People who live in Japan and are following the health care reform issue in the U.S. may be drawing some parallels. Part of the problem that some people have with President Barack Obama’s history-making legislation is that it falls way short of what is usually referred to as universal coverage. In other countries that do have universal health care, like the U.K., France and Canada, the government pays for medical care. Under Obama’s new plan, the majority of Americans will still have to buy their medical insurance from private companies.

Japan’s system (kokumin kenko hoken) is somewhere in the middle. It’s national in that the government has a health insurance program that pays for almost everything, but it isn’t universal. In Japan you still have to “buy” your insurance, it’s just that you have to buy it from the government. The difference is important, because in countries that have universal coverage everyone is covered regardless of their circumstances. In Japan, you are covered as long as you pay the government. Once you stop for whatever reason, you lose your insurance. That means you could pay your premiums (which are based on income, basically making it a separate tax) to the government on time for forty years and never even use it, and then, suddenly, because you lost your job or otherwise can’t pay, you lose your insurance overnight.

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