Opting out of the cartelized medicine in Japan

Saturday, May 12 2012 @ 12:26 PM JST

Contributed by: Y.Yamamoto

Dr. Hiroshi Shiono is one
of the very few Japanese
doctors who know how
to communicate with
their patients.
Chalmers Johnson defined my country of birth as a cluster of "Cartels of the Mind." He was absolutely right. But now I'm more inclined to call the same country where my body is about to return to dust "Cartels of the Body." Actually medicine is just one of those areas totally cartelized in this country.

I know for sure that most of my predominantly American audience will knowingly say, "We are more or less in the same situation here." It is true that PPACA (Patient Protection and Affordable Care Act,) better known as Obamacare, has a certain similarity to Japan's 54-year-old National Health Insurance Act. Article 5 of NHIA stipulates in equivocal words that every Japanese must be covered by one of the several types of medical insurance policies made available by the government.

I don't know how Obamacare glosses over the fundamental issue with the constitutionality of forcing everyone to become insured, but I'm certain the mandatory insurance coverages in both countries are nothing but extortion schemes under the guise of income redistribution. In Japan, an insured can basically expect from the government a 70% "subsidy" when he sees a doctor, but it's actually not a subsidy; it's none other than partial refund of the loot.

This, however, should not mean that the American people can generalize things, as they often do, so far as to ignore fundamental differences in the way the two countries were founded. While in the "homogeneous" Japanese society, people have been wet-nursing and babysitting one another for many centuries, America was founded 236 years ago based on the principle of self-reliance. How can America be "more or less the same" as the world's oldest nanny state?

Furthermore, the people in the worst rogue country in history named America have inflicted perpetual distress on other peoples especially those in Northeast Asia and Middle East since the onset of the evil American Empire. How can we victims share same problems, let alone same solutions, with perpetrators?

By now I've learned that this notion about our similarity is always used as yet another alibi for their inaction, mental inertia, physical cowardice and self-complacency toward the daunting tasks to reverse the process of America's Japanization.

They "think" they are still thinking, but if that's what they do, an ape or even a worm can think. Actually the verb "think" is 100% synonymous to "conceptualize or crystallize one's sensory perceptions."

I've already written off these guys whose brains have been irreparably damaged. But I still believe there are some, if not many, Americans who understand the key to preventing the Intellectual Revolution started by a former obstetrician from a miscarriage is to restore Thomas Jefferson's way of principled thinking.

Now I'm talking to a very small number of Americans who are still in their right mind.

In this essay, I will elaborate on my acts of civil disobedience I briefly touched on in my previous post, particularly how I'm fighting psychosomatic disorders such as hypertension and acute worsening of chronic diseases such as Parkinsonism while remaining medically uncovered and financially broke. I hope my story resonates with you level-headed Americans, and thus helps turn the actionable cause of civil liberty into real actions.

I have opted out not only of the medical insurance but also of all other entitlement programs. In a sense, the national pension program is the only exception, but actually it's not an entitlement. That's why thieves at Yokohama municipal government have been robbing me of more than 30% of my pension in the last 7 months, overriding the fiduciary responsibility to be held by the central government.

I saw a doctor for the first time in 10 years when I was ambulanced into the emergency room of a nearby hospital on January 26. Since then I have tried four doctors but the first three turned out to be quacks. The worst one was a crook by the name of Yoshinori Abe (阿部仁紀) who heads the Neuromedical Department of Byobugaura Hospital. He has a reputation as a distinguished doctor specializing in Parkinsonism.

I brought in an Excel chart to show Abe the very unusual patterns of the ups and downs in my blood pressure and told him of my own analysis of the graph, adding I might be wrong. I also told him about my chronology of Parkinsonism that dates back to the 1980s. Finally I made it clear that all I was expecting from Abe was his diagnosis and prognosis in writing, especially about the effects Parkinsonism looks to have on my blood pressure. By that I meant I didn't want any treatment, prescription, myography or any other pointless testing, in part because I knew I couldn't afford them financially, in the first place, especially when it came to refractory illnesses such as Parkinson's. More importantly, I would have declined it even if I had been offered these medical services at an affordable price, because I knew from my longtime experience with these guys that at the end of the day, they would never be able to solve my problems.

