Mika Tsutsumi is a spirited journalist and writer whose work turns a spotlight on the widespread hardships and poverty caused by official policies and the behavior of businesses in the United States.

Her best-selling book “Rupo Hinkon Taikoku Amerika” (“America, the Poverty Superpower”) exposed to Japanese readers the shocking reality of the lives led by millions in the U.S. — including tens of thousands who go bankrupt every year due to medical expenses and legions of students mired deeply in debt because of loans they have had to take out at high interest rates to pay for their tuition.

In that book, which won the Nihon Essayist Club Award in 2008, Tsutsumi also analyzed and described how excessive reliance on market forces across U.S. society has also created a “poverty business” that further exploits disadvantaged people and drives them down to the bottom of the social ladder.

That book and its sequel, “Rupo Hinkon Taikoku Amerika II” (“America, the Poverty Superpower II”), which was published in January 2010, have together already sold 450,000 copies — a blockbuster number likely explained in large part by the fact that some 3 million people in Japan are unemployed as the country’s near-two-decade economic stagnation continues. In addition, in the wake of the Japanese government’s U.S.-style “reforms,” millions more live in fear of experiencing similar poverty to that facing so many American citizens. The reforms begun during the administration of Prime Minister Junichiro Koizumi, who was in office from 2001 to 2006, aim to restructure Japan’s public sector based on market principles.

Ironically, though, despite the fact that she has researched the dark side of the American dream, the U.S. had been Tsutsumi’s dream country since she visited Disneyland in Los Angeles at the age of 5, as she recounts in her 2004 book, “Guraundo Zero ga Kureta Kibo” (“Hope That Ground Zero Gave Me”).

Born in Tokyo in 1971, the daughter of TV and print journalist Koichi Baba, Tsutsumi often spent her vacations in Los Angeles with her grandmother who lived there. Then, when she attended a private high school in Tokyo, she spent much of her free time immersed in American movies.

Her dream of studying in the U.S. came true when she entered Monterey Peninsula College in California in 1991. From there she transferred to New York State University to study international relations. She went on to get a master’s degree in that field at the City University of New York.

With that postgraduate qualification achieved, and her hopes of working for the welfare of people around the world, Tsutsumi went to work first at the United Nations Development Fund for Women (UNIFEM) before moving to Amnesty International in New York. Later, in order to experience working in a for-profit organization, as she puts it, she joined the New York branch of the giant, Japan-based Nomura Securities Co. in the summer of 2001.

However, the Nomura office was in a building next to the World Trade Center, and on the morning of Sept. 11, 2001, when the second airplane crashed into the center, Tsutsumi was knocked to the floor by the shock wave, though she was able to escape the building to safety.

Two years after that, Tsutsumi returned to Japan and started working with American peace activists as an interpreter, subsequently launching her media career as a writer and commentator on American social and political issues, while also making many fact-finding trips to the U.S. One of those trips produced her 2006 book “Amerika Jakusha Kakumei” (“Revolution of The Weak Behind The News”), which focuses on children from poor families recruited into the U.S. military and soldiers suffering from PTSD (post-traumatic stress disorder) as a result of war service in Iraq and Afghanistan.

On March 26, just three days after the fanfare surrounding U.S. President Barack Obama’s signing of the Patient Protection and Affordable Care Act, 38-year-old Tsutsumi found time in her hectic and unremitting schedule to talk to The Japan Times in Tokyo.

For your 2008 book “Rupo Hinkon Taikoku Amerika” (“America, the Poverty Superpower”) you interviewed many disadvantaged people in America, including those unable to go to hospital because they can’t afford the high medical fees and students from poor backgrounds targeted by U.S. Army recruiters. How did you find and contact those people?

I used all sorts of methods. For example, one of my friends, who is Cuban, is married to a teacher at a high school whose students are mostly from poor families. I heard from them that military recruiters often visit the school, so I went there to meet them. I also went to gatherings of returned soldiers. I handed them my name card, explained to them what I was researching and asked them for interviews.

