The Last Man

The Past
Was
Be Here Now

- George Harrison, "Be Here Now" (1973)

This one really is for the history books: at 2 a.m. local time, Kimura Jiroemon of Kyotango City, Kyoto Prefecture, died. (Link - J)

Kimura, born in the 30th year of the Meiji era, was 116 years, 54 days old at his death. For followers of the Gregorian calendar, Kimura was the last man alive to have been born in the 19th century.　(Link)

Sam Jameson (1936 - 2013)

From the Foreign Correspondent's Club of Japan, sad news for the community of Japan observers:

..Sam Jameson, former correspondent and bureau chief for the Los Angeles Times in Tokyo, former president of the FCCJ and life member of the Club, died on April 19 at 2 a.m. at Kitasato Hospital in Tokyo of a hemorrhagic stroke. He was 76 and had been hospitalized since March 24.。.

Samuel W. Jameson first joined the Club in 1963 when he arrived here as the first Tokyo Bureau Chief of the Chicago Tribune and then moved to the Los Angeles Times as Tokyo bureau chief in 1971...

One of his proudest achievements was helping to arrange the first-ever formal press conference of the Showa Emperor with the foreign press, in 1971. Since leaving the L.A. Times in the early 1990s he worked as a freelancer...

Sam -- he never stood on ceremony, at least not when speaking in English -- was a raconteur and an antiquarian, carrying inside his head a vast library of knowledge about Japan's politics, from the time of Kishi and Ikeda to the present.

The light in that library has now gone out.

For as long as I knew him, Sam was reputed to be at work on an encyclopedic study of Japan's politics...one that will now perhaps never find a publisher.

I wonder about who, if anyone, is in charge of his affairs and effects.

さよなら, サム...


Later -The full message from the FCCJ, now up on the website. (Link)

A long obituary in The Los Angeles Times (Link) and a mention in The Japan Times (Link). One cannot blame the JT staff overmuch: Sam had been retired for a long time.

Over at the soon-to-be-shuttered NBR Japan Forum, a number of members have posted their feelings and reminiscences (here, here, here and here).

Memory Of Kabuki Greats Passed

Kabuki great Ichikawa Danjuro XII passed away two days ago. The cause of death was pneumonia. He was 66.

Danjuro XII's death comes two months after the death at age 57 of Nakamura Kanzaburo XVIII, another towering figure of kabuki's revival and transformation. These two greats have passed away in what are the years normally spent training the next generation of actors. The brothers and sons of these two men will have to carry on their program of expanding the reach of the tradition through their brilliant performances as guides -- but without the lights and wills that heretofore guided the expansion.

The deaths of two giants withing such a brief span of time also casts a shadow of superstition over the demolitions and rebuilding of the Kabukiza. The latest iteration of the building will enter into service with a curse.

Actors and actresses of the stage and screen have entered politics but with uneven success. Screen lightweights Aoshima Yukio, Morita Kensaku and Higashikokubaru Hideo have all become governors, for example. Ishihara Shintaro's career as a political maverick has been boosted by the public relations savvy and drawing power of the "Ishihara Army" -- the stable of handsome actors managed by the agency founded by Shintaro's brother, screen superstar Ishihara Yujiro.

However, the wattage of the stage and cinema lights has not translated into power in Japanese parliamentary politics -- a disconnect that should concern Ishihara and Higashikokubaru, who are both now members of the House of Representatives. No actor has ever been close to a top-level government job, nor held the top job itself, as has been the case in the United States and the Philippines.

Former hoofer Ogi Chikage seems to risen the highest. She served out the second half of her last term as president of the House of Councillors, kicking tails whenever she felt it worth her while.

Kabuki actors, however, have had a particular role in parliamentary politics as party attractions. The presence of a kabuki actor at these formalized festivities gave the wretched affairs some pizazz, without the star power of the actors upstaging the important business of politics. Danjuro XII was a fixture in the political world, with the patron-client-friend relationship bringing benefits to both. It is not surprising that former prime ministers Mori Yoshiro and Koizumi Jun'ichiro paid their respects at the Ishikawa home yesterday.

