Tairo Hirayama to represent Tokyo 13th district

Amid all the excitement of last night’s live election coverage (DPJ won big, Hatoyama will be PM), I didn’t get a chance to check the results in my home district. So here goes.

In line with the overall nationwide trend, voters chose DPJ candidate (and ryokan heir) Tairo Hirayama to represent Tokyo’s 13th district (covering all but the western end of Adachi-ku). Hirayama beat LDP incumbent Ichiro Kamoshita by a small margin of 3,000 votes. Kamoshita will stay in the lower house as a proportional representation member, which will make things awkward if they ever run into each other in the halls of the Diet building.

In a statement on his website written last night, Hirayama adopted the same cautious tone as PM-to-be Hatoyama. He thanked supporters but said he considers the votes to be not for him personally but instead as votes for a change in government. Since he had already taken some painkillers to combat his lower back pain (ぎっくり腰 a new vocab word for me) he expected to stay up all night before heading to Kitasenju Station this morning to thank voters for their support.

At 62.82%, voter turnout in Tokyo’s 13th was lower than the 69% national average and not much higher than turnout in the July Tokyo assembly election.


Hirayama might want to shake hands with Kazumasa Fujiyama, his rival candidate from the Happiness Realization Party. Though Fujiyama received less than 3,000 votes or 1.1% of the total, that was just about in line with Hirayama’s margin of victory. Had those voters gone LDP the race would have been much closer. Even considering that the HRP voters were almost all Happy Science followers, Hirayama should thank his spirit guide that Okawa didn’t decide to throw his weight behind the LDP this time around.

Nationwide, the HRP failed to win a single seat or even surpass 1% of the popular vote in most districts. Without any significant voter support, the party stands to lose over 1 billion yen in security deposits for the more than 300 candidates it fielded.

Happy Science’s political movement, born of guru Ryuho Okawa’s vision of a nuclear holocaust, has failed. At one point it appears they considered giving up before the election, but in the end this was a bad idea that took on a life of its own. In a personality cult, once the leader sets his mind to something it can be very hard to stop. The leader himself may hesitate to admit to a mistake out of fear he’ll lose credibility, and of course his followers who think he’s a divine being would never go against his wishes.

I hope the authorities will keep a close eye on this group as it’s possible Okawa may still feel the urgent need to save Japan from certain doom by taking control of the government.


Perhaps the biggest national story set in Adachi-ku is the DPJ’s defeat of New Komeito President Akihiro Ota in Tokyo’s 12th district (covering Kita-ku and the western tip of Adachi-ku) was yet another humbling setback for the ruling coalition. Former DPJ President Ichiro Ozawa had considered running against him but decided to field a different challenger, singer and DPJ upper house member Ai Aoki (see photo above) instead. It ended up working, and Ota, who had not run in a PR spot, will have to turn in his MP badge (and of course resign as New Komeito leader).

In fact, nationally the New Komeito lost in every single-member district. The 21 members it will send to the next Diet session were all PR candidates.

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An ebullient Ai Aoki, winner in Tokyo’s 12th district (photo from Jiji Press)

Happy election day!

Update: Follow my Twitter stream for random thoughts on the election.

Today the polls are open for Japan’s 45th general election. It’s all but certain that the opposition DPJ is going to make significant gains, and might even win a two-thirds supermajority.

So while the results aren’t exactly in doubt, my colleagues and I will still try and keep things interesting. I’ll be following the election all day, and tonight I’ll be on live with Transpacific Radio.The coverage starts at 8pm Japan time and you can access the video feed here. See this link for more info on the live video.

For now, I’ll leave you with a couple photos I took of my local polling station:

Japan Lower House election – Meet the candidates Part 5: Proportional representation candidates

Now that I’ve covered my local race, now it’s time to take a brief look at some of the more notable candidates for Tokyo’s 17 proportional representation seats. I am limiting myself to candidates who are only running for PR seats, not those who have doubled up with a simultaneous candidacy in a single member district (With two exceptions: The DPJ’s Tairo Hirayama and LDP’s Ichiro Kamoshita are both running as PR candidates in the first spot in addition to Tokyo’s 13th). This means we are scraping the bottom of the barrel – candidates included just in case the party does well. We can’t be sure any party really believes in these people, but they are trustworthy enough to gain party backing.

