Japanese people go see their doctors more often than Americans do, and I was just curious how often it might be for her.

At that point she said, “I really don’t go see my doctor very often at all. Probably not more than once a month.”

Think about that for a moment.

From her perspective, going to see the doctor once a month is the equivalent of “hardly ever going to see her doctor.”

In the U.S., going to see your doctor once a month (when you aren’t already seriously sick) either looks like insurance fraud or like you’re a hypochondriac.

How can the Japanese healthcare system afford this?

That’s the question that a lot of Americans would instantly ask.

After all, from their perspective, the U.S. has “the best healthcare system in the world,” even if it’s also by far the most expensive and the most financially risky system for consumers.

So they reason, “well, if that’s the case here, then how can it be that Japan has such a great healthcare system and yet cost 40% or less on a per capita basis of what the per capita U.S. healthcare system costs are?”

Because the Japanese government hasn’t allowed corrupt players and sectors within the overall healthcare business there — like pharmaceutical companies and hospitals, let alone a private health insurance industry — to massively inflate the base prices of everything healthcare-related.

That’s one of the big reasons why.

(See the two videos at the very bottom of this article — especially the second of the two videos — for some unforgettable discussions about bloated healthcare costs. They will be seared into your brain.)

I’m also reminded of how skeptical a friend’s wife here in San Francisco was when I described Paolo’s video to her.

Her question back to me was, “How can Japanese people afford to do that? Where does their system get the money to have people going to see their doctor so often?”

Part of the answer is certainly that their healthcare costs were never massively inflated to begin with.

Another part is that they catch problems earlier — when they are much less costly to fix and cure.

My friend’s wife — like many Americans — has become so used to the healthcare dystopia here in the U.S. that she thinks this hellscape is normal and “worth the cost” because “we have the best healthcare in the world here in the US.”

As if.

One last thought.

If I were really cynical about the system here — which yeah, I guess I am — I might point out that when healthcare is more expensive, health insurance companies hospitals, Big Pharma and pharmacy benefit managers ALL make a lot more money than they would if medical issues were caught earlier and thereby more easily and less expensively cured.

Here’s the quiet part said out loud

When all of these different pieces of the US healthcare industry are for-profit, they have a clear and substantial financial interest in not catching illnesses and medical issues early.

I hope no one seriously disagrees with that last statement. Their financial interest is visible from 100 miles away, and it’s hard to not see.

Now, I’m not saying that the CEOs of all these companies got together in a secret Cabal and fixed prices specifically for this reason…and that they meet every quarter to adjust prices and coverage, etc.

And yet….

It’s kind of like when a Whole Foods Market and other grocery stores got nailed in New York back in 2009 for inaccurate scales used to measure the weight of food that sold by the pound.

“Shockingly,” it turned out that in more than 50% of the cases, the weights were heavier than they should have been…so prices were higher than they should have been.

If the scales had been mis-calibrated at random, then some of the “wrong weighings” would have been too heavy, and some would have been too light. They would have roughly balanced out…if this were a random thing.

Because the scales were causing customers to have to pay more than they should have been paying, we can infer that this was intentional.

Now…should we be drawing the same conclusion as to why our healthcare system pushes all the regular people in a direction that clearly makes it MORE likely health and medical issues won’t be caught until it’s more serious and more likely to generate more revenue to fix the problem.

I mean, it’s clear that you can deal with a Stage 1A cancer case a lot less expensively than will be the case if it’s Stage 3B or Stage 4A.

Annual health exams in the U.S. and in Japan

At the 3:30 mark in the above video, check out Paolo’s description of what an annual health exam looks like in Japan.

If you live in the U.S., would you like to have an annual exam like this? Especially one where the “basic” version is covered and there is no cost to you…and if you want to get the more extensive version of the exam, it’s only an extra couple hundred dollars.

This is dramatically different from what an annual checkup looks like here in the U.S., right?

At a certain point, you have to ask “Why?”

Is “just follow the money” perhaps the dirty little secret that helps explain why so much of U.S. healthcare costs so dramatically much more money than would be the case in Japan, Canada, Germany, France, Sweden, South Korea, et. al.?

It’s just a thought.

P.S. I’ve seen some excellent discussions on this general topic recently and over the past couple years — virtually none of these, however, have been seen in mainstream media (Fox, MSNBC, CNN, WSJ, WashPo, LA Times, etc.)

Here are 5 that I recommend checking out:

Firelight Chat: HEALTHCARE IN AMERICA

*REAL* RECEIPTS: What my Birth in Germany Costs in the USA | Universal vs. Private Healthcare

Krystal and Saagar: Obama’s New Book LIES About His Public Option Failure

Rep. Katie Porter and Insurance Whistleblower Wendell Potter Talk the Industry’s Greed

Rep. Katie Porter Grills Big Pharma CEO For Putting Profits Before Patients — FULL QUESTIONING

Related and recent articles

Has U.S. Healthcare Really Become a Mob Protection Racket?My Health Insurance Company Asked for Feedback on My Specialist. I Blew My Top. • How Can U.S. and Japanese Healthcare Costs Be So Insanely Different?A Friend Texted to Ask “Who I Favored” for 2024 and Hated My Answer • Quick and Easy Way to Convert from Japanese Yen to U.S. DollarsHow Best to Describe the U.S. Healthcare System to a Young Japanese Woman?

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Jeffrey Goodman

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