I have never been to an adult kabuki performance (Children's outdoor kabuki is another story). I thought at first that I had missed a chance to see either of the two recently departed greats in person.

Then I remembered that I had seen Danjuro XII once -- at a fundraising party for Kosaka Kenji in 2007.

I did not have a camera capable of capturing an image from across a vast, dark hall of the great one delivering his humble address, Mr. and Mrs. Kosaka standing stiffly to his right.

My only personal memory is a blur.

That Aso Slip Of The Tongue

Okumura Jun wonders (Link) why I did not dance a jig over Finance Minister Aso Taro's "my brainstem does the talking" attempt to link dying with dignity and the cost of life-extending technologies. (Link)

There are a number of reasons.

First is I like Aso-san, a lot. He is by his own admission a simpleton, the worst student he ever met. While a holder of reactionary views, he is inconsistent, liking many things other reactionaries find corrupt and immoral. I admire and cherish his insouciance and his patriotism -- qualities so lacking in most of the fanatics whose company he keeps.

Second, Aso has competition. While he has earned most of the attention this week for both his "hurry up and die" comment and for losing his shirt in negotiations with Bank of Japan governor Shirakawa Masaaki (Link), economic revitalization minister Amari Akira is probably still ahead on points. From his wandering off message as regards the strength of the yen (Link) to his incredibly bizarre four strategic targets for Government of Japan economic policy (Link) Amari seems intent on embarrassing himself and his boss.

The Abe Cabinet and the Liberal Democratic Party leadership are full of ticking time bombs: the poverty-scarred Shimomura Hakubun at MEXT, policy research chief Takaichi Sanae (Link), National Public Security Commission head Furuya Keiji, Shindo Yoshitaka at MIC...

Jumping all over Aso for his well-intentioned gaffe will only numb audiences in advance of the waves of nonsense that will be issuing from the Friends of Shinzo over the coming days, weeks, months and years.

Which brings up the third reason why I let Aso's comment slide: there is so much that is substantively wrong in what Abe and Company want to do to Japan that to pick apart a gaffe is to be complicit in a diversion of attention. That Aso said what he said does not reveal a heretofore dark hidden agenda or mindset anymore than Yanagisawa Hakuo's baby-making machines metaphor did (Link). What we learned is that Aso cannot express a thought to save his life -- which we already knew.

A Spot Perhaps Not So Sweet

I heard a version of Jesper Koll's Japan bull speech

(Link)

in December.

Here is my biggest problem with it.

At 4:34 in the video, Koll shows a graph of the wages and bonuses a typical salaried worker receives over his or her lifetime. Wages remain low over the first 15 years of work, then rise rapidly, reach a peak at around 55 years of age, whereupon they decline until retirement.

According to Koll, the passage of the "Mick Jagger" generation (Jagger was born in 1943) from its wage peak and into wage decline and retirement accounts for 80% of observed deflation. One has to assume he is talking about consumer prices deflation. He is clearly not talking about deflation in real estate -- that he accounts for differently. He does not even mention deflation in equities, an interesting choice given his day job.

According to Koll, the massive deflationary pressure from declining wages and bonuses will reverse as the children of the Mick Jagger generation enter their high wage post-40 years of age period.

Ummm, cannot say that I agree.

On the first of this month, the Ministry of Health, Labour and Welfare released this graph.

Let us look first at the top solid line.

[Source]

In 1949, births topped out at a never-to-be-seen again 2,678,792. They fell precipitously, bottoming out at 1,566,713 in 1957 -- a 42% drop in just 12 years' time. Births recovered as the Mick Jagger generation began having children, peaking at 2,091,983 in 1973 (note - half of this generation have already entered the stage when their earnings accelerate). This new peak of births is 32% smaller than the 1949 peak.

After 1973, births fell slightly less precipitously than after 1949, hitting 1,431,577 in 1985 -- a 12 year fall of 32%. However, unlike in 1957, births have never recovered. Births have fallen slowly but steadily, declining 38% over the last 27 years, falling below the number of deaths (thick dotted line) in 2007.