Keiichiro Nakayama, political commentator (People’s New Party, never before elected)  – A former Yomiuri reporter turned independent commentator who served as a member of Yoshiro Mori’s PR team when he was prime minister (not exactly a stellar record…) He ran for the upper house in 2007 under the PNP ticket but lost. He has penned several  books, apparently getting his big break covering the short-lived Takeo Miki administration (Miki took over from Kakuei Tanaka following the Lockheed bribery scandal and overreached in his efforts to achieve political reform), and seems to have made his career as one of those political reporters who becomes a mouthpiece and fixer for the politicians he’s supposed to be covering as a journalist.

Keiichiro Nakayama K-1791

Kazuo Ishida, LDP Tokyo Prefecture staffer (LDP, age 65, never before elected) – Ishida is the 28th and final candidate on the LDP’s PR roster. In 2005, their last choice for PR candidates was Taizo Sugimura, who got in and has come to be widely considered a disaster. It’s possible they decided to go with the safest possible candidate (a lifelong party man who has no delusions of grandeur or, from the looks of it, any real ambition).

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Junichiro Yasui, lower house member (LDP, never before elected) – Yasui is one of the Koizumi children who won his diet seat in 2005 on the wave of LDP support for Koizumi’s postal privatization plan. He’s a dropout of Waseda University but was known as the head of the Waseda retail district (one of the familiar-looking shotengai that you see around Japan). Once again he is low on the PR list and will probably not make it in this time.

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Masaaki Kuniyasu, former ambassador to Venezuela, former ambassador to Portugal (LDP, age 71, never before elected) – This guy doesn’t look happy to be running for election with such slim hopes of victory. He’s also toward the bottom of the LDP’s Tokyo PR list. According to his Asahi questionnaire, he’d like to see Japan known as a “an environmentally advanced nation.” It appears that he (or someone with the same name) wrote a book in 1996 titled The Truth Behind The Philippines’ People Power Revolution.

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– The New Komeito are running two people named Takagi next to each other in the Tokyo PR block, but they appear to be unrelated. One, Yosuke Takagi, is a former Mainichi Shimbun reporter.

Eiko Ishige, NPO board member, author (DPJ, age 71, reelected three times) – Thanks to Jiji I know she her sign is a Leo. Her field of specialty is elderly benefits, and she has written several books on the topic, including The Elderly and Welfare (A Book to Understand the Elderly). Judging from the title of one of her books, she considers herself a citizen activist. Her name has a difficult kanji for Ei that won’t show up when you try to search for it.

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– The Happiness Realization Party has adopted a strategy of placing recognizable names in their PR spots. The bassist from the Blue Hearts, a manga artist, and shady inventor Doctor Nakamats are all there in the Tokyo block. The former two are apparently believers, but Nakamats is just looking for cheap promotion just as he was when he ran to be Tokyo governor in 2007. He charges exorbitant amounts for dubious-looking inventions such as the Love Jet 69 sex toy available for 30,000 yen plus shipping.

OK, that’s it for now! You can see me tomorrow night with the live coverage of the election results with the good people at Transpacific Radio.

Japan Lower House election – Meet the candidates Part 4: Kazumasa Fujiyama (Happiness Realization Party

The final candidate in Tokyo’s 13th district is Kazumasa Fujiyama, running under the Happiness Realization Party ticket.

Before I get to this guy’s profile, I want to quote from an excellent piece on the party from the Irish Times:

Founded earlier this year to offer voters a “third choice”, the HRP has an eye-catching manifesto: multiply Japan’s population by 2.5 to 300 million, overtake the US to become the world’s premier power, and rapidly rearm for conflict with North Korea and China.

If elected, its lawmakers will inject religion into all areas of life and fight to overcome Japan’s “colonial” mentality, which has “fettered” the nation’s true claim to global leadership.

A new book, The Guardian Spirit of Kim Jong-Il Speaks , by party founder Ryuho Okawa explains that earlier this month at a session in the party’s Tokyo headquarters, the voice of Kim’s guardian angel warned of his plans. But at least Kim is alive – Okawa also claims to be able to receive the thoughts of Japan’s notorious wartime monarch, emperor Hirohito (1901-1989), and his deceased predecessors.