In the U.S., as well, there are many nonprofit organizations tackling various social issues, so I would telephone their offices and arrange appointments to speak with the people working there — which also helped to expand my network of contacts. Meanwhile, to contact soldiers, I posted messages on service people’s Internet bulletin boards.

Altogether, it’s like throwing stones in every direction.

Even though the U.S. is a TV-centered society, many good books are still available. People who don’t appear on TV but speak in the independent media often publish books, and I would go to bookstores stocking so-called alternative media to buy them. Then I contacted the authors and people who appeared in the books. However, to find people saying interesting things, I checked both the mainstream and alternative media — and when politicians gave good comments on social issues on TV, I’d visit them at their offices.

In the end, the amount of information I gathered was enormous, but I only used a fraction of it. I chose the most useful parts and put them together in the book.

You say in your book that some 900,000 people in the U.S. filed for personal bankruptcy in 2009 because they could not pay their medical bills. You also state that 75 percent of those people had health insurance. How come they fell into bankruptcy even though they had that insurance?

President Obama recently signed the health-care reform bill. It is said to create near-universal coverage, and Japanese people might think the system to be introduced is something like the one in Japan.

Here, people pay premiums to public medical-insurance organizations that pay both patients and doctors. Under the system, patients can choose hospitals and doctors by themselves, and those on low incomes pay lower premiums than those with high incomes.

However, the new system of “universal” health care in the U.S. will be completely different from that in Japan. In America, between patients and doctors there will be — as at present — private health-insurance firms, not public organizations as in Japan. The firms channel patients to particular hospitals and, in return, they are able to interfere with the management of the hospitals in ways such as pressing them to shorten doctors’ consultation times in order to increase profits and promoting savings in personnel costs through reductions in the number of nurses. Consequently, in many hospitals the doctors and nurses are too overloaded to deal properly with patients.

On the other hand, patients pay expensive premiums to health-insurance firms. When they become sick and require health care, they ask the companies to pay the medical expenses. But the firms often refuse to pay for any of a whole range of reasons — as the film “Sicko” by Michael Moore showed very clearly. For example, one of my friends had pain in her womb. She went to a hospital and got a CT scan. The CT scan showed she had a tumor, which turned out to be benign. But when she asked her health-insurance firm to pay for the CT scan, which was expensive, the firm said, “The tumor is benign, so you didn’t need a CT scan and we are not going to cover the cost of it.” As a result, my friend had to take out a loan to pay for the scan.

In Japan, there is an upper limit on the medical expenses that patients pay. For example, when a person is operated on for appendicitis, they will pay ¥80,000 to ¥90,000 out of the total ¥300,000 cost. When one of my friends was operated on for appendicitis in New York, she had to pay ¥1.5 million even though she had health insurance.

So the most serious problem with health care in the U.S. is not the fact that 45 million people don’t have medical insurance. The main problem is that many people with health insurance still have to file for bankruptcy when they become sick only once — while the suicide rate of overworked doctors, which is already higher than for other professions, keeps rising.

Hence there’s a situation where more and more overworked doctors are killing themselves, or quitting, while more and more patients are becoming medical rejects.

Will the new U.S. legislation make health care available to everyone at a lower cost?

No. Even under the new legislation, health-care costs will remain expensive and patients who cannot shoulder the costs will go bankrupt. We must be aware that the root cause of the problem will still be there. This legislation only creates 30 million new customers for health- insurance companies by spending tax money.

We see the media saying this is Obama’s great accomplishment, but it’s actually necessary to look inside the legislation itself and at the real problems the U.S. faces now.

Many people in the medical field there are already angry about this new legislation. One reason is that it stipulates that health-insurance firms must pay a fine if they reject patients with pre- existing conditions. But the legislation doesn’t affect the firms at all because the fine is only $100 a day.

Consequently, going back to patients with pre-existing conditions, if someone with an incurable disease, for example, needs medical treatment costing $100,000, a health-insurance company would choose to refuse them and pay the fine. That’s because if the patient is likely to die within a year, it will cost the firm less to reject that person and pay the fine. In such a case, that person would become one of the 45,000 medical rejects a year in the U.S. who die because they cannot receive proper treatment.