So what does all this mean?

a) the numerically largest generation ever is leaving the workforce.

b) a numerically large generation is entering its high-wage period. However, their numbers are only around 75% of the generation whose total earning power they are supposed to be replacing.

c) there are dramatically fewer children and young people to serve as consumers and workers. Good for them on an individual level as they will (in theory!) be able to bid up wages and demand lower prices for goods. Bad for the country in terms of aggregate spending.

d) With births below replacement level, total population -- i.e., total consumption -- is going down and at an accelerating rate, the number of deaths over birth rising from 18,516 in 2007 to 210,000 last year.

Koll is probably right about a boom coming on. However, it is for the folks selling investments and savings vehicles to the echo generation. That generation has to plan for lifespans of 90 years and for taking care of elderly parents for two decades before falling themselves into decrepitude -- all with little help from whatever survives of the national pension system.

A surge in spending due to rising wages and bonuses?　The birth and death numbers do not offer solace.

And no no one in the Diet is losing much sleep over the implications of the above graph. To borrow a simile from Chris Rock, statistics and macro are like kryptonite to this blessed land's parliamentarians.

Just Catching Up

Following up on the recent post on the new societal panic, the double deaths of caregiver and dependant living in virtual isolation (virtual in that the most famous cases have taken place in urban environments) is a The Mainichi Daily News editorial on the subject (E).

In the recent post on the hanging of Ozawa Ichiro's portrait in the Diet, there was the mention that the House of Representatives Steering Committee had approved the hanging of troubled lawmaker Suzuki Muneo's portrait in the House as well.

Here it is folks, in all its ragged glory.

Let's call the style "Hokkaido Primitive."

Some might say that the portrait makes Suzuki look demented. Some might argue that for Suzuki, demented is a step up.

And yes, that is Sato Masaru on the left, the former Ministry of Foreign Affairs bureaucrat who spent 512 days in pre-trial detention for refusing to answer questions about Suzuki's under-the-table dealings and the man who called Suzuki "MOFA's Rasputin."

Image courtesy: Jiji Press

Fewer Than Two Continued - On Death And Dying

Where the new figures for household size in the Tokyo Metropolitan District intersect with the prevailing zeitgeist in two ways.

The first is the reporting of the increasing number, as if it were a surprise, of famous persons dying alone (kodokushi) and not being found for several days or even weeks.

The first really shocking case was of the former porn actress, television talent, then later blogger and AIDS activist Iijima Ai, who was found dead in her home three weeks after her last blog post in December 2008. The 2009 discovery of the body of longtime film and television superstar Ohara Reiko in her home two weeks after anyone last heard from her further shocked the country. Newscaster and television talent Yamaguchi Mie was found dead alone last year under similar circumstances.

Of course, with the greater number of persons living alone, that the number of persons dying alone should be rising should not surprising. Given the anonymity of the big cities and the hyper-sensitivity over respecting a person's privacy, that persons are not being found dead for days or weeks should also not be surprising.

That the number of persons dying alone at home has not, until recently, been a societal obsession can in part be traced to the incredible rates of hospitalization of the very ill and very old, with over 82% of deaths occurring in a hospital and an addition 3% in special homes for the aged (J - page 9).

Iijima, Ohara and Yamaguchi were 36, 62 and 51 years of age respectively at the time of their deaths. Both Ohara and Yamaguchi had spent many years prior to their deaths caring for aged and incapacitated parents.

It is in the latter situation that the new figures on the size of households gives folks the heeby-jeebies, though in the case of Ohara and Yamaguchi, the parents each had been caring for had either been moved to an elder care facility or died.

In recent weeks there have been a spate of stories about caregivers dying, leaving their disabled or senile charges to die of starvation, thirst or cold. The most shocking was a case in mid-February of a 45 year-old woman dying, leaving her four year-old mentally retarded son to die a few days later of an as yet unrevealed cause, despite visits to the home by what were supposed to be help providers. In more recent days, news organizations have been reporting on couples or parent-child homes where the deaths of the caregiver have left the other, incapacitated resident to die, either slowly or quickly, from lack of care. Despite the fact that these pairs of individuals are not technically dying alone, these types of double deaths are being classed kodokushi.

