Regarding the Oct. 22 letter "Avoiding an all-around nightmare" (from the anonymous hospital worker): I would like to point out that people with private foreign health insurance do not expect each clinic in Japan "to have fully staffed English-speaking insurance and billing experts." Foreigners in Japan, however, do tend to live in limited areas and it wouldn't be a nightmare at all to have some hospitals in such areas employ these experts. At least, it's not a nightmare or considered naive in Hong Kong, Singapore, Bangkok, Kuala Lumpur, Manila and Jakarta. Why is it so difficult to have such an arrangement in Tokyo or Osaka?
As for insurance payments to hospitals and clinics, checks in U.S. dollars or euros are quite a thing of the past. Nowadays funds can be remitted in yen within a few hours. Since bureaucracy in Japan seems far more complicated than it is abroad, I don't think remittances would be a problem for Japanese staff used to dealing with ministry procedures.
I don't have the "attitude that the world should speak English." I am Italian, but I understand that on the international stage, the language is English — not Japanese or Italian, unfortunately. For this reason, I think it's rather naive to expect all foreigners in Japan to speak Japanese. So, the local requirement (to enroll in national health insurance) sounds just like another obstacle that makes access to Japan more difficult for foreigners and should be fiercely opposed.