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Health Insurance for National Defense: The Impact of WWII on the Health Insurance Systems in Japan and the United States
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private provision of health insurance led to America’s victory and should continue while the government could not have justification for the establishment of universal national health insurance. Furthermore, because the mainland escaped from massive attacks, the state could not claim the strong power to produce universal national health insurance as a tool to rebuild the nation. The two legacies of the war—the growth of private health insurance and the VA health service—along with the AMA’s strong power, also narrowed the possibility of passage of Truman’s plan. By aggressively promoting private health insurance and discrediting the VA health insurance, the AMA succeeded in blocking the introduction of universal national health insurance.Japan
In Japan, the politics of health insurance reform was not dominated by the state
and the JMA but by the state and the occupation government.
93
The JMA could not retain
a strong power during postwar reconstruction because it was blamed for cooperating with the state’s war efforts and was in the middle of the reorganization. At the beginning of postwar reconstruction, the occupation government directed the abolishment of veterans’ benefits, including their access to medical care, but it sought to strengthen national health insurance programs in Japan. Because of the damage on the mainland by the severe attack and postwar economic depression, the occupation government needed the strong authority to reconstruct not only infrastructure but also social policy as a tool to service the economy and people’s lives. Many of health insurance associations had became inactive, and the occupation government and Japanese officials and scholars initially agreed to cause radical reform by integrating multiple national programs into a single program.
94
But American interests and foreign policy influenced health insurance reform
in Japan through the window of the military occupation, which resulted in a policy shift to moderate reform, the improvement of individual programs.
In December 1945, the Labor Advisory Committee attached to the Economics and
Scientific Section made recommendations to the Public Health and Welfare Section (PHW), which were responsible for most of social welfare programs in the occupation government, regarding social security reform. In particular for health insurance field, the interim report dated April 5, 1946 noted that with separate programs for government employees, industrial wage earners, farmers, and the self-employed, the PHW should consider “the feasibility of consolidating some or all of these programs into a unified, comprehensive social insurance system.”
95
In March 1947, Crawford Sams, head of the PHW, issued a formal invitation for a
mission from the United States in order to consult about social security reform in Japan. According to a PHW memorandum, the Mission “will consult…for [the] purpose of drafting a National Health Bill which will incorporate a unified National Health Insurance Program with a National Medical Care Program.”
96
William Wandel, who led
93
A large part of this section is included in Adam D. Sheingate and Takakazu Yamagishi, “Occupation
Politics: American Interests and Struggle over Health Insurance in Postwar Japan,” Social Science History 30 No. 1 (2006): 137-64.
94
About the condition of health insurance associations, see Kazunari Araki, “Kokumin kenkō hoken kumiai
no genjō to sono keiei taisaku [Conditions of the National Health Insurance and Proposed Reforms,” Shakai hoken jiho 20 No. 7-8 (1945): 1.
95
SCAP PHW, “Advisory Commission on Labor First Interim Report,” 2, April 5, 1946, RG 331, Records
of Allies Operational and Occupational Headquarters, World War II, 1907-1966, Box 9382, File 8, NACP.
96
SCAP PHW, “Memorandum for Record: Air Priority for Social Security Mission,” August 14, 1947, RG
5, MacArthur Memorial Loose Papers, Public Health and Social Security Mission, Q-RA Rainbow Division, 1945-1951, Microfilm 64, Macarthur Memorial. Norfolk, Virginia.
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| | Authors: Yamagishi, Takakazu. |
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private provision of health insurance led to America’s victory and should continue while
the government could not have justification for the establishment of universal national
health insurance. Furthermore, because the mainland escaped from massive attacks, the
state could not claim the strong power to produce universal national health insurance as a
tool to rebuild the nation. The two legacies of the war—the growth of private health
insurance and the VA health service—along with the AMA’s strong power, also
narrowed the possibility of passage of Truman’s plan. By aggressively promoting private
health insurance and discrediting the VA health insurance, the AMA succeeded in
blocking the introduction of universal national health insurance.
Japan
In Japan, the politics of health insurance reform was not dominated by the state
and the JMA but by the state and the occupation government.
a strong power during postwar reconstruction because it was blamed for cooperating with
the state’s war efforts and was in the middle of the reorganization. At the beginning of
postwar reconstruction, the occupation government directed the abolishment of veterans’
benefits, including their access to medical care, but it sought to strengthen national health
insurance programs in Japan. Because of the damage on the mainland by the severe
attack and postwar economic depression, the occupation government needed the strong
authority to reconstruct not only infrastructure but also social policy as a tool to service
the economy and people’s lives. Many of health insurance associations had became
inactive, and the occupation government and Japanese officials and scholars initially
agreed to cause radical reform by integrating multiple national programs into a single
program.
But American interests and foreign policy influenced health insurance reform
in Japan through the window of the military occupation, which resulted in a policy shift
to moderate reform, the improvement of individual programs.
In December 1945, the Labor Advisory Committee attached to the Economics and
Scientific Section made recommendations to the Public Health and Welfare Section
(PHW), which were responsible for most of social welfare programs in the occupation
government, regarding social security reform. In particular for health insurance field, the
interim report dated April 5, 1946 noted that with separate programs for government
employees, industrial wage earners, farmers, and the self-employed, the PHW should
consider “the feasibility of consolidating some or all of these programs into a unified,
comprehensive social insurance system.”
In March 1947, Crawford Sams, head of the PHW, issued a formal invitation for a
mission from the United States in order to consult about social security reform in Japan.
According to a PHW memorandum, the Mission “will consult…for [the] purpose of
drafting a National Health Bill which will incorporate a unified National Health
Insurance Program with a National Medical Care Program.”
93
A large part of this section is included in Adam D. Sheingate and Takakazu Yamagishi, “Occupation
Politics: American Interests and Struggle over Health Insurance in Postwar Japan,” Social Science History
30 No. 1 (2006): 137-64.
94
About the condition of health insurance associations, see Kazunari Araki, “Kokumin kenkō hoken kumiai
no genjō to sono keiei taisaku [Conditions of the National Health Insurance and Proposed Reforms,”
Shakai hoken jiho 20 No. 7-8 (1945): 1.
95
SCAP PHW, “Advisory Commission on Labor First Interim Report,” 2, April 5, 1946, RG 331, Records
of Allies Operational and Occupational Headquarters, World War II, 1907-1966, Box 9382, File 8, NACP.
96
SCAP PHW, “Memorandum for Record: Air Priority for Social Security Mission,” August 14, 1947, RG
5, MacArthur Memorial Loose Papers, Public Health and Social Security Mission, Q-RA Rainbow
Division, 1945-1951, Microfilm 64, Macarthur Memorial. Norfolk, Virginia.
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