Being able to commune with the dead is but one string to Okawa’s bow. A reincarnation of Buddha, he achieved great enlightenment in 1981, according to the party’s website, “and awakened to the hidden part of his consciousness, El Cantare, whose mission is to bring happiness to all humanity”.

Before he founded the Happy Science religion in 1986, Okawa wrote books under the names of Muhammad, Christ, Buddha and Confucius. Conveniently, if improbably, speaking in Japanese, some of the prophets had much the same message: Japan is the world’s greatest power and should ditch its constitution, rearm and take over Asia.

The Happies boast that they have sold 11 million copies of their bible, Shoshin Hogo (The Dharma of the Right Mind), in Japan since 1986, and opened 200 temples.

Okawa’s books, mixing new-age philosophy with self-improvement tips and political views, have sold millions more, apparently providing the funding for the campaign. Translating those beliefs into political power, however, has proved easier said than done. Tokyo voters shunned the Happies’ candidates in this month’s municipal election, which ended LDP rule in the city and set the DPJ up for a historic national win next month.

Also, you might be interested to see the Happy party’s new manifesto video. It’s very similar to the one they produced for the Tokyo assembly elections (that animated treasure was unfortunately taken down), only this time slightly more professional:

Now, to the candidate:

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Profile: An architect by trade, Fujiyama became a full-time Happy Science member in 1995 and has since risen to become a leader in Tokyo – he previously served as the head of the Science’s Nippori Branch and Adachi Branch before being named deputy leader of the Tokyo Branch in 2009.

Before becoming a full-time Happie, Fujiyama was an employee of Haseko Corporation, a construction/engineering firm that’s listed on the Tokyo Stock Exchange. It’s unclear whether he was a member of Happy Science before 1995 or if he

One of Fujiyama’s bases of operations is the Science’s Nippori branch (seen here on Google Street View), which I happened to spot during a walk the other day:

Policy: As all Happiness Realization Party candidates appear to be carbon copies of one another, it’s no surprise that Fujiyama supports all the planks mentioned in the above video – slash taxes, smash North Korea, and somehow make Japan the world’s biggest economy by 2030 (I suspect they’d have to destroy all other countries to do this).

When asked in an Asahi questionnaire about how he would like the world to see Japan, he answered as “a great economy.” (経済大国)

Fujiyama claims in a blog post that the owner of a building near Kameari Station said she’ll support him because she hates paying consumption taxes.

Something interesting: Fujiyama bears an eerie resemblance to party founder and leader Ryuho Okawa:


Fujiyama asahi P_20090626SNSA0030S



OK, I’ll admit that their parts are on opposite sides, but don’t you think they both have a sort of “divine salaryman” look going on?


My next and final profile post will look at a few of the Tokyo proportional representation candidates.

Japan Lower House election – Meet the candidates Part 3: Shuji Watanabe (69) JCP

Profile: Watanabe is a former Adachi-ku assemblyman running on the JCP ticket. At 69, Watanabe is liver-spotted and somewhat frail-looking when campaigning. He is an old school communist – he never went to college but instead joined the party in 1960 after finishing technical school. Three years after graduation he began working as a sanitary inspector at a clinic for the poor, where he was an active unionist who pushed for improved benefits for workers. He entered electoral politics in 1971 and won a seat on the Adachi-ku assembly, where he has won re-election nine times (I assume consecutively). He has apparently retired from the assembly to run in this election.

Chances of winning: I don’t think he expects to win. True to the JCP’s commitment to being a vocal minority party, I think the point of him being there is to try and direct the debate in favor of the JCP’s policy platform. He doesn’t even have his own real website, so I kind of doubt the party’s commitment.

Policy: Watanabe is running on a typical JCP line of protecting employment. See my earlier post on the JCP to see why I find them unacceptable.

Something interesting: I can’t say for sure, but something tells me this guy is related to Yasunobu Watanabe, the Tokyo Prefectural Assemblyman who handed his seat to JCP candidate Yoshie Oshima in July.



