Japan's National Health Insurance Costs Me Nearly ¥100,000 ($667) a Month. I Still Think It Is Worth Paying

Japan’s National Health Insurance is expensive.

As a freelancer, I sigh every year when the notice telling me how much I owe arrives.

In my case, it is nearly ¥100,000 ($667) a month.

That easily exceeds ¥1 million ($6,667) a year—enough to buy a decent used car. And I have to pay it every year.

For that much money, the hospital could at least serve me some tea when I visit.

That said, I am not actually dissatisfied with the National Health Insurance system itself.

The Terrifying Prospect of a ¥6 Million Appendectomy

The other day, I was watching a video by a YouTuber who lives in Singapore. It featured a case in which someone underwent an appendectomy there and received a medical bill of roughly ¥6 million ($40,000).

¥6 million for an appendectomy.

That is the price of a luxury car.

In Japan, if you developed appendicitis, you would probably worry that it would hurt and that you did not want surgery.

But when the cost is ¥6 million, the bill is more frightening than the pain in your abdomen.

Japan has public health insurance as well as a high-cost medical expense benefit. Even if you develop a serious illness, there is little risk of your medical bills growing without limit.

Seen that way, I can accept paying nearly ¥100,000 a month if I think of it as buying an enormous sense of security.

Although I would still prefer it to be a little cheaper.

Seeing My Parents’ Premiums Made Me Appreciate It Even More

I was surprised when I once saw how much my parents paid for health insurance.

It was far less than I paid.

That is only natural when you think about it. Premiums are determined by factors such as income. Once people retire and their income falls, their burden becomes lighter too.

At the same time, people tend to need medical care more often as they grow older.

In other words, I am currently one of those supporting my parents’ generation.

When I grow old, it will be the younger generation’s turn to support me.

It is a remarkably well-designed system.

I am a little worried, however, about how many young people will still be around to support me by the time I become elderly.

Even so, I believe in this kind of mutual support.

But Please, No “Dine-and-Dash” Healthcare

There is, however, one kind of story that makes even me angry.

I mean news reports about unpaid medical bills and fraudulent use of the insurance system by foreign nationals.

There is no issue at all with foreign residents who work honestly in Japan and pay their insurance premiums. They should use the same system as everyone else.

The problem is with people who receive medical treatment without paying what they owe and then leave the country.

It would make me angry if a Japanese person did the same thing. But once someone returns overseas, even sending them the bill becomes difficult.

Meanwhile, I am paying nearly ¥100,000 every month.

Yet someone else can take only the benefits of the system and then say goodbye.

It is like dining and dashing—except the thing they consumed was not a bowl of ramen but medical care worth millions of yen.

Whenever this subject comes up, someone explains that the amount is tiny compared with total healthcare spending.

But that is not the point.

Even if it were only ¥100 ($0.67), dining and dashing would still be dining and dashing.

A small amount does not make it acceptable.

The Convenient Phrase “Life Matters More Than Money”

When issues like this arise, there are also certain phrases that we inevitably hear from left-leaning commentators and others.

“Life matters more than money.”

“Would you abandon a foreigner just because they have no money?”

How admirable.

I also believe that if someone collapsed in front of me, we should help them.

But that is not the issue I am raising.

The question is what conditions should apply to people using Japan’s healthcare system, and what measures should be taken when someone returns home without paying their premiums or medical bills.

We may be discussing those questions, but suddenly we are asked which matters more, life or money.

Obviously, life does.

But that does not make medical care free.

Doctors and nurses still need to be paid. Hospitals have electricity bills, and medicines cost money.

If chanting “life matters” could reduce a hospital bill to zero, I would chant it every day too.

I Am Paying for More Than My Own Medical Care

Ultimately, social insurance is a system that works because everyone follows the rules and shares the burden.

When you are healthy, you support people who are ill. When you grow old, younger people support you.

I like this system.

That is why I can more or less accept paying nearly ¥100,000 every month.

But that acceptance depends on everyone else following the rules too.

I cannot accept being told that fraud and unpaid bills must simply be tolerated because “life matters.”

I also believe that life matters.

But as someone paying nearly ¥100,000 a month, I would appreciate it if someone occasionally worried about the life of my wallet too.