Michael Moore's "Sicko" is not the first to say that the United States health care system isn't that great.
The WHO ranked the United States as № 37.
So where does Japan rank on the WHO chart? Japan is № 10. Of all Asian countries, only Singapore checks in higher at № 6.
While neither system the Japanese nor United States is perfect, I've received superior care from the Japanese system. I didn't always feel this way.
"Sicko" has a Japan connection.
There's a great Japan related anecdote sixteen minutes into the movie Sicko. Maria's primary care physician referred her to see an ophthalmologist, a neurologist, and get a MRI. All three of these requests were denied by Blue Shield of California. Maria then gets ill while vacationing with her family in Japan. She gets the MRI in Japan and discovers she has a brain tumor. Like any good American, she sues. There's video of the March 13, 2003 trial which shows Glen L. Hollinger, M.D., the medial director for GSMPA (the contracted medical group for Blue Shield of CA), admitting that his signature on the denial letters was a stamp and that he doesn't actually look into detail as to whether people should be denied procedures. In other words, very little priority and follow through is done to see that the denials that American medical insurance companies issue are actually "not medically necessary," as Maria was told by Blue Shield.
F.O.B., I thought the Japanese system sucked.
I'm not dying from some horrible disease. I've always had health insurance in the U.S.: either through my parents when I was a teenager or via a health insurance company subsidized by a large, publicly traded company. My company has switched providers multiple times. I've experienced Cigna, UnitedHealthcare, and Blue Cross/Blue Shield of North Carolina. I'm married with a family and concerned that my child gets the best possible care, and
I have the income to afford it, so I've always purchased the premium PPO packages with the highest premiums and the lowest deductibles.
I would not be a good anecdote for Michael Moore's "Sicko."
Like most Americans, I was taught that thanks to the free market system, America's system was the best in the world. America's blind belief in this may explain the disparity in the WHO survey that shows how Americans have the highest satisfaction in their system. My American dentist during my teenage days would rant about how Hillary Clinton's health care plan would ruin America's #1 position in the world. At the time, I nodded in agreement. I didn't realize how much of his opinion was bound in self-interest and his own prejudices.
My first few years in Japan in the early '90s didn't change my opinion. I didn't speak the language very well. I didn't know how to communicate with the dentists and doctors. The first dentist I went to confirmed every stereotype I had about why Japanese and British people had such crooked and horrible looking teeth (not anymore, by the way. How quickly things change in fifteen years). The dentist's drill was powered by a pulley system, rather than the modern air system. The walls were not painted white, which helps gives the illusion of a sterile environment by looking cleaner. The atmosphere reminded me of the 1985 dentist scene in the movie
タンポポ ("dandelion") by
伊丹十三監督 (Director Jūzō ITAMI).
The dentist wanted to take a souvenir picture of my American dental work … oblivious to the American fears of overexposure to X-rays. Most people receive far more radiation from CRT monitors and airplanes in their lifetime than from their two to four medical X-rays a year. A fellow English teacher at the time summed up the visible difference in Americans dental care with the following cultural explanation:
"Japanese and British people only go to the dentist when it hurts when they eat. In Japan, the display of teeth is like the display of bone. It's gross and thus avoided. Since your teeth aren't on display when you smile, the appearance of your teeth, be them yellow and/or crooked, isn't important."
"Dentists in Japan don't need to look at the color of your skin, eyes, or hair to tell that you're an American. One look inside your mouth and they'll say 「やっぱりアメリカ人ですね。 ]
("You're an American all right.")
My first experience with a hospital visit was also marred by my inability to communicate effectively. Much like the hospital scene in Lost in Translation, there are some doctors that will communicate with the patient entirely in Japanese, even if it's clear that the patient doesn't understand the language. I believe they do this for liability reasons. If a doctor (whose native language is Japanese and his limited foreign language skills) attempts to communicate in a foreign language and misspeaks, the misunderstanding is the doctor's fault. In Japan, however, the official national language is Japanese. If the doctor gives you a diagnosis in Japanese and you don't understand, that's
your fault. That being said, many doctors have been taught overseas and even those taught in Japan have to learn the Latin terms for many diseases and often will attempt "Medical Nihonglish"— incredibly difficult medical terminology intertwined with broken English grammar.
My second experience with the Japanese medical system also occurred during my first three years in Japan. I had a full blown case of influenza, which was triggering an asthma attack.
I don't remember that much about the experience because I was delirious. I do remember coming home from work during winter feeling unexpectedly feverish. I vomited a few times prior to boarding a bus from
難波 (Namba) to my home in
大正区 (Taishō Ward). The fever was so bad I passed out on the city bus and missed my stop.
I could barely breathe and I felt like I was close to death due to asphyxiation. I had too much pride to ask others for help and I attempted to go to what I thought was a general hospital's 24 hour emergency room after hours (around 2 am). Nobody would help me and nobody knew how to help me because they couldn't understand me.
I had broken up with my girlfriend that year and had nowhere to go, so I ended up crawling to a neighbors apartment on the same floor whom I knew. She used to be a nurse. She ended up caring for me over the next couple days, making me easy-to-digest traditional meals of rice gruel.
The experience brought out a bigot in me that I didn't know existed. I was swearing and calling the Japanese system an inferior piece of shit compared to the U.S. system and repeating all the
negative things I had heard about Japanese medicine from other foreigners:
Things on the Internet about Japanese medicine aren't 100% true.
- Japanese doctors aren't used to and thus don't like patients asking questions.
- Depends. As long as you ask respectfully and don't phrase the question in such a form that you're telling the doctor what you think the diagnosis is and/or what drug you need, they're more than happy to answer questions.
- Japanese doctors give you unlabeled drugs without telling you their purpose.
- False. Most Japanese don't care to ask so they may not volunteer the information. But if you ask, they'll tell you.
- False. They'll give the patient the option as to whether they want to hear the bad news. Doctors in Japan get ethics training like all other doctors that practice Western medicine. As for bedside manner, it may not be the manner a non-Japanese is used to, but they do have bedside manners.
Apocryphal non-Japanese at the Doctor Miscommunication Example
Foreigner goes to the Japanese doctor's place. Doctor says 「どうしましたか？ 」("What's wrong?")
The patient wants to say 「頭が痛い。 」("My head hurts.")
Instead he says 「頭が悪い。 」("My head is bad.") which means "I'm stupid" in Japanese.
After the nurse and doctors finish laughing, the doctor pats him on the head and replies back with the Japanese proverb, 「馬鹿が死ななければ治らない。 」 ("Only death can cure a fool.")
That was then. This is now.
Actually knowing Japanese and having enough years under your belt will do wonders towards your impression of the foreign country.
Right now I'm getting state-of-the-art insured dental care that was deemed medically unnecessary by my my former U.S. gold-plated plan (replacing of old 1970s era
amalgam fillings which have mercury in them and conduct heat and cold easily. I was also able to get a prescription refilled that my gold-plated plan provider refused to refill despite my doctor prescribing it for me. They considered the drug "experimental." That's a health insurance term which is used as a synonym for "expensive."
Soon I'll have a new crown put in place. I'm paying extra for the cosmetic crown that looks like a white tooth as opposed to being made of silver or gold. That price is still cheaper that what I'd have to pay for the silver crown in the States.
The health care system in Japan does have it's problems, just like all systems. But on a whole it's superior to the States. And that's based on my anecdotes from living and experiencing the health care here in both countries over a period of many years.