Yasunobu Watanabe

Japan Lower House election – Meet the candidates Part 2: Tairo Hirayama (DPJ, age 37)

I am running out of time before the election (and have lots of research to do before my major live-streaming/blogging event tomorrow night), so I’ll be quickly running down the rest of the ticket in Tokyo’s 13th district:

Tairo Hirayama (DPJ, age 37) – This guy has been just about ubiquitous around Ayase recently, much more so than his LDP rival Ichiro Kamoshita.

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Profile: This first-time candidate was a guest lecturer at Akihabara’s Digital Hollywood University (a school specializing in IT and media) where he taught a class on e-commerce. His main occupation is running a non-profit organization that helps small companies set up e-commerce websites. While not as prolific as Kamoshita, Hirayama has authored several books including Net Shop Management Standard Guide – 37 Iron-clad Rules for Attracting Customers and Sales Promotions Known only to Top-selling Stores.

He is originally from Iki, a tiny island in Nagasaki prefecture between Kyushu and Tsushima where his parents run a ryokan (traditional Japanese inn). I assume he is running in Adachi-ku because that’s where the DPJ placed him. He does not claim any prior affiliation with the area.

A turning point in his life came in 1995 when as a student at Waseda University he volunteered for the rebuilding effort following the Great Hanshin earthquake that devastated the Kobe area. It was there that he learned how to lead people; it’s also where he met his wife Sachiko, with whom he now has three children.

Policy: His campaign vans and literature all feature a big sticker announcing his support for the DPJ’s childcare cash handout program. Under the program, most families with children will receive 26,000 yen a month until their kids finish middle school. He’s made that the centerpiece of his campaign. He’s also been emphasizing his youth – the masthead of his website contains a logo with the word “age 37” in flames.

In an Asahi policy questionnaire, he said he’d like Japan to be known as a nation of “peace and culture.”

Chances of winning: The Nikkei-Yomiuri joint poll showed Hirayama slightly ahead. I’d say he will probably win backed by the groundswell of support for a DPJ-led government. He has the backing of 80% of DPJ supporters.

Something interesting: Hirayama’s wife Sachiko (apparently in her early 30s), who worked at a local Kyushu TV station before getting married, is no slouch – she won a female entrepreneur award in 2007 (with a 3 million yen grand prize!) from FujiSankei and Daiwa Securities for her creative business plan to open a “next-generation store” in Tokyo based on her online business Ikimonoya, an online retailer of gourmet Japanese food. The site is run under the brand of the Hirayama Ryokan, the traditional Japanese inn located on Iki that has been in her husband’s family for three generations. She is president of the ryokan company and her husband Tairo is the Representative Director (some sources say Tairo’s mother is the okami-san, the Japanese term for lead hostess/general manager, while others say it’s Sachiko now). Unfortunately the site shows no indication that they actually opened a store since she won the award in March 2008.  She reportedly lives on Iki full time, so it must be very lonely for her husband in Tokyo.

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Sachiko Hirayama

How Japan’s proportional representation voting system works, from Nikkei

Today’s Nikkei print edition has a great Q&A about Japan’s proportional representation system. Here is my explanation for how it works, borrowing from that Q&A and some Internet sources:

  • There are 180 seats (of the lower house’s 480) that are decided by PR. The country is divided into 11 regions, or “blocks”, which each receive some of the 180 seats. In addition to voting for a candidate in their single-member district, voters write in the name of the party they wish to receive their region’s PR seats. Votes remain valid if they are for an individual running on that party’s PR list, or if they are for the party leader.
  • Seats are awarded using the D’Hondt method. Though somewhat complicated, this is a fair system for allotting the seats as intended. Putting it in my own words would be tough, so I’ll just quote Wikipedia:

In a closed list system, each voter casts a single vote for the party of their choice. In an open list system (such as Japan’s), the voter votes for a candidate personally, but the vote is principally counted as a vote for the candidate’s party.

After all the votes have been tallied, successive quotients or ‘averages’ are calculated for each list. The formula for the quotient is \textstyle\frac{V}{s+1}, where:

  • V is the total number of votes that list received; and
  • s is the number of seats that party has been allocated so far (initially 0 for all parties in a list only ballot…)

Whichever list has the highest quotient or average gets the next seat allocated, and their quotient is recalculated given their new seat total. The process is repeated until all seats have been allocated.