Without even giving a glance at the graph, Abe said to the effect that I was seeing a wrong doctor, then. From his sullen voice, it was evident that he felt seriously insulted by this unusually demanding patient because in Japan, the doctor is the god, who is not used to being told what to do.

Finally I decided to settle for the fourth one named Hiroshi Shiono (above photo) despite the fact that he honestly admitted he has little expertise in neuromedical diseases. But the most important thing was the youngish doctor, unlike the other three, was willing to listen to me very attentively.

I told Dr. Shiono that my systolic blood pressure had shot up to 240 mmHg on January 26 mainly because of too much stress I was going through in recent months. I added that admittedly my salt intake from junk food had been way too much, as well.

Astounded at the chart I had prepared on Excel, he said: "I have seen very few patients go this high, much less survive it. As you know, the lower threshold for the category 'Hypertensive Crisis' is only 180. If your brain artery had ruptured as it could well have done, and I had been removing your brainpan at that time, I must have seen a lot of blood erupt from your skull and hit the ceiling of the surgery room."

He prescribed me a stronger medicine called "Exforge" ("Diovan" which had been prescribed by another doctor, combined with a "calcium channel blocker") to tame my easy-to-boil blood.

As to my excessive intake of NaCl, I said, "Doc, I have no intention to go from one extreme to the other. Besides I don't want to live on an unsavory (salt-less, sugarless, tobacco-less and sexless) life because to me that would be putting the cart before the horse." The discerning doc laughed, and said, "That would be the best way to manage your health."

Now I visit his clinic, off and on, for a refill of prescription and ad hoc tips from him. Each time I see Dr. Shiono, we carefully analyze the chart I'm always updating on Excel to review his prescription policy and my dose strategy, and then quickly exchange words about the areas of our common interest such as classical music - and that's it. This is something that rarely happens between a Japanese doctor and his patient. I think I chose a right doctor.

For one thing, I decided to raise the threshold for systolic reading from 140 to 180 so I can suspend the dose until my wild blood soars to that level. When I told Dr. Shiono about my experimental strategy, he said, "Let's give it a try." Immediately after getting a nod from Dr. Shiono, I went ahead with my plan. As a result, in April alone, I saved my medical cost at least by some 20K yen. This is something to a person who is on the verge of bankruptcy.

Until I called it my second career in 2005, I was not allowed to opt out of Japan’s medicare system because throughout the half century I was in business, the premiums for the mandatory healthcare insurance had been withheld from my paychecks. When I finally retired, city hall insisted it was a legal requirement for me to "voluntarily" pay premiums so I could seamlessly switch to the other type of health insurance, which is primarily meant for the self-employed, the retired and the jobless. On top of that, I was told anyone over 65 was also “eligible” to be covered by the “Nursing Care Insurance” by paying an extra amount of yen. I said to myself, and those zombies in city hall, as well: “Enough is enough.”

Still today, I think I will remain uncovered until the last day of my life for the 5 reasons specified below.

Reason 1: Extortion under the guise of welfare

Simply I can't afford to take out the insurance policy. Aside from that, according to my calculation, the insurance premiums I was coerced to pay for 46 years from 1959 to 2005 totaled at least 15-20 million yen when restated at the “present value.” It is true I received some "benefits" in return when my ex-wife gave birth to our two sons and my family members, including myself, saw doctors over not so serious illnesses. But these benefits did not aggregate any more than several million-yen at their present value. In short, I have been ripped off by the Japanese government under the name of welfare and mutual aid. I think if I had decided to stay in the same extortion scheme in 2005, that would have been something English-speaking people describe as “pouring good money after bad.” (What's good about additional extortion is a different issue, though.) The Japanese way of saying the same thing is: “Throwing extra money at the thief on the run.” The entire deck of cards is stacked beforehand so the player always loses the game.

Every time I tell how I've been robbed by the government, they knowingly answer: "You've got to know this is an insurance program, not a savings account." The new sales pitch I hear from them is like this: "Actually the Japanese government is a very generous insurer who is willing to underwrite the worst possible risks such as your house which was burned down by the fire last night. The only problem is that the premium rate isn't affordable to someone who has just gone homeless."

Reason 2: Medical conformism

It's a known fact that 99% of the Japanese are conformists. That allows those in the medical profession, including more than 54,000 bureaucrats in the Ministry of Health, Labor and Welfare to make believe the Japanese do not vary from an individual to another even in terms of susceptibility to specific diseases. As a result, now it is a common understanding across the nation that testing, diagnosis, treatment and prescription can, and should, all be standardized.

