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  • Hoofin: Health insurance advocate “Free Choice Foundation” is fronting US health insurance business

    Posted by Dr. ARUDOU, Debito on December 15th, 2009

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    Hi Blog.  What follows is an essay written not by me, but by an alert friend who thinks something fishy is going on here.  Look:


    Readers may remember a few months back when posted about a new Immigration guideline that suggested the government would be checking for registration with national health insurance (kokumin kenko hoken) or the employee version (kosei kenko hoken) on visa renewals.

    As has been explained in Higuchi and Arudou’s Handbook for Newcomers, Migrants, and Immigrants, all residents are required to be enrolled in one of these, or some lesser known ones that are accepted by the government.

    In the past, enforcement of this rule seems to have been lax.   So the new guideline was meant to make it less lax.

    A group styling themselves as the “Free Choice Foundation” became an internet presence to object to this enforcement of the rules, which they call a “change” of the rules.    Their main theme, avoidance of kokumin kenko hoken (or kousei kenko hoken), has been couched in terms of consumer choice, language barriers, and a failure of the Japanese medicine to live up to some standard particular to “foreigners”.  But their remedy is only that NJ residents should be able to buy what amounts to gap insurance through the internet, or presumably go without insurance entirely if they choose.   They say that, for the Japanese government, this should be the end of the story.

    The chairman of the Free Choice Foundation, Ronald Kessler, made his arguments in a September 29, 2009 Japan Times story, here:

    Now blogger Hoofin, a regular commenter here, seems to have found a connection between  Kessler and HealthOne, one of the main companies in Japan using the internet to sell policies to NJ residents.

    Moreover, Kessler K.K., the Free Choice Foundation, HealthOne and its sponsoring company, Legend Travelers, as well as “National Health Insurance Watch”–a website that shares different two ways (with a disclaimer!) how NJ can use deceit to get themselves off kokumin kenko hoken—all five are supported by the same internet server that is registered to Mr. Kessler.  In America no less!

    What is the real story?   Is it about free choice?   Fairness to NJ?   Or simply arguing that Japan should ignore its own social insurance laws when it comes to NJ, so that someone else can make a business out of it?

    COMMENT:  Yeah, come to think of it:  As a person who has always had a difficult time scraping together much money for activism (believe me, I’ll always be impoverished by my activities), I was curious how this group was able to make all this money for a very flash website, lobbying, advertising in broadsheet publications…

    Arudou Debito in Sapporo

    28 Responses to “Hoofin: Health insurance advocate “Free Choice Foundation” is fronting US health insurance business”

    1. Kimberly Says:

      Your reasoning makes sense to me. When I interviewed for Nova (didn’t take the job, but they offered it to me), the recruiter specifically said that teachers were NOT required to join kokumin kenkohoken, and that she would “ask if it was okay” if I DIDNT want to enroll in the travel insurance they were pushing on all the teachers. Nova isn’t really around anymore but they were DEFINITELY getting a cut from that insurance they were claiming was not only acceptable but better than KKH. I wouldn’t be surprised if some of the other schools, “activist” groups etc were too. Those insurance companies could lose a lot of money if more people switch.

    2. Doug Says:

      To me the real story is about free choice (No I do not work for the foundation and have never donated). I do not think “only NJ should be able to buy private insurance” – I am not sure if Free Choice thinks that or not. Either way regardless of who sponsors the website there are many NJ in Japan (who are not involved with the insurance industry) who are here short term (3~5 years) that would prefer to be able to maintain their existing insurance.

      Just ask some of the international school teachers (many of whom are my friends and many of which also have trouble scraping together much money) which spend 9 months a year in Japan and 3 in their home country. Most of these people would prefer to have non emergency type treatments, etc. done in their home country where they speak the same language and sometimes have physiciancs they have known for years treating them. The Japanese system just is not the best option for them.

      I do not think that someone is just trying to make business out of ignoring social insurance laws. There are many unique circumstances in Japan where it is not practical to ask everyone to participate in Japan’s system.

      I could understand making the system mandatory for those holding PR (showing the intent to stay long term in Japan) or citizens (such as Debito-san) but for those that are here for 3 years working for an international company or 5 years working for an international school I think it is unfair and unjustified to make visa holders participate.

      There are also cases where people would like to maintain their existing policies rather than having to return to their home country and re-apply for insurance because they were forced into the program in Japan (re-applying for insurance has its own issues and problems).

      There should be some flexibility in the system.

      I think fiscally Japan is better off than worse off having some of us “deceivers” (like me) in country. Alot of “deceivers” in the Kansai area have left Japan (due to a large company moving the Asian HQ out of Japan and it has had a major impact in the Kansai area.