If you don’t want to go through the calculation, you can use the following shorthand for your region – for example, for a party to win one of Tokyo’s 17 PR seats, it needs to garner 1/17 of the vote, or 5.9%. Every 5.9% of the vote after that gets it another seat. It’s not precise but it’s a rough indicator.

  • Parties are required to submit a list of PR candidates in advance, with candidates prioritized by region. For example, the LDP’s list prioritizes incumbents, many of whom are also running in single-member districts (see below).
  • Candidates are allowed to run both in a single-member district and one PR block. This means if the candidate loses in the single-member district, he or she can still be sent to the Diet if the party wins in the PR block.
  • It is possible to give two or more candidates the same level of priority if they are running in single-member districts (they then act like understudies for each other). A double-candidate who wins in the single-member district is automatically withdrawn from the PR list and the understudy takes his or her place. Note that in the LDP’s list, the first 22 candidates are all tied for first in priority. If only one wins in the PR block, then all 22 will get seats before the 23rd candidate.
  • PR candidates who were given equivalent priority who lose in the single-member districts are not given sub-ranks ahead of time. The seats will be alotted among them in order of who came closest to winning in their respective single-member districts. So if Yukari Sato loses in Tokyo’s 5th district by just 1,000 votes and Yuriko Koike loses in Tokyo’s 10th by 2,000 votes, then Sato would be given priority over Koike.
  • If a party wins in an unexpected landslide, there is a possibility they could fail to field enough PR candidates to satisfy the voters’ mandate. In that case, it sucks to be them because the seats go to the party who got the next greatest number of votes. This happened in 2005 when every candidate won on the LDP’s PR list in the South Kanto block, resulting in the election of 25-year-old Taizo Sugimura. They had enough votes to get at least one more seat but had to give it up to another party (story courtesy of Lord Curzon). This strikes me as a little undemocratic, since that means a party that the voters specifically voted against will win a seat.

Japan Lower House election – Meet the candidates Part 1 – Ichiro Kamoshita (LDP)

The August 30 general election will select all 480 members of Japan’s lower house of parliament. 300 of those seats are apportioned to 300 single-member districts, elected in first-past-the-post contests similar to the US House of Representatives. The other 180 are chosen by proportional representation among 11 regions, which means that in each region parties will receive seats in the proportion that their party receives votes.

My job for the next few days is to profile the candidates in my local district, Tokyo’s 13th.


First up is the incumbent LDP dietman and licensed psychiatrist Ichiro Kamoshita. He’s been re-elected five times and served as environment minister in the Yasuo Fukuda cabinet.

A native of Adachi-ku, Kamoshita spent his entire education in the district before entering the Nihon University’s medical school. He then worked as a psychiatrist until 1993, when he ran and won his first election under the ticket of the Japan New Party, a party that was formed during Japan’s period of political instability and now no longer exists.

Since joining the LDP in 1997, he has risen quickly, scoring a position in the second Abe cabinet in 2007 as environment minister.

Unfortunately for Kamoshita, his rise came at a time of turmoil for LDP governments. Abe’s cabinet reshuffle came soon after the LDP’s punishing defeat in upper house elections that resulted in the ruling coalition losing control of that house. Simultaneously, the media was unearthing scandal after scandal on cabinet ministers, which just months before resulted in the suicide of then-agriculture minister Toshikatsu Matsuoka. During his tenure as environment minister, Kamoshita became best known for becoming the focus of his own funding scandal as discrepancies were found in various official financial disclosures.

When Abe suddenly resigned in September and handed the prime ministership to Yasuo Fukuda, Kamoshita was kept on along with most of the rest of Abe’s second cabinet. He was spared further scrutiny of his political funding as similar discrepancies were found in the disclosures of high-level DPJ officials.

Kamoshita is a member of the LDP’s Tsushima faction, a group that traces its roots to the Takeshita faction of the 1980s. Known as “mainstream conservative,” the Tsushima-ha is led by former health and welfare minister Yuji Tsushima and has 68 members, notably current agriculture minister Shigeru Ishiba, gaffe-prone ex-defense minister Fumio Kyuma, and last but not least the flamboyant Japan Post-bashing Kunio Hatoyama, who was justice minister and then internal affairs and communication minister under Aso.