Obama also gave up the negotiations with pharmaceutical companies on lowering the prices of prescription drugs, the prices for which have been skyrocketing in recent years.

Why was health-care reform watered down so much?

Well, if you see who are the big contributors to U.S. election campaigns — such as heath-insurance firms and pharmaceutical companies — you can predict where politicians will likely have to make policy adjustments in return once elected and their contributors exercise enormous influence over their policy-making.

So we’ve had the financial-sector bailout, military spending keeps rising — and now there will be more money for the medical-insurance sector. These are all big political-fund contributors.

Did you anticipate that Obama’s health-care reform plans would be watered down after he became president?

Yes, to a certain extent. My concern mounted when I saw the federal budget in January this year, which included $1.45 trillion for Wall Street bailouts, a $664 billion military budget and ¥164 billion to pay interest on the national debt.

But how much was the budget for people who lost their homes, student-loan debtors and health-care reform?

Well, U.S. citizens cannot change the budget; what they can do now is pressure the government and make their own changes happen. On Sept. 12, 2009, around 2 million people demonstrated in Washington D.C. against President Obama’s policies, The media reported that most of those were Republicans, but actually there were also many people who had lost their homes, students who can’t pay the high tuition fees demanded of them, returned soldiers, doctors and mothers and more. They are all angry and raising their voices.

Did you go to the demonstration?

Yes. I met many people at the demonstration and some were arrested by the police.

Besides such political movements that pressure the government, what else can change the politics of the U.S.?

I think the key is to review the relationship between campaign money and elections. An election campaign in the U.S. requires enormous amount of money. Obama collected $750 million for his campaign. To defeat him in the next presidential election, the opposing candidate would have to collect more money than Obama. Without hundreds of millions of dollars, a presidential candidate simply cannot do their PR well enough to attract votes. However, to raise hundreds of millions of dollars, candidates end up taking contributions from very rich individuals and big corporations that exceed those from regular citizens. In this way, one vote becomes a dollar bill instead of a voter.

If people can change the election- campaign system, the situation will change dramatically. But on January 21 this year the U.S. Supreme Court actually loosened regulations on the permissible scale of political-fund contributions. In the next congressional election (on Nov. 2), corporations will be able to contribute as much as they like to candidates’ political funds. Even companies in the United Kingdom or millionaires from Dubai will be able to fund the candidates — and so possibly influence U.S. policies. This corporatism was the theme of “America, the Poverty Superpower II.”

Education and medicine are big markets now in the U.S. My book has chapters on several particular aspects of this, and it concludes that a nation — any national government — must be responsible for lives of the citizens and their future.

In the U.S., though, the government abandons such responsibilities and entrusts them to the market. I don’t want Japan to follow in the footsteps of the U.S. — and I hope that U.S. citizens can stop this corporatism and get politics back in citizens’ hands again.

In Japan, former Prime Minister Junichiro Koizumi instituted market deregulation such as allowing manufacturing companies to use temporary workers supplied through jobs agencies. His administration also reduced the budget for welfare, including allowances for single mothers. Now, Prime Minister Yukio Hatoyama is reversing those policies by banning the use of such temporary workers in the manufacturing industry and raising allowances for single mothers. What do you think of Hatoyama’s policies?

Each of Hatoyama’s policies seems to be like a small disconnected dot. They lack overall political vision. For example, if the government bans companies from using job-agency temporary workers on their production lines, a huge number of them will be out of work. The government has not prepared for that, which should have been part of the policy package.

Regarding the allowances for single mothers, the question is why are they so poor in the first place? The reason is because the costs of child-rearing and education are too high for them, and women’s wages are still low. So, again, they need an overall policy package to address the problem.

I want the prime minister to have a vision of the kind of society he wants to create for us — and then bring it nearer with each new policy.

