Photo/Illutration Lawmakers from the Liberal Democratic Party and Nippon Ishin (Japan Innovation Party) discuss reviewing the social security system on Nov. 21. (Yotaro Hamada)

Since almost no one can work their entire lives, those who are young now will someday become old and become increasingly reliant on the social security system. 

Because dialogue, rather than confrontation, between generations is necessary, an important role of politicians is to create momentum for discussions of reform of this system.

The Liberal Democratic Party and Nippon Ishin (Japan Innovation Party) have begun working-level discussions for reviewing the social security system that was included in the coalition agreement signed by the two parties.

A major policy direction will be reducing the social insurance premium burden of the working-age generation that has been pushed by Nippon Ishin.

As such, the focus of discussions will be the premiums paid by senior citizens as well as increasing what they pay whenever receiving medical or elderly care.

One immediate topic for discussion will be creating a framework to reflect financial income, such as from securities, on insurance premiums and what is paid out of pocket.

Another topic is reviewing insurance benefits for medicine that have similar ingredients and uses as over-the-counter drugs but which require a visit to the doctor.

The coalition agreement also called for reviewing the differences by age groups in payments made at medical clinics and other facilities.

Currently, those under 70 make, in principle, out-of-pocket payments of 30 percent of the total cost, but that ratio is reduced to 20 percent for those between 70 and 74 and to 10 percent for those 75 and older.

Including financial income in the base when deciding premiums is logical since it follows the principle of shouldering a burden according to ability to pay.

If infrastructure can be constructed to allow for accurate calculation of income, it could lead to fairness among all age groups in terms of premiums as well as the tax burden and benefits.

But if out-of-pocket payments are increased, that will directly hit the pocketbooks of patients who need care and medicine for illnesses or injury.

Senior citizens use medical institutions more frequently than younger generations.

Even if each visit may have a lower payment amount, the total cost will become much higher.

Since it will be difficult for the elderly to work to increase their incomes, they will face greater concerns about a rise in unavoidable expenditures.

There will be a need to carefully determine exactly how much of an additional burden each individual will have to shoulder.

Nippon Ishin Lower House member Satoshi Umemura is the party’s point man for discussions with the LDP.

On the party’s official social media site, he posted a comment that said since the medical care system deals with the lives of the people, discussions should not be about seeking an all-or-nothing conclusion, but should create a base that will reassure the public.

That is a proper recognition.

Japan’s social security system has been described as one in which benefits center on senior citizens while the burden is focused on the working-age generation.

But that is only one aspect of the issue at a certain point in time.

Over the course of a person’s entire life, many people will not need medical care while they are working, but will face increased expenditures for medical and elderly care when they are more advanced in age.

An important role for social security is to average out that burden.

Of course, there is a need to place a top priority on dealing with expenditures related to child care that is a heavy burden on the working population.

Reform should move toward creating a sustainable social security system that balances the burden and the benefits of the working-age population and senior citizens.

--The Asahi Shimbun, Dec. 1

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