EDITORIAL: Health care for the aged

The government and the ruling coalition are finally beginning to consider specific ideas on how to reform the hugely unpopular new health care insurance program for people aged 75 or older.

As part of efforts to develop a more effective program, the Ministry of Health, Labor and Welfare recently organized a meeting of officials involved in the daily operation of the system across the nation to hear their accounts of the type of complaints they receive. The idea was to give the ministry a better handle on ways to improve the program. These officials are bearing the brunt of discontent among senior citizens about the system, which was introduced in April.

In spontaneous outbursts of anger and frustration, many participants in the meeting accused the health ministry of starting the program without doing the necessary legwork first.

"We have been unable to provide complete explanations about the system (to the aged) because vital information about the details has been so slow in coming to us," one participant fumed. "Frequent changes, such as a temporary freeze on premium payments (for some people) and the change of the name of the program, have created confusion," said another.

The barrage of criticism directed at the health ministry at the meeting underscored its ignorance of the realities of health care for the aged while planning and implementing radical changes to the system.

The key proposals being considered by the government and the ruling camp to improve the system include: reducing the premiums paid by low-income beneficiaries; taking a new look at the deduction of premiums from pension benefits; reviving municipal subsidies for thorough physical examinations.

A particularly serious problem concerns the increase in premium payments by some low-income beneficiaries. Much of this problem can be traced to the transfer of the system's operations from the hands of municipalities to new prefecture-based regional units. This administrative change resulted in the removal of relief measures for low-income elderly people that were financed independently by cities, towns and villages.

The new system has even introduced a penalty for continued arrears in premium payments: invalidation of the health insurance card. That makes it all the more urgent to change the system in this regard.

The fuzzy character of the new operators of the program, which are neither municipal nor prefectural governments, is also creating problems. Most of the insured don't know where they should go when they want information, for instance. The new entities may be less conscious of their responsibility for the smooth operation of the system than they should be. These new organizations and the efforts to make them known to the public may need to be reconfigured.

Saying all this, however, doesn't mean supporting the growing chorus of calls for simply reducing the financial burden or postponing its imposition. These calls are coming from lawmakers who have been surprised by the strong public backlash against the new system.

One typical proposal from this camp would extend the current freeze on premium payments by senior citizens who are dependents of corporate employees.

That would be unfair to the dependents of self-employed workers who have long been paying premiums for their national health insurance coverage. If this inequity is maintained, this health care reform cannot achieve one of its fundamental objectives.

It is vital to make a sharp distinction between the unpopular but necessary components of the reform that the government must persuade the public to accept and the system's outright shortcomings that must be fixed as quickly as possible.

The opposition camp plans to submit a bill to the Diet shortly that would scrap the system. But what would happen after it is done away with? The opposition bloc wouldn't be able to win public support for a simple return to the old health care system for elderly people, which was harshly criticized. It must be remembered that all the opposition parties except for the Japanese Communist Party agreed with the ruling coalition to create a new health insurance scheme for the aged.

We hope the ruling and opposition camps will engage in constructive, forward-looking debate on how to make the system better.

--The Asahi Shimbun, May 16(IHT/Asahi: May 17,2008)