You wrote a book titled “Seishain ga Botsurakusuru” (“Regular Workers Fall”) with Makoto Yuasa, an antipoverty campaigner. Today not only temporary workers but also many regular workers are facing hard times as their pay is cut and they have to work unpaid overtime because their companies are struggling. For everyone now, once they lose their job, it is very hard to get another one. It is as though all workers are in a poverty spiral. How can we get rid of the spiral of poverty?

The most important thing to do is to watch the government and each policy proposal carefully. No matter how many nonprofit organizations give out meals and blankets to homeless people, they are not solving the problem. That won’t happen unless politics changes and the economy improves. Most people only pay attention to politics at election times, but they have to keep watching what the politicians they voted for are doing after the election is over. They can watch debates in the Lower House and the Upper House of the Diet on the Internet, and voters can also visit politicians at their offices. When politics goes in a direction contrary to voters’ wishes, they should move the politicians. And it’s not only the activists, but also ordinary people who should act.

You studied international relations at universities in America. After graduation, you got jobs at the United Nations Development Fund for Women (UNIFEM) and at Amnesty International. But then you moved to Nomura Securities Co. Why?

The goal for most of students majoring in international relations was to work in the United Nations. I worked as an intern at the U.N. for one summer and fortunately got to work at UNIFEM. But after I saw that things didn’t move forward because of the conflicting interests of member countries, I was disappointed by the bureaucracy of the U.N. And I thought that if ordinary citizens were running an organization, it would work better. So I applied to Amnesty International and got a job. Amnesty was great as a civil movement, but it was weak at fundraising. So I decided to work in Wall Street, where money talks and things work out and get done. So I joined Nomura, where everything works efficiently and fast — but less than three months later I experienced 9/11.

After the 9/11 attacks in 2001, you left Nomura Securities and came back to Japan. What changed in yourself?

Right after 9/11, American society’s priority was shifted to the “war on terror.” In New York, most of the media coverage was about when the next terrorist attack would hit the city. All that people talked about was terrorism, and they were saying, “It is useless to plan our future because we don’t know when we are going to be killed by terrorists.”

However, I responded with such questions as “What is terrorism?” “Who are the terrorists?” “What is our future?” But the media coverage then was all about the war, and there was no diversity of opinion in the media. Because I was in the building next to the World Trade Center, I saw the attack and experienced flashbacks of the tragedy. To overcome the flashbacks, I needed to know the truth. Because the media didn’t give me the truth, I thought I had to search for it by myself — and so I would need to be a journalist. That’s why I left the company and came back to Japan.

In your book, you said you had always believed the U.S. was a land of democracy, freedom and human rights. Did it change?

Yes. The “war on terror” changed many things, including leading to the installation of surveillance cameras all around New York City and people being arrested on the street. But because the “war on terror” doesn’t have a clear end point, the government can keep on with its emergency rule forever.

However, a lot of people are actually working hard to get their freedoms back. I put their interviews in my new book, titled “Amerika kara Jiyu ga Kieru” (“Freedom is Disappearing from America”), which will come out next week. For example, I wrote about a bookstore clerk in a small town who is campaigning to protect the freedom to sell and buy books on any subject. There are also students who are angry about the fact that market mechanisms have been applied to the country’s education system. And because politicians didn’t listen to them, some of them sent their representatives to Congress. There are a lot of great citizens’ movements like these happening in the U.S.

In Japan, there’s not much media coverage of citizens’ political activities in the U.S. Why do you think that is?

That’s because as great a step as each action may be, most are too small to be covered by the mass media. But the accumulation of such actions can lead to big movements. Throughout U.S. history, American people have changed the country in many ways, such as abolishing slavery, attaining women’s suffrage and ending the Vietnam War. So American citizens have moved the nation in wonderful directions before — and most of those improvements were made through the accumulation of small actions.

However, today’s mass media in Japan and the U.S. train their focus on sensational incidents and don’t cover important movements by citizens. But I strongly believe that the real change will come through the patience and courage of people determined to never give up on striving for a great future and continue moving in that direction.

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