Policy: Aside from the official LDP platform of emphasizing economic recovery first and the LDP’s “power of responsibility” (責任力), Kamoshita has his own set of labor-related proposals that he’s outlined in the form of a Scientology-style stress test. They include encouraging telecommuting and helping people to have two homes (a small apt. near the office and a weekend home on the beach).

Kamoshita’s literature and website will not let you forget that this man is a real live doctor. It’s this personality-driven appeal that shines through more than his policies.

Here‘s his answer to a Mainichi questionnaire on his policies, though I doubt you’ll find much that’s surprising. He supports the Koizumi reforms “to a point,” supports a missile defense system, wouldn’t ban corporate political donations, supports temporary employment, opposes the recording of police interrogations, etc. etc.

Chances of winning: He might not make it. The Nikkei-Yomiuri poll gives the edge to his rival from the DPJ Tairo Hirayama, and he’s lost to the DPJ before in 2003 (but won election as a proportional representation candidate). A news report on one of his campaign speeches indicates a lack of enthusiasm. About 100 people watched him speak in front of Kitasenju Station, but apparently no one applauded or cheered. One observer noted, “I’ve never seen such a quiet campaign speech.”

Tell me something interesting: Ichiro Kamoshita is one of those rare Japanese politicians who actually has a life outside of politics. Soon after he was first elected in 1993, he began to write prolifically in the self-help genre, and to date has authored more than 90 books mostly on mental health, including such titles as Read This Book if You No Longer Feel Like Meeting People, A Book to Cure “Not Being a Morning Person,” Subtle Habits of “Women who Are Chosen [by Men]”, and Mother, Don’t “Love Your Kids Too Much.” Many of his books seem to apply the same basic approach to various problems. So if he loses this one, you can bet he can keep working as a writer.

He has also released three music-therapy CDs – one each for dieting, skin conditions, and constipation.

Kamoshita visited the potentially sinking nation of Tuvalu in his capacity as Minister of Environment to initiate an effort by JICA, Japan’s aid implementation agency, to assess local conditions for future support from the Japanese government to mitigate the effects of climate change.

Curzon on Japan’s Medical System

The New York Times blog has a Q&A series on the health care systems of the world, and their latest post concerns the health care regime in Japan. The supposed expert is Dr. John Creighton Campbell, professor emeritus of political science at the University of Michigan, apparently presently in Tokyo, and author of a book on Japan’s health care system.

Cards on the table: I have generally had pretty good health care coverage while living in the United States, although I have been burned with enormous bills at times, and generally support some government alternative that covers the uninsured. I have had some nightmarish experiences with Japan’s medical system with incompetent doctors, meaningless medicines, and endless hospital visits — and am infuriated when it is brought up as a wonderful alternative to the American system. In a nutshell, here are the inherent systematic flaws in Japan’s medical system that are in dire need of repair:

* The average US doctor sees 1,600 patients a year or so, while the average Japanese doctor sees 6,000 patients a year. That’s because there’s a maximum fee doctors can charge patients/the system per visit, so the incentive for doctors is to get you to come back as frequently as possible. My US doctor gives me 10 days of antibiotics and tells me to get back to him if I still feel ill; the Japanese doctor gives me 48 hours worth of a cocktail of multiple medicines and tells me to come back as soon as possible.

* There are hordes of incompetent doctors out there and few legal remedies to medical malpractices. I’ve had my own problems with poor care, such as one problem that was in danger of becoming chronic after three doctors incorrectly diagnosed the problem (the fourth got it right and solved it almost immediately; my family doctor in the US diagnosed it correctly over the phone with a mere description after the second doctor was giving me problems and I called overseas). AndI have numerous friends who have been permanently crippled by shoddy surgery — incorrectly setting broken bones, wrong setting of pins in knee surgery, botched eye surgery, all with no effective or meaningful legal remedy. Medical negligence is a serious problem that is only recently starting to be addressed. Basic rule: if you can afford to get a major medical procedure done in the US, do it.

