Social Security from Managed Care to Long-Term Care in the USA
- Visions and Revisions -
Introduction
The world has introduced many models of social security to Japan, and only the good aspects of them were emphasized. However, every model casts both a light and a shadow. It is necessary to evaluate them with consideration to both their advantages and disadvantages. Often, the Japanese look down on their own social security, while it could be better, and see the foreign model better on the outside. Our point of view becomes limited when living in Japan. It is easy to become a person with narrow views being isolated by the island country. In addition, the faults of foreign models look few because the information from the outside is scarce. Significantly more accurate information must be collected in order to judge Japanese social security.
In 1998 I lived abroad in Ann Arbor, Michigan and studied at Michigan University. During my stay, I actually encountered a more severe condition of American Social Security than had been portrayed in Japan. There were many mistakes in my idea that it was easy to become independent, to get more freedom, and to be given many chances without discrimination in the USA. The worry is deeper and vaster in a large country, too. The tear of the sparrow is hardly passed only by one solution.
I noticed that Japanese social security could be accomplished preferably on a certain respect compared with it internationally. In other countries, the social security, which a lot of Japanese are naturally undertaking, is seemed to be such productive and sufficient that Japan is viewed as an ideal country. The social security of Japan, in of itself, is a system that serves as a good international model. In Japan, the person who is in need of aid and is given the social security is occasionally demanding and receiving the social security with the highest degree. On the other hand, the person in need of aid and not given the social security is satisfied with the current state and does not demand more.
I took the training of the Michigan University summer seminar (Uunivers foundation sponsored by the Tanabe Seiyaku Co.Ltd.) in 1994. At that time, the work on the elderly through the team approach by advanced professionals was introduced in Turner clinic. I was impressed by what I saw at the short seminar, and set my mind on studying the team approach abroad in more depth. After getting over some hurdles, I was able to meet the team again in 1998, four years later. To my surprise, the clinic had been promoted to a huge geriatric center which was admitted internationally as the practice for the senior citizen. 1999 is international year of older persons. That is why I focused this book on the elderly in American Social Security system, which is also useful for long-term care insurance system and social security structural reform for the 21st century
Professor Andrew W. Achenbaum of the University of Michigan is a historian in the social security of the elderly in the United States and specializes in the pension aspect of social security. I translated Chapter 1, sections 1 and 2 of "Social Security -Vision and Revision-" (Cambridge University Press) written by Professor Achenbaum into Japanese. In the first half of his book, he explains how President Franklin Delano Roosevelt founded the social security for the first time in the world, and details into how the medical insurance for the aged and the disabled (Medicare) and medical treatment to help the poor (Medicaid) were introduced from the process of the social security method amendments. It is Professor Jeffrey B. Halter (Director at the Geriatrics Center of the University of Michigan and Chairman of the American Geriatric Medicine Association ) who made my translation possible. He had coordinated my study abroad, taking me as an overseas researcher of the Ministry of Education in Japan and introduced me to Professor Achenbaum. Professor Achenbaum sent me a warm message "Nations such as Japan and the United States, which created progressive mechanisms for dealing with the needs of their senior citizens, now find themselves overwhelmed by increasing numbers of long-lived citizens. It is important for experts in both countries to keep track of developments in other pacesetters. So we are all grateful for their efforts to make such comparative analyses possible."
Chapter 2 is based on the overseas training material of the American medical treatment of MMPG (Medical Management Planning Group), which Mr.Seiichi Saito introduced to me before I went to study abroad. I was surprised to learn about the current state of American medical treatment that could not be fully understood from currently published books that were incomprehensible and too detailed. The keyword, which is now well known to medical physicians and patients in the United States, was "Managed Care". All contradiction and dissatisfaction has originated from Managed Care for the medical treatment expense control. The United States is revolutionizing social security from the fee-for-service payment system to the fixed amount payment system. On my return to Japan, I asked Kunihiko Kawahara, chairman of MMPG, to unify this current state by all means, and to introduce it to Japan, centering on Takao Inazu and Kousuke Sakai in the MMPG.
In the seminar at Michigan University, I was introduced to Mr. Kazuhito Ihara who presently works for JETRO (Japan External Trade Organization) in New York. Mr. Kazuhito Ihara is the author of Chapter 3 about the United States long-term care for the elderly. His experience of the long-term care for elderly people comes from his experience in the Japanese Ministry of Health and Welfare, where he was engaged in the establishment the long-term care insurance system. It became my intention to introduce the current state of the United States long-term care, so I asked Mr. Kazuhito Ihara to write a chapter of my book. I was very impressed and undertaken by his zeal of the long-term care for the elderly.
I returned home to Japan after only three months of study. In such a short time I was not able to accomplish much, but I realized I wanted to bring the truths of the United States social security system to Japan. With my limited knowledge, I needed the support and hard work by many people and turned to my friends in both Japan and the United States. With their power and assistance, I have been able to introduce this light of the American social security and the reality of its shadow to Japan. I was only able to translate Professor Andrew W. Achenbaum' s "Social Security-Visions and Revisions" and edit "Social Security from Managed Care to Long-Term Care in the USA-Visions and Revisions- American social security to long-term care" which both depended on the writing and work of others.
I only possess the power of understanding the daily language of the United States and it is outside of my realm of capability to explain the business language. In addition, it is not my thought that I can understand and inform others of all aspects of American social security with only three months abroad. Japan has only been absorbing the sunshine of other social security systems up to this point. As we approach the 21st century and the turning point of the social security age, we must first unveil the shadows of worldwide social security system and we will then be lead to the shine, which is oppositely learnt, and ultimately reach the goal of social security. I will introduce the light and the shadow of this American social security to everybody with the conviction of finding this goal. When we reach the goal of social security, its light and shadow can be offered as a compass for the friend of the whole world who requests the social security. However, we will have to endure a lot of hardships as we wait and follow along this road.
I wish to express our gratitude to Mr. Mamoru Satou of the University Education Publication Co. Ltd. for the publication acceptance of walking on the road with me. A part of this edit depended on the research consignment expense of long life medical treatment research "Research on the construction of senior citizen's integrated diagnosis and treatment system".
Hiroshi Sumii, Dr,CSW,CCW: sumii@hpc.ac.jp