      I do not think people are trying to cheat anyone – I think people are trying to find the best solution for their own personal situation in a country where life as a foreigner is trying (as demonstrated repeatedly on this board) at times.

      Even the proposed health care legislation in the U.S. does not pose such requirements (although the elite – Congress, Senate, President – are exempt). After all why would the elite vote themselves into a program that they wish to impose on the rest of the citizens where there will be a bureacracy deciding if certain treatments are warranted.

      I relate the last paragraph as I believe freedom of choice for us “minions” is necessary in a free society. I believe Japanese government officials (sorry I do not have the source)

      Most (not all) of my Japanese friends by the way also believe it is unfair to force short term residents into this program and when special circumstances are explained they completely understand the rationale of opting out. Most of my friends see this as an attempt to increase revenue into a system that is going broke.

      It is unfair to compare someone here on a 3 year visa to a citizen of Japan. Cheers

      — Problem is, as the system stands now, if PRs are suddenly required to get on JH insurance once they become PRs, they’ll get slapped with a huge bill for back payments. Boy will that deter people from the upgrade. This will also happen to anyone AFAIK who decides to jump horses mid-course.

    3. Hoofin Says:

      Responding to Doug @2 :

      I don’t know where you got the part about Ron Kessler saying “only NJ should be able to buy private insurance”. That wasn’t my understanding, and the blurb above says Free Choice’s remedy to the problems it alleges is “only” (i.e. the only remedy) is that NJ residents should be able to buy private insurance and ignore the Japan national programs.

      There is nothing about Japan’s laws that prevents expats who are here for only a few years from maintaining insurances in their home country. In countries with national programs, they go back in anyway, at no or little cost in the meantime. America is typically its own exception. I don’t think Japan’s social insurance policies should be written for America, as is clear from what you say about U.S. Congress.

      Doug says:

      Just ask some of the international school teachers (many of whom are my friends and many of which also have trouble scraping together much money) which spend 9 months a year in Japan and 3 in their home country. Most of these people would prefer to have non emergency type treatments, etc. done in their home country where they speak the same language and sometimes have physiciancs they have known for years treating them. The Japanese system just is not the best option for them.

      I am wondering why someone would be in a situation where they only work 9 months in a year–voluntarily this is–and then complain about having “trouble scraping together much money”. A lot of the world can’t make ends meet on 9 months’ work in a year.

      Doug says:

      I do not think that someone is just trying to make business out of ignoring social insurance laws. There are many unique circumstances in Japan where it is not practical to ask everyone to participate in Japan’s system.

      And yet on the “National Health Insurance Watch” website related to Ron Kessler’s server, a main theme of complaint is that people don’t want to pay into the system because it’s money out of their pockets when they think they can find a cheaper alternative. Like the blurb said, there’s even an instruction guide on what kind of lies might work.

      The other reasoning just sounds like pure opinion: only those really, rully committed to Japan should have to pay in. And people around just 3, or even 5 years, should be able to shirk or do their own thing with HealthOne’s “private” plans. Of course, the dividing line will always be the line where the non-payer gets over. Otherwise, “unfair”, “unjustified”. How about the cases where the rest of Japan is forced to provide a hospital system so that people whose private gap insurance runs out can pay up just their premium and get the care they need? Free Choice Foundation never talks about that situation, because it messes up the storyline.

      And then the rest is Shakespeare’s Protesteth Quote, or rehashed Reaganism. The blurb writer clearly used the word “deceit” to refer to what the – connected “Health Insurance Watch” was suggesting to the expat readership. (“CD QX”, by the way, is ham radio usage for “calling all distant stations”. Ham radio is another of Ron’s angles.)

      The allegation that universal health programs are a cost that drive businesses to the Third World, and that those who don’t pay their dues are making society “better off” because they are spending that ill-gotten extra money on other businesses, or even investing it. What they really do is push the cost on to the people who play by the rules.

      Flatly, the whole dodger reasoning gets a little boring. It starts out with all the different reasons why non-Japanese who are here for some finite period should have it different. OK, fine. The “obvious solution” to this, then, is always one of the fine products from HealthOne or its similar ompetitors — who may be all one company in the end for all we know. No one from the “Free Choice” crowd ever proposes a “foreigner” mutual aid society under Japanese insurance laws, that will do the same miraculous things that the private insurers allegedly do. But cut out the profit to the private insurance company owners (again, not part of Ron Kessler’s argument, because it messes up the storyline.)

      They fax various officials all over Nagatacho, but never to the ministry (Health and Labor) that actually has authority over these kinds of issues.

    4. Doug Says:


      Your point is well taken and I agree that is an issue. Back payments do not seem fair either. The issue is complicated and each person has different issues.


