Bureaucracy in action
Posted by Sean at 19:04, December 30th, 2004Japanese language and culture, as you’ve probably heard many times, are full of nuances as impossible to grasp as the wisps of smoke that curl toward heaven from a bowl of incense in a darkened room. Therefore, it may interest you to know that some concepts translate into and from English with no loss of meaning at all.
Consider, as an example, the reform of government programs undertaken by the Koizumi adminstration and the ruling coalition that supports it. The idea is to deregulate and even privatize certain operations in certain spheres–Japan Post reform has gotten the most attention, but the health-care behemoth is on the list, too:
Ministers attending a Cabinet meeting Tuesday agreed to give the report, presented Friday by the Council for Promotion of Regulatory Reform, an advisory body to Prime Minister Junichiro Koizumi, serious consideration.
In another gesture supporting easing government regulations, one of the prime minister’s key structural reform initiatives, the Cabinet approved a plan to revise in March the three-year deregulation promotion program that has been in force since April.
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In line with Koizumi’s public pledge to push forward with deregulation as an integral part of his reform agenda, in May the government established the Headquarters for Promotion of Regulatory Reform, made up of all Cabinet members.
One of the top discussions in the regulatory reform council was on the idea of lifting the ban on providing mixed medical services, enabling patients to receive a combination of medical treatment covered by government-backed health insurance plans and medical treatment not so covered.
The mixed medical service system currently is limited to hospitals designated by the government as medical institutions with specially advanced medical technology.
The ban, of course, prevents some patients from having access to the best combination of treatments for whatever ails them. Westerners who have swallowed the entire media diet of stories about the self-abnegating Japanese, and thus think of the place as populated by 125 million potential kamikaze pilots, seem to imagine that everything federal employees do is attuned to the greater good. If you’re one such trusting soul, it may interest you to know that Japanese bureaucrats act like…well, bureaucrats:
Objecting strongly to the council’s argument was the Health, Labor and Welfare Ministry, bureaucrats of which were anxious about a decline in the role of government-backed health insurance plans that come under the ministry’s jurisdiction.
In defending its position, the ministry claimed that a mixed medical service system would deprive patients of the right to equal treatment.
Major university hospitals, including those attached to Tokyo University and Kyoto University, meanwhile, pushed for a complete lifting of the ban, arguing that progress in advanced medical technology was being hindered by too many regulations around the government-backed health insurance plans.
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This resulted in a compromise being hammered out that ensured the ban remained, in return for a ministry promise to expand the current system to extend government-backed insurance coverage to exceptional cases currently not covered, such as heart transplants from brain-dead donors.
It’s the sort of thing that belongs in a textbook, huh? Unelected officials find their authority (and thus their source of influence) threatened, and they justify their opposition by claiming that what they’re worried about is, of course, that reforms will infringe on the rights of citizens. Being career civil servants, they’re much better at strategy than their opponents, who, as the people who have to deal with the day-to-day problem being addressed, don’t make their livelihoods by maneuvering. Then, somehow, their territory is actually expanded by the plan ultimately extruded by the chain of committees, compromise proposals, and negotiations.
I think it’s fair to say that most of the people who go into civil service here are as patriotic and idealistic as their counterparts. The problem isn’t really that Japanese bureaucrats are worse than bureaucrats elsewhere; it’s that the system disproportionately favors them. They get used to having their way as a matter of course, but they still get to see themselves as sacrificing personal gain because of the revolving-door system (that is, you take lower-than-private-sector pay through your normal working life, then get a cushy job in a private or semi-public company on retirement so you can spend the next 20 years making good on the connections you’ve built up). The recent economic troubles have made that system shakier, and the various bureaucracies have, understandably, therefore been clinging all the more to the power they’ve got. Reform is, needless to say, difficult in such an environment. Even a slight loosening of restrictions on treatments people can get is a good thing, though.