The badly misguided policy initiative to promote the so-called “maina hokensho," which is integrating the national health insurance card with the My Number Card, is a textbook example of how misplaced policy priorities can lead to a costly debacle.

The politicians who led the initiative should be aware of the heavy responsibility they bear. 

Starting Dec. 2, new issuances of the current health insurance cards (hokensho), paper cards that serve as proof of enrollment in the public health insurance system and are required to receive insured medical treatment, will cease.

This is due to the government's push to transition to the Individual Number Card system, where a My Number Card, a government-issued identification card, can be registered for use as a health insurance card.

Last month, government advertisements about this program in newspapers and magazines featured prominent headlines that said, "Even if you do not yet have your My Number Card, you can still receive medical care as before."

This stands in sharp contrast to this summer's ads that encouraged the use of the My Number Card for upcoming clinic visits and medication pickups.

According to government officials involved, this change in tone is due in part to the inauguration of a new prime minister and the departure of digital transformation minister Taro Kono, who championed the My Number Card, from the Cabinet.

Two years ago, Kono abruptly announced the discontinuation of the current health insurance cards by the fall of 2024. Previously, the government had explained that discontinuation was a future goal and that insurance cards would be issued upon request.

Kono faced strong criticism for this move, which was tantamount to forcing the early acquisition of the My Number Card by holding the insurance card "hostage." 

However, the administration of then Prime Minister Fumio Kishida endorsed Kono’s forceful initiative.

Meanwhile, the shift to the new system got off to a rocky start, plagued by a raft of errors and system glitches, including cases where My Number Cards were tied to the wrong person's information or hospitals displayed incorrect health care cost-sharing rates for patients at their counters.

Although some troubles are inevitable during massive system changes, the threatening announcement of "discontinuation" at the fixed deadline might have amplified feelings of anxiety and distrust among people.

Even recently, only about 20 percent of patients are using their My Number Card.

To be fair, there is merit in promoting the My Number Card to improve efficiency in health care services and related information processing.

However, if it undermines the higher value of "guaranteeing benefits to people enrolled in the public health insurance system and maintaining trust in the system," it's a complete reversal of priorities—a clear misjudgment.

How this policy initiative went awry is reminiscent of the public pension fiasco nearly two decades ago in a health ministry project to integrate past pension records, which existed before the introduction of the basic pension number, into the new system.

Because of the flawed integration process, approximately 50 million past records were discovered in 2007 that had not been integrated with the basic pension number. These pension records left “in suspense” heightened distrust of the system.

In this blunder, too, suspicions about the relationship between contributions and benefits were to blame. The lessons from the policy disaster have not been heeded.

Ultimately, the government was forced to patch things up. From December onward, a "certificate of qualification verification" with nearly the same functionality as the current health insurance card will be issued.

This will be sent to all people without a My Number Card and seniors over 75 whose health insurance cards are expiring.

This is because there can be cases where families might have registered seniors for a My Number Card without the seniors’ awareness, with the intent of gaining My Number Points. 

These points, which can be used with cashless payment services, were given to people who have made the switch.

Compared to the co-use of the current insurance card, the qualification verification certificate system adds complexity and raises concerns about potential new problems.

Steps must be taken to ensure that citizens' rights to medical care are not compromised in any way.

--The Asahi Shimbun, Nov. 15