Monday, May 05, 2008

In Rude Political Health

In what is a probably astute gesture of restraint, the leadership of the Democratic Party of Japan has reportedly backed away from the plan for a vote of censure in the House of Councillors.

A DPJ candidate's defeat of the Liberal Democratic Party candidate in the Yamaguchi #2 by-election and the prime minister's disastrous public polling numbers have robbed a bill of censure against the PM, a member of the other house of parliament, of much of its former luster. The DPJ has proven itself relevant: it does not need an act of political theater to convince the public of its sincerity and importance. On balance, a censure motion now poses more of a risk to the DPJ's standing than the DPJ can perhaps stomach. Proceeding to a vote on a legally dubious bill could boomerang, leading to the public to call into question the DPJ's credibility.

As if to balance its new restraint in regards the censure with excess elsewhere, the DPJ has announced a plan to proceed with a bill terminating the new over-75 elder care system.

The move is smart in seikyoku (political street fighting) terms. The elderly vote in far greater numbers, both in aggregate and proportionally, than the young. In terms of regional power, retirees are a larger fraction of the voting public in the low population rural prefectures, where the move of a few thousand votes from one column to the other could switch a district from LDP to DPJ control. Elderly-dominated districts are also over-represented in the Diet due to the incomplete equalization of the declining rural districts with stable or growing urban-suburban ones. Appealing to the old cannot only win you more votes within a district, it can win you more districts period, due the dominance of elderly voting a larger number of districts. Add to this structural justification for pandering to the retirees a tone-deaf ruling coalition incapable of even breathing without offending—and you have what must be a seductive opportunity to position the DPJ for a seizure of power.

Such positioning is Ozawaism at its worst. It is Tanakaism reversed: the irresponsible promising to undo all unpopular LDP policies—even the difficult and necessary ones—in order to win the next election. It is irresponsible and dishonest—justifiable only to revolutionaries to whom the end of winning political control justifies the means. That Kan Naoto—a former minister of health and welfare—should be the DPJ's spokesman for this facetious termination bill is disturbing. He of all the leaders of the DPJ should know that health insurance system is doomed to a financial unraveling unless fundamental reforms of elder care are undertaken.

In seisaku (political policies) terms, the recently instigated elder care system seems a fair solution to the looming elder care crisis. With the young a decreasing fraction of the total population, relying upon on the underconsumption of healthcare by the young as the subsidizer of the healthcare of the very old puts one on a collision course with reality—no matter what one may think of the social justice aspects of the intergenerational transfers...

(I am an apostate. I hold as self-evident that the young today have high paying jobs in an advanced industrial society thanks to the savings, self-sacrifice and hard work of preceding generations. Whining about being taxed to death in order to coddle rapacious old folks grants to the individual an unearned aura of autonomy across time.)

The decision to deduct (tenbiki) a regular extra insurance fee from the pensions of persons over 75 years of age in return for lowering the patient's visit costs to 10% of the total cost does penalize very healthy seniors. Then again, all insurance systems penalize the healthy.

Having a regular fee deducted from one's pension and a low per visit cost avoids a major problem with the elderly: self-rationing of healthcare. One wants the healthcare system to discourage frivolous visits to the doctor—one of the reasons (aside from the obvious fiscal ones) that the authorities over the last decade have increased the percentage an individual pays out of pocket from the original 10% to 20% and 30%. However, one would want the very old to seek treatment for minor ailments before they deteriorate into major and expensive-to-treat illnesses. One would want the system to stimulate the individual retiree into rationalizing a visit to the doctor as a way of recouping for himself or herself at least some fraction of the money the government has forcibly taken from his or her pension.

The regular pension deduction and lower per-visit cost also addresses one of the real problems of the cost curve of healthcare over time—that the last six months of a person's life are the most expensive. As organs and internal systems fail, doctors and hospitals deploy all kinds of life-prolonging medications and devices...

(One unfortunately misinterpreted gesture has been the government program encouraging physicians to give their patients questionnaires asking them to specify about what kind of life-prolonging treatments they would not want deployed in case of incapacitation. Some critics [Veracity Alert - The following is according to Shūkan Gendai - quote at your peril] of the system have depicted the gathering of this information as a preliminary step to charging higher monthly fees to those individuals expecting more aggressive and expensive life-prolonging strategies. They have pointed to the assigning of a point system to certain kinds of treatment as evidence--as if a person amassing a certain number of points after saying "yes" to a particular number of life-prolonging treatments would be then charged an "X" amount in fees. The actual goal of the point system is almost certainly to help hospitals decide on how much to spend on certain technologies and treatments, and avoid overinvestment into life-prolonging technologies the patients do not want employed.)

To expect an individual to have liquid savings able to cover 20% or 30% of the cost of these end-of-life treatments, especially as life-prolonging technologies advance in their ability to increase lifespan, is simply not reasonable. Better to have each person pre-paying over the course of her or his retirement into a general fund, creating a special drawing right for the individual for the time when her or his vital systems begin to shut down, leaving the individual at that time liable for only 10% of the cost out-of-pocket.

Now, if the above is indeed a proper description of the new elder care system, it would take a special kind of genius to be so unnerved as to never, ever attempt to explain it. Perhaps the LDP and the New Komeitō deserve to be sent to perdition for having both delayed the introduction of this system and left it to the bureaucracy to justify.

However, the cowardice of the ruling coalition is no excuse for the DPJ's turning its back on reform. The public is not stupid: it will ask what the DPJ's plan is for the long-term financially stability of the healthcare system. Being in an advantageous position on the electoral map is a fine and wonderful thing—and elections are about winning. However, as a party that will win at best a plurality of seats in the House of Representatives, requiring the cobbling together of a coalition in order to form government, the DPJ should be at least considering the possibility that a reputation for conscientiousness could make the signing up of allies a slightly easier task.

Kan Naoto speaking out in favor of reverting to the previous system puts pressure on the DPJ's House of Councillors membership to speed up the consideration of the termination bill. Submitted to the House of Councillors in February, the bill has yet to see the inside of a committee chamber. A suspicious mind could even posit that the DPJ councillors have been stalling on their allies—all of whom are enthusiastic supporters of a rescinding of the new system.

Perhaps being in charge of one of the houses of the Diet has made DPJ's House of Councillors members the party's "responsible wing" —which would be a neat reversal of the traditional image of the House of Councillors membership as the breakfast cereal (i.e., the flakes and nuts) of every political party.

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