新しい未来に目を向けて－パサデナ・ロータリークラブでの講演 2006年8月28日在ヒューストン日本国総領事 加茂佳彦
Distinguished guests, ladies and gentlemen:
It is my honor to be invited to speak to you today. I accepted a kind offer to speak for 20 minutes on a subject of my choice, but it will be a challenge for me to both keep you engaged and to conclude my presentation in just 20 minutes as I often tend to deviate.However, today I am going to focus on social issues currently under debate in Japan. For those of you who may not find this topic to be one of interest to you, at the end of my presentation, I will be happy to take questions on other subjects.So let me begin.
Japan’s economy has revived.Worry has faded about the possibility of Japan suffering from bankruptcy. The Japanese are recovering confidence gradually. However, apprehension is growing among Japanese as to what our future holds.We had to endure a long economic slump, while witnessing fundamental political and strategic changes occurring in East Asia.These changes have brought home to us that an overhaul of Japan’s social systems is in order.
1.Debt issues
The Japanese Government is suffering from a huge amount of debt. How to repay the public debt is the most urgent problem the government must solve now that it has successfully recovered from an economic morass. The public debt accumulated by the Japanese public sector amounts to a hefty 150% of its GDP. The government’s main option for settling the balance is to combine two policies; namely, curtailing government spending and increasing tax revenue.Put another way, this issue poses the following questions: how should funds for social programs, including pension, medical services, education and other social welfare be secured, and how much should the current 5% consumption tax be raised?
What caused this fiscal nightmare you may ask?It is the result of the Japanese government spending a huge amount of money in an attempt to boost Japan’s ailing economy during the 90’s. In order to build funds for government spending, it borrowed money from Japanese nationals. This brought about a greatly bloated economy. However, if we look for an indirect but more fundamental cause, we hit upon demographic changes which are still underway, specifically the low fertility rate and the progressive aging of the Japanese population. These changes have caused Japan’s labor population to dwindle, thus curtailing tax revenue. At the same time, our social security expenses are soaring as the percentage of elderly in our population increases. So as you can see, the issue of managing our social security programs while at the same time repaying our mounting debt has become a legitimately major concern.
2.Medical services
In every country, good medical services are needed and sought by everyone. Japan is no exception. We want better medical services provided in our country so that we can live longer, happier, and healthier lives.
There are strengths and weaknesses in Japan’s health services.A major strongpoint is the fact that every Japanese national is covered by medical insurance. Our system’s weaknesses include the fact that the most advanced medical services are not readily available in Japan and that our medical services are not necessarily ideally coordinated or orchestrated to the maximum benefit of patients.
With a shrinking and aging population, it is imperative that we preserve the universal medical insurance coverage of Japanese nationals, and that we also maintain the quality level of medical services as much as possible. As funds decrease for medical services, the financial burden for those services will have to shift from government coffers to those who receive them.
While we boast of our insurance coverage, we are envious of the American people’s access to the most advanced medical services which are available only in the U.S.Ethical, pharmaceutical, and technical constraints preclude Japan from competing with the U.S. in this regard. We have less specialized medical training available, and therefore we must turn to the U.S. for such knowledge and training. An even more serious problem we experience is a shortage of MDs in general throughout Japan. Due to the declining number of births, for instance, it is becoming unpopular for medical students to choose to become doctors specializing in pediatric medicine.Such doctors are especially not readily available in remote rural areas. Although we need more doctors, we face budgetary constraints which prohibit attempting to substantially increase governmental support for medical school programs.
Japanese doctors are impressively in command at Japanese hospitals. They are very well respected and bear heavy responsibilities.However, they are often too busy to spend enough time with their patients. It is fair to say that the coordination among doctors, or the division of labor between the MDs and the medical staff, is insufficient at best. Japanese patients however, have better access to the best hospitals. If you are determined to see a renowned doctor at a prestigious hospital, you may see him or her without a referral or an appointment, but you had better get up early and wait for your turn patiently. Another positive aspect of Japanese health care is that our hospitals’ service fees, including hospitalization expenses, are much less than those in the U.S.Japanese patients can also stay in the hospital longer thanks to excellent insurance coverage and inexpensive medical fees.
The medical services situation in the U.S. is quite a contrast. MD Anderson certainly offers the most sophisticated medical services, but they also come with a hefty price tag. A comparative study shows that MD Anderson charges 7 times more than an equivalent Japanese hospital does. I was surprised to learn from an insider of the hospital that the first thing a patient has to do is to prove his or her ability to pay for care at the hospital. Only those who can provide such proof will be allowed to receive care at the hospital. The sophisticated medical services provided there however, do serve as a show case for the whole world to learn from and to strive to emulate. Its doctors and other medical staff function as a team in order to achieve the best results when treating patients. The importance that is placed on emergency medical treatment at this hospital and other major U.S. hospitals is indicative of the future direction in which the contemporary medical services are heading. As a Japanese national, I would like Japanese doctors and hospitals to learn more about what is happening in the U.S. and to rethink the Japanese approach to medical services where appropriate, while of course still keeping our comprehensive medical insurance in tact.