With Japanese enjoying, if that can be the term, extended lifespans, and the chances of one member of a two-person household being seriously incapacitated in some way increasing, the number of these kinds of double deaths is sure to increase unless civil society or local government develop ways on keeping tabs on caregivers and their charges. A great deal of help is currently available. With the society as a whole aging, however, the capacity for society or local governments to continue to provide help services will diminish.

Some companies, such as the ALSOK corporation, advertise home surveillance cameras for younger relatives to keep tabs on the status of their elders. The concept seems way too creepy and invasive to come into common usage, however. This may change. Indeed, the installation of cameras might come to be seen as a natural part of the aging process -- that once you are past a certain age, you will never have a moment's privacy again, even in your own home.

Don't Count On the Dead

I was talking with an investment professional a while back about capital accumulation. At one point in the conversation, the investment professional insisted that Japan's inheritance laws prevented the accumulation of family wealth, with serious adverse consequences on the rate of new company formation -- the assumption being that you need a wealthy class of risk takers, either family members or angel investors, to provide the capital entrepreneurs need to start new businesses. I cannot remember whether the investment professional was criticizing the requirement of equal division of the property of the deceased (surviving spouses get 50% - otherwise legitimate heirs get equal portions of the property) or whether he was complaining that the level of the inheritance tax was too high.

Anyway, the purported stupidity of the inheritance laws was a big deal.

The memory of this conversation got me to thinking about inheritance taxes and what effect they might be having on the state's fiscal balances. The number of persons is increasing, surpassing the number of those being born first in 2005 and unstoppably from 2007 on. In between 1984 and 2009, the number of those dying annually has increased by 54%. It seemed to stand to reason that the state's total take from the estates of Japan's deceased must be increasing year-by-year, largely line with the increases in the number of deaths.

Data source: http://www.mhlw.go.jp/toukei/saikin/hw/jinkou/suikei09/index.html

"Surely," thought I, "though the total take from personal income has been decreasing from lower bonuses, less overtime, greater use of lower-temporary workers and a decreasing workforce -- at least the ever increasing cohort of those running down the curtain in a given year will be doing their share to make up for losses elsewhere. Yes, the fall in the values of most classes of assets post-Bubble and in the Lost Two Decades since will have seriously eroded the inheritance take...but with the increasing number of the deceased, the state should be enjoying at least a mild, if ghastly, increase in revenues from the dearly departed."

Not so. Not by a long shot.


Source: http://www.mof.go.jp/jouhou/syuzei/siryou/141.htm

The light blue bars are the total inheritance tax collected by the state, according to the Ministry of Finance. Inheritance revenues peaked in Heisei 5 (1993) at a little under 2.94 trillion yen. They have fallen precipitously and consistently since then.　Last year (2009 - Heisei 21 - not on the graph) the state collected 1.52 trillion yen in inheritance taxes. Revenues have thus fallen 48% since 1993 even as the numbers of those "paying into the system" have risen 30%.

So despite their rapidly increasing ranks, not even the dead have been of much help in the Japanese state's search for a way to put its fiscal house in order. At some point the downward trend in inheritance revenues should reverse itself, probably sharply, as the immediate postwar generation begins passing into the Great Beyond, leaving behind their hoards, or whatever may be left of such after the postwar generation's having lived for so very long, for the state to plunder tax.

It ain't happened yet, though.

The Green Grass of Home

The Monday article by Gavin Blair on the declining numbers of murders in Japan had a very interesting observation in it by the crime researcher Professor Hamai Koichi of Ryukoku University:

“In other research I carried out 50 percent of people thought that crime had greatly increased in Japan, but only 4 percent felt it had in their neighborhood. That’s a huge gap,” he adds.

It is funny but I saw the same odd discrepancy -- between perceptions of a miserable national situation and a rather contented take on one's own station -- in the Pew Survey on Global Attitudes regarding the views folks hold of the Japanese economy and their own personal income situation.

Pretty damn low… and yet, when you ask the same persons about their level of satisfaction with their own economic situation, you get:

Fascinating...and frightening. I cannot think of a pair of graphs that more clearly indicates that whatever fiscal or monetary ideas the DPJ may have on offer, the likelihood that folks are going to risk their current stability in order to try something new, that is become entrepreneurial in their behavior in order to reap potentially huge rewards, is pretty darn slim.

