2
Introduction
The Second World War killed approximately fifty million people, while it led policies
and institutions to improve people’s health. This paper will ask why and how these events
occur ironically at the same time and rethink the development of health insurance policy.
1
This paper will examine how war mobilization formed and consolidated the Japanese
national health insurance system. It is through an examination of the Japanese war
experience, the fifteen-year war,
2
that we understand how and why Japan reached a
nearly comprehensive national health insurance system with a unique structure. Although
this paper focuses on the Japanese case, my goal is to develop an argument to better
understand the impact of war and the variations in war experiences to the paths of health
of other countries.
Richard Titmuss pointed out a half century ago that “total” war would lead to the
development of social welfare policy.
3
More recently, Jytte Klausen argues that war
creates a new notion of what the state can and should do in economic and social policy.
4
However, historical and comparative political scientists have made only limited efforts to
theorize the effect of war experiences on welfare state development. War, like any other
single variable, cannot explain such development alone. Nonetheless, war prompts the
state to intervene in promoting policies and institutions to improve people’s health. Most
simply, state leaders who seek victory at the international level must attempt to improve
people’s health to produce good soldiers and good munitions and to control or stabilize
social demands. Titmuss saw how the events in the United Kingdom and its war
experiences led to the expansion of social policies, including the Beveridge Report
released in 1942 and the establishment of the National Health Insurance in 1946.
5
1
To prevent confusion, comprehensive national health insurance guarantees the health insurance coverage
for all the citizens. National health insurance programs can exist without comprehensive system, such as
Medicare and Medicaid in the United States. Private insurance is compatible with a comprehensive system
as a supplement to public insurance or as a substitution for the public insurance.
2
The Japanese “fifteen-year war” includes the period from the Manchuria incident in 1931, the Nikka
Incident (Second Sino-Japan War) beginning in 1937, and the pacific war from 1941, to Japan’s
unconditional surrender in August 1945. Followed by the tradition, I write the names of Japanese and
Chinese people from their last name in the text. But the footnote has an integrated style, which writes first
name first.
3
Richard Titmuss, Essays on ‘The Welfare State’ (New Haven: Yale University Press, 1959).
4
Jytte Klausen, War and Welfare: Europe and the United States, 1945 to the Present (New York: Palgrave
1998).
5
Titmuss, Essays on ‘The Welfare State’, 83-4.
Convention