Soon after the man-made disaster at the Fukushima nuclear power plant of Tokyo Electric Power Company, I introduced to my audience a nonfiction writer named Takashi Hirose, who is still ardently working on the revelation of the untold facts about the far-reaching and profound effects of radioactive contamination resulting from the meltdown of the nuclear reactors. In the video embedded in my post, he talked about his previous experience having moonlighted as a translator. According to Hirose, he translated a lot of medical literature authored by American and German doctors. At that time he was stunned to know there is a huge difference between Japanese doctors and their Western counterparts in the way they deal with their patients. In stark contrast to Western doctors, Japanese quacks totally ignore 個体差 (the inter-individual diversity.) As the fingerprint or the DNA sequence can never be the same from one person to another, every patient has his unique predisposition toward illnesses. But the only thing Japanese quacks sometimes care about is allergy to anesthetic agents.

For my part, there are many inexplicable things I have noticed when looking at the Excel charts of my blood pressure. Firstly there are abnormally huge discrepancies between systolic readings and diastolic readings. I suspect this has something to do with my Parkinsonism because it's a known fact that the blood pressure of sufferers of Parkinson’s disease is far below average. Secondly, my blood pressure readings are too volatile to explain from the standard way of interpreting these figures. Thirdly, more often than not the readings are too uneven between the right and left wrists. The manual that came with my Citizen Digital Blood Pressure Monitor says discrepancies up to 10-15 mmHg are within the margin of error. But in my case, it often goes well beyond that level.

Thus far I have asked 4 physicians what they think underlies these irregularities. Dr. Shiono said, "I can't tell for sure, but give me some time; I'll try to find out the probable causes." That’s quite OK because no professional can tell everything offhand. But the other 3 invariably pretended they hadn’t heard my question and refused to take a close look at the graph. To these conformists, the official criteria for classifying blood pressure levels into 4 or 5 categories are everything. (The Japanese criteria are a little different from other countries'.)

Another evidence of Japan's medical conformism is the funny idea that EVERY Japanese MUST take 定期健診 (a regular physical checkup) basically on a yearly basis. The nationwide obsession with periodical checkup dates back to the 1930s when the testing was an absolute necessity at the army induction. It's amazing, however, to know the same mental and physical conformism still prevails here 67 years after the war defeat.

Reason 3: Arrogance on the part of doctors

These conformists in the medical profession are also extremely arrogant. Who do you think knows best about your body? Of course it’s none other than yourself who knows it much better than anyone else. This is even truer with me; I know my body inside out because I have lived with it in the last 27,898 days, or 669,552 hours. But this is the last thing that would cross the minds of Japanese doctors and even their customers.

That is why when you first visit a Japanese hospital as an outpatient, the receptionist never fails to tell you to fill out a standard form which they call 問診表 (a questionnaire for screening.) On several occasions in the past I have seen doctors in Switzerland, Australia and America, but I have never been asked to go through this pointless procedure, or never seen other outpatients told to do so.

Some 10 years ago, I experienced a sudden bleeding from the throat. I visited a reputable Tokyo hospital with a 3-page Word document which I had prepared beforehand to detail my entire chronology about the respiratory organs. But the receptionist pushed it aside and insisted I should fill out the standard, 1-page, multiple-choice questionnaire. I said, “What if I refuse to do so?" Her answer: “Perhaps we, too, refuse to give you treatment.” I had to comply, but I ticked “Yes,” for instance, on the question whether or not I was pregnant at that time. Afterward I had to sit around in the waiting room for a couple of hours. When it was my turn, believe it or not, the quack spared only a couple of minutes for this patient. During that time, he was single-mindedly keying my answers to the multiple-choice questions in his computer. Finally the bastard ordered me to have an X-ray and other tests, for which I waited another couple of hours. In this nation of dupes, the doc is the Almighty God. The problem, however, is that this god is always brain-dead.

Reason 4: National obsession with prolongation of purposeless lives

By the same token, their suckers are not allowed to have nonstandard attitudes toward their own lives. No matter whether you suffer an incurable disease, and no matter whether you don't really want to survive it at the cost of your own purpose of life, you have to follow whatever instruction the doc gives you.