Where I grew up, there was the saying that “the grass is always greener on the other side of the fence” – that try as one might, one would never find one’s own station satisfactory, that one would always look enviously beyond one's own small patch of ground.

And green indeed was the traditional color of envy.

In contemporary Japan, however, it seems there is nothing quite so nice and comfortable as the green grass of home.

Violent Intentions

My love she speaks like silence,
Without ideals or violence,
She doesn't have to say she's faithful,
Yet she's true, like ice, like fire.

(...)

The wind howls like a hammer,
The night blows cold and rainy,
My love she's like some raven
At my window with a broken wing.

- Robert Allen Zimmerman
"Love Minus Zero/No Limit" (1965)

Multiple choice quiz, on a serious subject.

In which country are you most at risk of being intentionally killed, in a given year?

a) Japan
b) the United States
c) Italy
d) the United Kingdom
e) Mexico

The answer is, of course, a) Japan.

You are 38% more likely to be killed in Japan as in the United States. You are three times more likely to die a violent death at a human hand in Japan than in Italy or the United Kingdom. The rate of intentional killings in Japan is one and half times the rate in drug-war wracked Mexico.

Of course, the catch is the term "intentional killing"...and by whom:

Annually, per 100,000 persons

We have public service announcements posted on our keijiban, warning of masked attackers lurking in dark alleyways and lanes. However, by far the most dangerous person any of us will ever meet is the one staring back at us in the mirror.

- A post for The Lawyer, who opened up a little used email account last week and found a message that a good friend had taken her life.

----------------------------------------------------

Sources of statistics: Cabinet Office, CDC, Eurostat, WHO

The original version of this post had the suicide and homicide numbers for Italy and the United Kingdom flipped. - MTC

It is a fine plan...and it is worth the fighting for

After weeks of relentless bad news, the Fukuda Cabinet woke up to a some cheerier public support numbers today. In a poll conducted on Friday and Saturday by the Nihon Keizai Shimbun, the Cabinet's approval rating actually rose 3 points from the low recorded three weeks ago. A still pathetic 24% of those polled support the government. However, this uptick marks the first rise in the Cabinet's popularity since it was sworn in eight months ago .

The Cabinet's better numbers did not boost the fortunes of the Liberal Democratic Party. The percentage of voters saying that they support the LDP sank another 3 points to 31%, opening up a 5 percentage point deficit between itself and the Democratic Party of Japan, which earned the support of 36% of those polled.

Though the results are likely to provoke a nervous tic in the denizens of LDP headquarters, the ruling coalition would do iteslf a hell of a lot of good if it could send the message "Don't Panic" out to the Diet rank-and-file. From what was broadcast on Sunday morning's NHK Nichiyō Tōron, the ruling coalition is going to have a very decent couple of weeks ahead defending what has heretofore been a lead weight for the government: the new over 75 eldercare system.

Considering how the new plan was demonized in the buildup to Yamaguchi #2 by-election, one might think that having to defend the plan would have a deleterious effect on the ruling coalition's popularity.

While there are superficial resemblances between the upcoming struggle over the eldercare system to the fights over the extension of the Indian Ocean dispatch, the gasoline levy and the road construction bills, there are some significant dissimilarities as well--ones which bode ill for the opposition.

First, the opposition has no alternate plan other than reverting to the old system. In the Indian Ocean dispatch reapproval and the road construction bills, the opposition could argue it was fighting for a new approach, a reimagining of the nation's policies. In this instance, however, all the opposition has promised to do is put off change--despite the smoldering public sense that the previous system was doomed.

Second, the opposition is not stopping the imposition of the new system--only its reform. The new system is ongoing--the funds are being withdrawn directly from the pensions of the enrollees; the per-visit fees have already fallen to 10%. What the opposition can stymie or even reject is fiddling so as to make the system fairer, such as the proposal to lower the deductions of the very poorest seniors to 10% of the standard deduction.

Third, the new system offer a good, incentives-based compromise solution to the questions posed by created by medical advances leading to increases in lifespan. The debate on Nichiyō Tōron exposed the intellectual vacuity of the opposition's alternative visions for handling a complex set of competing social and economic goals.

