Social Responsibility and the Freedom to Choose
Some people question the Free Choice Foundation's motives. They wonder if we are advocating that non-Japanese residing in Japan be allowed to evade their responsibility to pay into Japan's social system. Before we can properly address this issue, we think that it is first important - and, indeed, necessary - to clearly define just what the two concepts of 'social responsibility' and 'the freedom to choose' are. Let's begin with social responsibility.
What does it mean to be socially responsible?
Let's assume for a moment that a non-Japanese comes to Japan with no coverage and refuses to buy either private or public health insurance after he or she arrives. Clearly, this person is showing no social responsibility. Our reasoning is straightforward and simple. Even a healthy person can develop a sudden and serious illness or meet with an accident requiring extensive medical treatment that far exceeds his or her financial capability to cover. A medically-uninsured person (whether a non-Japanese or a Japanese citizen) is no different than an uninsured motorist - both are a potential liability to society. Indeed, many countries require visitors to provide proof of travel medical insurance before they can be legally issued a visa by an embassy or consulate. Ironically, Japan is one country that does not require such proof and people may actually come here - legally - uninsured.
 We at the Free Choice Foundation only seek to preserve what is best for all, to keep humanity in our medicine - namely, by preserving choice |
There have been innumerable cases in which uninsured individuals (in Japan as well as other countries) have run up extensive medical bills at hospitals and then been unable to pay them. These expenses - most of which end up being unrecoverable - have a direct impact on the constant increase in medical costs, which in turn causes governments as well as private insurance companies to raise the amounts their premiums. In such situations, the entire healthcare platform is adversely affected. All members of the system (be it public healthcare or a private plan), whether they be insured individuals, medical providers or benefit payers, have an effect on each other as well as on the system as a whole, and all are sensitive to the use of the system by non-insured patients. Therefore, failure to actually belong to one system or another can cause serious damage to society as a whole.
So, simply considering social responsibility alone, our organization strongly advocates that all persons, regardless of whether they are expatriates or Japanese citizens, should contribute to an insurance program in order to fulfill their obligation of social responsibility to society. We cannot stress this point more emphatically!
Now, considering freedom of choice . . .
First of all, however, let us say that our organization and movement has absolutely, positively, totally and completely nothing to do with abortion. In the U.S., the phrase "freedom of choice" has become synonymous with the abortion issue, which is one reason that we coined the name 'Free Choice' instead - to avoid any confusion.
Now, returning to our topic, we reiterate our deep concern that our organization not be misconstrued as a band of freeloading foreigners who merely wish to escape social and financial responsibility. Indeed, nothing could be further from the truth. So then, what is freedom of choice? Well, let's examine the term.
If there is to be a 'choice' that one can make, there must of necessity be more than one viable option from which to pick. And, herein - at the very beginning - lies our fundamental problem with the new Immigration guidelines set to go into effect in April 2010. These guidelines will do away with the choice of an alternative system which may be better for a large number of honest and hard-working non-Japanese that reside in Japan.
Of course, having the 'freedom' to make a choice (any choice) carries with it the implied and understood responsibility that such choice be determined not only with regard to what is best for oneself, but also for society as a whole. Both interests must be weighed when exercising this right. We at Free Choice not only understand this principle, we highly advocate it as well. Free choice simply for the sake of free choice is and has always been detrimental. Indeed, the right of choice with no underlying responsibility attached is better known by a slightly more sinister name - anarchy.
Having said that, no healthcare system (be it private or socialized) can automatically be best for any one person or group of people, nor should it be expected to be so. Individuals have different needs, different susceptibilities, different ailments, different financial circumstances - let's face it, people are simply different. They are not nuts and bolts that can be dutifully fitted into whatever hole is most convenient for the bureaucracy. By definition, they are individuals. And, shouldn't healthcare be about people; indeed, by definition, shouldn't it be about humanity?
Yet, humanity would indeed be the first casualty should Immigration begin dictating Japan's healthcare policies. Immigration - a Ministry of Justice office - has absolutely nothing to do with health care, which falls under the jurisdiction of the Ministry of Labor, Health and Welfare. Certainly, Immigration should have no more right to determine the type of healthcare plan we can buy than it has to tell us which schools our children must attend.
The right to freedom does not come without social responibility.
Humanity is as simple as recognizing special needs...
Knowing these truths, it is not at all difficult to anticipate that expatriates (not just in Japan, but non-citizens living in any country) would have different, additional and/or specialized needs than the natural citizens among which they live. Take, for example, the fact that non-Japanese often prefer to receive treatment from one of Japan's international clinics solely because the language barrier is not as great. (Would you like the chances of your condition being misdiagnosed and/or inappropriate drugs prescribed greatly increased simply because you and your doctor could not fully understand one another?) Furthermore, many non-Japanese are alone, or at most have just a spouse and children with them. In case of serious illness or injury, the cost of flying extended family members in could very well be prohibitive. And, in the case of death, the repatriation of remains can also be quite costly. Public healthcare does not cover such expenses - it was never designed to, nor should it. These are just a few of the day-to-day concerns that we as non-Japanese residents must seriously consider when managing our healthcare coverage. Is it, therefore, such an unusual or unreasonable request to make that we be given the right to choose the health care system that best meets our specialized needs as expatriates?
Again, we are not seeking a way to get a 'free ride;' we do not believe in that. Nor do we seek or advocate in any way a dismantling of the present social medical system. It works for some; indeed, it works for many, and we believe that all living here (be they natural citizen or non-citizen) should have access to it if they so desire. We at the Free Choice Foundation only seek to preserve what is best for all, to keep humanity in our medicine - namely, by preserving choice!