(Page 2 of 24) - Health Insurance for National Defense: The Impact of WWII on the Health Insurance Systems in Japan and the United States authored by Yamagishi, Takakazu.

Abstract:

I tackle two puzzles in this paper: why did Japan and the United States begin to develop
health insurance policies almost from scratch during WWII; and why did they adopt
different systems by the end of postwar reconstruction? For the first question, I argue that
the health insurance systems in both countries were developed for making war
mobilization more efficient. For the second question, I argue that the differences in each
country’s wartime experience—the state’s projection about the duration and depth of
mobilization, the eventual length of the war, the sequence of war planning, and the result
of the war—influenced how, and to what degree, the Japanese and American states
intervened in health insurance. The goal of this paper is to construct a framework for
understanding the relationship between war and health insurance by examining the cases
of Japan and the United States.

In a war, the state has to survive by fighting; after the war, the state has to survive

by recovering. This simple fact influenced not only the state’s international affairs, but
also social policies. World War II and postwar reconstruction, for example, were
responsible for the expansion and consolidation of health insurance systems in Japan and
the United States. Scholars, however, have done little to theorize the impact of the war on
the development of health insurance system. The goal of this paper is to construct a
framework for understanding the relationship between war and health insurance by
examining the cases of Japan and the United States during the war and postwar
reconstruction period.

Before the war, in contrast to European counterparts, neither Japan nor the United

States had a mature health insurance system. But the health insurance systems in Japan
and the United States radically expanded their health insurance systems during the war
(from 1931 to 1945 for Japan, from 1941 to 1945 for the United States) and postwar
reconstruction (from 1945 to 1952 for both). However, the health insurance systems that
they adopted were qualitatively different. While Japan adopted a near-universal national
health insurance system that consisted of multiple national health insurance programs, the
United States adopted a hybrid system that composed of national health insurance for
military-related personnel and private health insurance for those who could afford it. This
paper tackles two puzzles: why did Japan and the United States begin to expand their
health insurance systems during the war; and why did they end up adopting the different
health insurance systems by the end of postwar reconstruction? For the first question, I
argue that in both countries the state intervened in health insurance in order to make war
mobilization more efficient. For the second question, I argue that the differences in each
country’s wartime experience largely influenced the diverted path of the health insurance
systems in Japan and the United States.

This article is composed of five sections. The first presents my case selection. The

second describes three approaches that I rely on, and the third demonstrates my argument
that synthesizes them. The fourth examines how war activities affected the development
of the health insurance systems in Japan and the United States. Finally, the fifth
demonstrates how postwar reconstruction influenced them.