In a nutshell:

- the Democratic view is that all Japanese are equal, ergo, all Japanese should all have the same health insurance system;

- the Communist view is that Japan has a lot of rich individuals and they should simply be forced to pay higher taxes to keep the current system solvent;

- the Socialist view is that women live longer so they will be paying more into the system in total, there are fewer doctors in certain areas and certain specialities, costs keep rising every year and we need this all to stop;

- and the Japan New Party...thinks that putting "ne" and "yo" after every statement makes that statement into an argument (seriously, it was excruciating).

If this is going to be the debate, then this is one that the ruling coalition wants to take place at length, under the cameras, in the House of Representatives committee chambers. Not only does the coalition have the better plan but they have Health, Welfare and Labour Minister Masuzoe Yōichi, the Cabinet's most popular minister, as the point man.

Finally, the original system and the reform bill are bitter medicine that in the end benefits no one but the public.

Contrary to the beliefs of the gopher-brained in the ruling coalition, the public respects the making of hard choices, once the reasons for the reform are explained to them. That was the miracle of "Koizumi magic" - the rapid switchover in public support numbers for tough, mold-breaking reforms once Prime Minister Koizumi Jun'ichirō and his subordinates began explaining why a reform or a decision was important.

As for what made Article 59 passage of the Indian Ocean dispatch reapproval and the road construction bills so damaging was the perception, correct as it turned out, that the primary beneficiaries of the passage of this legislation were, in order

1) the military establishments of other countries, and

2) rural district LDP Diet members and LDP member local government officials.

Not the Japanese public.

The new eldercare system is perceived, by contrast, to be electoral poison--with no identifiable client-patron rationale--and for that reason, gives the Cabinet and the ruling coalition a chance to win something they most desperately need: a reputation of being courageous.

Now ever since last year around this time, perhaps ever since the readmission of the postal rebels in late December 2006, the ruling coalition has offered not the slightest sense that it understand the public mood...or that it knows how to handle a legislative calendar.

Prime Minister Fukuda Yasuo's and his Cabinet's eulogies have already been composed. However, the LDP and the Komeitō may have at last sunk so low that the members may be willing to go against their better political instincts and trust the public--rather than pandering to elements of it--and may, after having suffered the consequences of a year of atrocious calendar management, realized that getting bills passed on time after sufficient public debate is a part of being the normal functioning of a Diet.

If they have, then the battle over the reform of the eldercare system gives the ruling coalition a chance to halt the slide in its popularity and electability. The gains may be temporary--looming in the fall is the debate over the legislation formalizing the transfer of the gasoline levies to the general fund.

But dead and doomed are the Cabinet and the ruling coalition ?

Not if they argue the case for the eldercare system on the merits.

The new elder care insurance system and the disappearing art of dying at home

Over the next few weeks, the ruling coalition and the Democratic Party of Japan-led opposition will have to make some tough decisions about the newly-installed eldercare insurance system.

The ruling coalition will have to look at the numbers and decide whether or not the system can really afford the proposed fiddle with the payments of low income elderly. In the proposed revision to the law, low income couples would see the monthly withdrawals from their pensions shrink from 30% of the standard cost for their prefecture to 10% of the standard cost.

The proposed revision seems to defeat one of the basic goals of the program: encouraging the very poor to go to see a doctor early on because they have already paid a significant lump sum upfront. The proposed revision would of course also decrease the aggregate contributions to going into the insurance system -- meaning that the revenues supporting the the program will have to be drawn from elsewhere.

For its part, the promise-happy DPJ-led opposition will have to decide whether it is serious about the submission of a bill to House of Councillors bill reversing the imposition of the new eldercare system. The opposition camp has made pledges and noises about passing a such a bill by the end of the month....then again, the opposition also swore that if the the road construction bill were overridden, it would pass a motion of censure in the upper house of the Diet against the Prime Minister.

One can hope that both sides in this political fight will leave the program alone. While unpopular, the new program has the ambitious and admirable goal of providing for the healthcare system that exists--not those of some fantasy trade-off-free universal low cost system for an imaginary group of cuddly and genki oldsters.