Earlier this month, the government released very intriguing results of a survey, which said 23.4% of respondents had answered in the affirmative to this question: "Have you ever seriously considered suicide?" When it came to pollees in their 20s, an astounding 28.4% answered they had thought about killing themselves. This is yet another confirmation of the estimate by Yoshi Yamamoto, Director of the Mental Health Center of Yokohama. In his 2004 book titled Japan Unbound, John Nathan quoted him as saying, "Some 5 million Japanese are contemplating suicide at any given moment."

Unlike any other animal, people have their own reason to live on. When they lost the purpose to pursue, they never really want to survive. I don't necessarily think Japanese doctors should treat their patients like Dr. Kevorkian did. But at least, those in medical occupations should not take it for granted that prolongation of aimless lives is their mission. These days newspaper reports have it that one of the most prosperous industries in this terminally-ill nation is what they call "Poverty Business." The same can be said of "Death Business."

This is, however, not to say every Japanese is living a hopeless life. For one thing, the wife of the owner of a Tempura shop I visit every once in a while is a jazz singer. I don't know if she does genuine jazz, which is a rarity here, because I haven't heard her actually sing. A couple of years ago she collapsed because of a sudden brain hemorrhage. When she fell into a coma, the doctor said she would never recover consciousness again. But when it was about time her blood vessels would become gangrenous anytime soon, she suddenly came back to life. The presumed cause of the miracle: her husband, who is also an amateur jazz musician, let his beloved wife hear uninterrupted jazz from the CD player he placed at her bedside.

Once again, even in this nation of conformists, people's attitudes toward the life-or-death issue can largely vary from an individual to another. The ways doctors treat their patients should also vary accordingly.

Reason 5: Heavenly assumption (Gini Coefficient=0) applied in hell

Needless to say, affordability of medical costs on the part of patients also varies largely. In late-February, the bastard in the Imperial Palace complained he had a slight difficulty breathing. The Imperial Household Agency hastily took him to the prestigious hospital attached to Tokyo University where nation's first-rate doctors recommended surgery. Among the dozens of surgeons who were summoned to perform the cardiac operation, there was 神の手 (literally translated as a God's Hand) who no one but royal family members and big bosses of yakuza syndicates can afford to retain. Despite the fact Article 14 of the MacArthur Constitution says, "All of the people are equal under the law," the Emperor and his kin are all exempt from the mandatory health insurance. As a result, the unsubsidized cost for easing Emperor's respiration reportedly reached 5 million yen. But give me a break. The bastard along with his spouse and some of their servants stayed in gorgeous rooms like suites in a 5-star hotel for more than 2 weeks. So everyone knows the IHA was lying as usual; the total cost must have been well beyond 10 million.

Don't take me wrong, however. I don't think there's anything wrong with the extravagant spending because as usual stupid taxpayers willingly footed the bill. It's my fault, or my parents', that I came into existence in this imperial shithouse.

I find it totally unacceptable, nonetheless, that we commoners are also treated by quacks as if we were Emperors. The only difference is the fact that the average Japanese can't afford any more than 5-10% of the cost involved in the surgery by the God's Hand even when he suffers a much more serious illness. When it comes to my own solvency, it's way below average. When I was ambulanced into the emergency room, I had to pay an unsubsidized 25K yen which accounted for more than 10% of my monthly pension. In return, I got absolutely nothing because at that time the only thing I could think of was to find the right place and the right time to kill myself.

Actually my Reason No. 5 for staying out of the mandatory health insurance refers to the inequality in ROI. As I said, how much I can invest in my health care is not at issue here. What I find totally unacceptable is my return on investment which is always zero in the context of my pursuit of life. Unlike the Emperor, which is nothing but a worthless worm, I still have something to achieve before Grim Reaper claims my life. I just hope some of you will agree that my arithmetic makes sense.

These are the 5 important reasons I will stay out of the cartelized medicine until the last day of my life.

This post will soon be followed by MY REVIEW of a book titled "9 out of 10 Illnesses can be Cured All by Yourself" with a subtitle that reads: "Do you still want to remain a juicy patient?". In this revealing book, Dr. Hiroshi Okamato explains why he quit practicing medicine in 2001. This is a rare insider's account of Japan's medical cartel formed among doctors, pharmaceutical companies, medical equipment manufacturers, the Ministry of Health, Labor and Welfare, and the mainstream media.

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