BenTaubHospital serves as an emergency hospital. Their emergency room looks like a Japanese hospital.It is always filled with many patients with various ailments, lying on beds, side by side. One doctor is assigned to take charge and direct the treatment of a patient. This approach is effective and also economizes on human resources, and it has had good results according to the hospital’s spokesperson.
It is uncommon for Japanese patients to come to the U.S. for treatment, and I think this is because the average Japanese person cannot afford the expense of American medical services. But there are some who do come to the U.S. for new drugs that are only available here. Either for the newest drugs or for the most advanced surgery, the U.S. is the last hope for many Japanese patients as well as many others.
3. Education
The Japanese early education system once enjoyed worldwide acclaim for its quality and achievements. It drew teachers and educators from all over the world to its classrooms where they tried to learn as much as possible about what made it work so well.However, recent years have seen the degradation of its quality due to changes that have been made in academic requirements and class hours.Academic requirements were lowered and less disciplined studies were introduced in the hope of fostering creativity and mitigating the examination hell. So what happened? Many public schools failed to maintain their academic standards, and as a result many students turned instead to private schools and cram schools.In addition, a couple of years ago, the Japanese government decreased the level of government funding provided for local school districts to hire teachers. Some worry that this will result in the further deterioration of early education by increasing the disparity among school districts across the country. Criticism for the government’s insufficient support and for the current school curriculum is mounting. As a result, a review should be undertaken in order to determine how to recover from this unfortunate situation. As a resource scarce nation, Japan cannot afford to fail to provide a top rate education.
Contrary to its early education system, Japan’s advanced educational system, generally speaking, has failed to impress others in the world. Its students don’t work hard enough, and its teachers don’t compete enough. The best schools in the U.S. certainly look more competent and advanced. Japanese universities are currently in a state of transformation. National or public universities have become financially independent, and they are struggling to find which path they should take in terms of management and education during a time of decreasing population. They have just begun to ask what competition will mean for them.
In my view, however, the Japanese university education has been underestimated to some degree. With all its shortcomings, it is also undeniable that it has contributed to the successful development of Japan’s economy and to the sustenance of Japan’s civic society. Our universities’ academic achievements should not be overlooked because they are published in Japanese.English is not used in their class rooms or labs, as Japanese textbooks are readily available on any subject imaginable.
Having said this, it is becoming a considerable handicap to lack competence in English language skills in today’s world of IT and globalization. The Japanese are well-known for our poor English language skills.For many years, our society has not stressed them as a key to success in life. Facing the problem of the major language barrier that exists today, fervent arguments are now underway for and against the introduction of English language education at the elementary school level. It may take a while, perhaps one generation, but we will certainly become more comfortable and proficient in English.
4. Disparity
Another social issue that is frequently discussed now in Japan is the increasing income disparity in the Japanese population. Japan has been one of the most equal, parity-ridden, and homogeneous societies since the end of WWII. We devoted ourselves to economic development under the security protection provided by the U.S. and achieved employment and income growth. The fruit of thiseconomic development was shared among all Japanese nationals more or less evenly.
So is this utopia disappearing? The disparity began during 90’s when the Japanese economy became stagnated, and the Japanese business community tried to maintain its competitiveness by cutting their employees’ wages. Some employees were even more unfortunate and lost their jobs.
Also, new college graduates had difficulties finding steady jobs and had to settle instead for low paying temporary ones. In addition, aging of the working population has also contributed to the growing income gap among Japanese employees. In an older peer group, income differences become greater as the result of long years of competition among them.
Having said this, the widening income gap Japan is witnessing among its nationals may be considered minimal at best by foreigners. Japan is still an overwhelmingly homogeneous or equalized society in terms of income or asset distribution. By international standards, there are neither many rich people in Japan, nor are there many poor ones.
Why then is there such concern regarding disparity? A comparative study by Professor Otake of OsakaUniversity provides a convincing explanation.According to his study, there is a perceptual difference between Americans and Japanese regarding disparity. Although income disparity in the U.S. is much greater than in Japan, this issue apparently fails to touch the nerve of the American society. Americans believe that they are endowed with equal opportunities in the U.S.They accept, or should I say tolerate, that academic qualifications and personal talents play vital roles in whether or not one achieves success. To the contrary, Japanese do not like to see these factors determining one’s fortune in life.We would prefer to believe that success can be achieved by virtue of one’s efforts alone. We would resent it and feel that it was unfair for an income disparity to result from academic qualifications or natural talents.
Is this weird? Perhaps so; Japanese have a natural genetic inclination to place a great value on equality and/or conformity.This is the result of the fact that our existence for thousands of years has been as rice farming villagers for whom such qualities are and were necessary. This DNA is quite strong, and it sometimes overrides the rational. We do not want to see an extreme disparity in income distribution among our fellow countrymen and women, but in order to keep our society vibrant and growing, we should foster equal opportunities rather than equal income distribution and thereby advance efficiency and productivity.
This concludes my remarks. Thank you.