I am currently in a country where people take it for granted you’ll pay for medical services you receive. In the U.K., where I live, the National Health Service (NHS) has long made people take it for granted that you receive medical services for free. The British system is conceptually very straightforward: public. The Japanese ‘paid’ service is not so straightforward, since it also is heavily subsidised by the government. It’s a hybrid system lying between the public-only system like the NHS and the private-only American system. A hybrid system is not so unusual, even in Europe some countries like France start to embrace it.
As everybody knows in the U.K, NHS is cracking at its seams (understatement), while the Japanese system is in a relatively healthy state. I am actually here to receive the kind of treatment you’d have to wait for months to receive under the NHS. A paid system can solve lots of problems fraught with totally publicly-funded systems. One such problem is the health service degenerates into a two-tier structure where the private sector could just charge anything and the public health makes you wait forever. An obvious middle ground is to pay a bit and not wait. An injection I have here costs a fraction, literally, like a twentieth, of the equivalent in the private health in the U.K.
I’m not saying the NHS cannot be made to work. It absolutely should be, it’s super good in principle, ‘free at the point of delivery for anybody’. I think in the Blairite years it was generally working. I had an operation quickly without having to pay a penny at the time. Brilliant. The snag is it relies too much on the public finance at the time. If the government is heavily in debt, the system, and hence people, suffer, at the mercy of the economic situation at the time. The brilliant principle suffers as a result. The principle-wise-not-so-brilliant Japanese system is relatively robust against bad economic tides, because the patients pay a significant proportion (on average about 30%). Still 70% is of course a lot of public spending, but is paid for mainly by contributions from private companies (employers and employees, like National Insurance) well, basically taxes.
So for a long time I was an advocate for a hybrid system, i.e. a little compromise that works, rather than an idealistic system that doesn’t. Until the Covid hit. In Japan, where the hospitals are basically private businesses, they were not obliged to take patients, and therefore many did refuse to do so in the Covid times. The government, while imploring them to change their mind, had to prepare ‘confinements’ — like converted hotels that had no business at the time. People talked about a ‘public health meltdown’ and were right to fear for one. Really fortunate the country did not have the epidemic in the same proportion as the U.K. If it had done, the system surely would have melted down. Above all morally, what are the doctors made of, if they can refuse to treat very ill patients? The system allowed such abomination. The NHS on the other hand accepted all the very ill Covid patients, as a result of which thousands of medical professionals got infected and died, after helping as tens or hundreds as many.
Now the Covid’s over, every clinic and hospital in Japan continues to happily run as a business. I’m welcomed by smiling receptionists, see a consultant, have a test on the spot with the equipment housed on the spot, even an MRI machine is found in a small clinic. I pay at a machine like a car park in the U.K., and go home. The patients can choose their preferred doctor in their preferred clinic, there are websites and review sites, basically people shop around. You have to wait in the queue, of course, for a popular doctor in a big hospital, for hours.
The two systems cannot be more contrastive. I believe that any life critical service should be in public hands. Only in a deep crisis could the realisation come that ultimately privately-run businesses would not be viable for such services. At other times, people prioritise practicality. So I use a currently working private system I don’t believe in, leaving behind a currently broken public system I believe in. I imagine a Labour MP who sends their kids to a private school should feel the way I do.