* * *

A few weeks back I looked at the publicity campaign for a book by Sakurai Yoshiko. In the ad, the right wing's Madonna calls on the Japanese people to rediscover their identities in their traditions, one of which she identifies as "seeing the dying off while seated at their bedside" (kazoku no saigo wa mitoru).

Too bad Sakurai's moral lashings are reprehensible nonsense--people are not staying away from being by the bedside of their dying relatives out of selfishness or disinterest--for she does hive near an ultimately unsustainable trend in the country's handling of death.

Public opinion polls conducted by the Ministry of Health, Labour and Welfare find that about 60% of citizens would prefer to die in their own homes in their own beds. However, figures from the Ministry show that while fifty years ago 80% of all deaths took place at home, in 2007 only 12% of all deaths occured at the deceased's residence.

The Tokyo Shimbun published this dramatic graph of the new reality of death and dying:

Image courtesy : Tokyo Shimbun

The number of deaths at home has plummeted (white line) while the number of deaths in hospitals and other medical facilities has soared (black line). The percentages of each have almost completely reversed over the course of the last 50 years. Since Japanese have low rates of deaths from accident and disease and nearly all suicides happen outside of hospitals, this number--8 out of 10 deaths in a hospital--can only represent the accelerating warehousing of the feeble elderly in medical facilities.

The immense additional cost to the national health insurance system resulting from this complete reversal in the treatment of death is one of the major reasons for the new elder care system's introduction. It is simply not reasonable to expect that the previous system of low payments and a moderate deductible can finance the final hospitalization of 850,000 pensioners per year.

Beyond the monetary cost of keeping all these near moribund persons in a hospital, the opportunity cost--the loss of hospital bed space to a persons with little chance of long-term survival or improved quality of life--is large and growing. It should not be at all surprising that there is a crisis in "patients in need of emergency care being turned away from hospitals multiple times because of a lack of beds and proper facilities". In 2006, 83.5% of all hospitals beds were occupied at any one time. For assisted care facilities (kaigo ryōyō byōshō) the occupancy rate was 94.1%.

Unless there is a dramatic shift in behaviors--meaning at least a doubling of the rate of those dying at home over the next decace--the dying elderly will simply overwhelm the physical plant of the healthcare system. As the passing of the baby boomers drives the number of deaths per year from its current 1.1 million to at least 1.7 million, where will those near death going to be drawing their final breaths?

Perhaps I am just doomed to suffer the disquiet arising from the ravages of intelligence, but underfunding the health care of the very old in order to score cheap political points seems a hell of an answer.

Stars in the Clouded Sky

Not in my normal line, but as regards the collapsed schools of Sichuan, a coda.

None of the newscasts I have seen nor any of news reports I have read has paused to note that China, with exceptions, still has a one child per couple rule.

The parents we are seeing grieving on television or in photo images have not lost a child.

They have lost their child--the singular expression of all their hopes and striving.


Later - Jim Yardley of The New York Times gets close.

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.

Do You Wanna Be Startin' Somethin' ?

And they say there is a dearth of innovation in this country.

Japan sees wave of suicides using detergent-produced gas
Associated Press

By MARI YAMAGUCHI – TOKYO — At least four people killed themselves Friday by inhaling fumes from a detergent mixed with other chemicals amid a wave of similar suicides that has reportedly claimed about 50 lives this month in Japan.

Authorities are alarmed by the sudden rise in such incidents — an average of two a day were reported in April — because the chemicals are easy to get and the fumes could spread to affect bystanders or rescuers.

A 47-year-old man killed himself Friday in a Tokyo luxury hotel, said Fire Department official Toshiyuki Miyake.

Officials said emergency workers also found a 29-year-old man dead in his Tokyo apartment; a man in his 50s at a public gymnasium in northern Tokyo; and a man in his 30s in an apartment in nearby Yokohama. All died after inhaling hydrogen sulfide gas, produced by mixing detergent and a bath lotion...

It is such a good thing that religious zealots, individuals with grudges, the mentally ill--or some combination thereof--are all illiterate.

For the good of my own conscience, I am not going to go into my thinking in any more detail than that.