* There is ancient and inferior technology, especially in smaller practices. I’ve been in medical clinics in Kyoto where doctors were wielding devices that looked like they belonged in museums. I shudder to think what the people out in Sadoshima or the wilds of Hokkaido have to face.

* Pharmacology is random and placebo-centric. Doctors give medicines in little paper bags with instructions on how to take them, but the type of medicine and amount is rarely included. Antibiotics are distributed in doses of only a few days, which runs the risk of doing more harm than good and spreading disease.

* Dental care is atrocious! I do not lie when I say that Lady Curzon goes to the same dentist as the Japanese Imperial Family. Her most recent trip earlier this year to repair a chipped tooth was, frankly, poorly done. During Golden Week, we spent a week in the US, and my hometown doctor in a small rural town, wielding technology that was cutting edge circa 2007, did a far superior job. We had US insurance covering our cost, but even if we didn’t, the total cost would have been roughly equivalent to the cost in Japan.

* Japan provides great care if you get typical Japanese old-age problem like cancer; you are in real trouble if you get a typical Westerner old-age problem like heart disease. According to the figures of the MacKenzie Consultants, which I don’t have in front of me now so these figures are only approximate, the survival rate for heart attacks in the US, UK and Germany is between at 60-80%; it’s 30% in Japan.

Which brings me to the article, with Curzon commentary embedded where the spirit moves me to agree with, or take issue with, Dr. Campbell’s assertions.

How does the Japanese system provide health care at lower cost than the American system?

Japan has about the lowest per capita health care costs among the advanced nations of the world, and its population is the healthiest. That is largely due to lifestyle factors, such as low rates of obesity and violence, but the widespread availability of high-quality health care is also important. Everyone in Japan is covered by insurance for medical and dental care and drugs. People pay premiums proportional to their income to join the insurance pool determined by their place of work or residence. Insurers do not compete, and they all cover the same services and drugs for the same price, so the paperwork is minimal. Patients freely choose their providers, and doctors freely choose the procedures, tests and medications for their patients.

[Basically correct. And yes, lifestyle is the most important factor.]

Reimbursement rates to doctors and hospitals are negotiated and set every two years. The fees are quite low, often one-third to one-half of prices in the United States. Relatively speaking, primary care is more profitable than highly specialized care, so Japanese doctors face different incentives than U.S. doctors. As a result, the Japanese are three times more likely than Americans to go to the doctor, but they receive many fewer surgical operations.

What does the Japanese health system do particularly well?

First, Japan is egalitarian and medical bankruptcy is unknown. [Nonsense. At my previous firm, one attorney had as part of his personal practice handling individual bankruptcy, and many of his cases involved families filing for bankruptcy to cope with a spouses long-term care. This was often also accompanied by a legal divorce so that the spouse receiving care would qualify for extra benefits/cheaper care.] An individual’s income influences the quantity and quality of medical care probably less than in any other country. Premiums and out-of-pocket costs are minor concerns for most, and low-income people and the elderly receive subsidies to afford care.

Second, the Japanese system is quite good for chronic care, particularly because it has so many older people. Along with appropriate medical care, Japan also provides long-term care to all older people who need it through a public insurance system that started in 2000.

What is your biggest criticism of it?

Financial stringency and organizational rigidities have led to inadequate hospital services in some areas, particularly in emergency care, where patients in ambulances are sometimes turned away. [Yup, how many stories have we seen in the last year of people dying in ambulances after being turned away from a dozen or so hospitals?] There also are doctor shortages in some regions and specialties. [As noted, I shudder to think of the medical technology available in the sticks — where most of the old people live.] Consultation times can be too short for complicated diagnoses and for psychotherapy. Specialized training and certification for physicians should be better, and cutting-edge surgical techniques should be more available.

Many of the problems are largely due to underinvestment, and the severity of the cost control has become an issue in the current election campaign.

What is the most important lesson Americans should learn from the Japanese system?

In the 1980s, health care spending was increasing as quickly in Japan as in America, but the Japanese government learned how to influence medical care provision without rationing by manipulating how it paid for services. Annual spending growth has thus been quite low despite a rapidly aging population. Including everyone in a controllable system was a prerequisite. Japan is not a single-payer system, but like France and Germany, it has been able to control costs by tightly regulating multiple insurers.