      About Kessler – What I heard him say may have been out of context

      I know several international school teachers quite well, know their salaries, and know how tough it is for them to make ends meet. They only work 9 months a year because school is not in session year round. During the summer most are taking additional courses to stay up to date in the education field, etc. You do not sound like the type of guy that thinks school teachers (elementary, middle school, HS….etc) are overpayed..I personnally think they are way underpaid for the responsibility they have.

      The main argument of most expats I know is not a cheaper alternative (because private insurance is not always cheaper) but ease of use overseas.

      None of the people I am talking about in my argument would fall into the category of your comment below

      “How about the cases where the rest of Japan is forced to provide a hospital system so that people whose private gap insurance runs out can pay up just their premium and get the care they need? Free Choice Foundation never talks about that situation, because it messes up the storyline.”

      I agree this is an issue but there are many of us that are not a burden on Japan and do carry our own insurance.

      You say – “The allegation that universal health programs are a cost that drive businesses to the Third World, and that those who don’t pay their dues are making society “better off” because they are spending that ill-gotten extra money on other businesses, or even investing it. What they really do is push the cost on to the people who play by the rules.”

      How is the money “ill gotten”? They are still paying for health insurance and are not gaining any additional “ill gotten” money. For most a private insurance policy that provides equal coverage as Japan’s National System will likely cost as much as Japan’s system or even slightly more.

      The company I am talking about is not moving to 3rd world countries but they are moving high paying R&D and Management positions to other locations in Asia. I would hardly consider some of my friends that worked their as people that have earned “ill gotten” money.

      You are suggesting that expats/international school teachers/etc. should keep their health insurance in their home contry and also buy into Japan’s program as well, therefore paying twice? For a short termer that does not make sense to me or seem fair.

      Finally you state, ” Flatly, the whole dodger reasoning gets a little boring.”

      Sorry to bore you…I do not think labels add much to the conversation (which in the past I have found very interesting)…..I would be interested in hearing your idea for a “foreigner mutual aid society”. Is this something you would be in favor of?

      I would be more open to a rule or law that requires those here on a 3 year assignment, for example, to show proof of insurance that meets or exceeds the coverage offered by the Japanese National Health system. This is very fair and reasonable and these people will not be a burden on Japan or the social welfare system.

      A friend of mine is the business manager for a fairly large international school. His case against forcing NJ to join the program (especially teachers and admin at the school) is quite compelling. Interestingly enough almost all of the Japanese employees at the school agree that the international staff should be able to use the program provided by the school as it is much easier to use in their home countries.

      Finally, most people who come to Japan are not aware of this rule. It is not spelled out on the application for the Certificate of Eligibility and no one at immigration tells you about it when you get your visa. No one explained this requirement to me when I received my visa or renewed it several times. I was not even aware it was a law until the issue was brought up earlier this year.

      Now they want you to pay “back premiums” when you do not have coverage…it almost sounds like a bait and switch to me.

      I think if the Japanese Government actually enforced the rules in the first place and everyone was made aware of the rules up front this situation would have never arisen.

      My prediction is we will end up seeing something to the effect that foreigners will need to show proof of insurance to obtain or renew their visa.

      Anyway – Hoofin, in the mean time, I guess we just have to agree to disagree on this issue.

      Have a good one

    5. Kimberly Says:

      I think the bottom line has got to be: it’s a social insurance system. You’re not only paying for your own insurance but also (if you are a healthy, employed person… and most international school teachers are making MORE than the average Japanese salaryman of the same age as far as I know) paying into a system that helps children, the elderly, the handicapped, pregnant women etc. Yes, you lose money if anyone in your family who would fall into those categories lives overseas…. Japanese single people get a raw deal too, I suppose… but there’s always the chance that those people will choose to stay, and may someday have their own children or elderly in-laws, may even (heaven forbid) become elderly and/or disabled themselves. And then the rest of society is pitching in for THEIR health care.

      Not the worst system in the world, IMO.

    6. Hoofin Says:

      Responding to Doug @4:

      I totally agree with you that there are individuals in Japan, and throughout the world, who present unique situations.

      You describe an international school that has some kind of private arrangement. But it’s not clear beyond this what the coverages are and how much people have to pay. Do they get to deduct their premiums off their national tax here, like for kokumin kenko hoken or shakai hoken?

      If they stop teaching in Japan, does the insurance “carry over” back to their home countries? Or do they have to apply for brand new ones?

      Most jurisdictions get to regulate the insurance sold in their areas. Does a regulator in Japan get to see the policy? Set the price?

      I appreciate what you are saying. It’s simply that with the folks who want to do something different than the real hokens, there is usually just one storyline. And it involves private insurance that isn’t signed off on by anyone in the government.

      You’re right, too: more information should be given out at the time someone receives a visa. In fact, kenko hoken registration should be done right then and there, along with nenkin. That way, there are no mistakes. If someone has coverage through their company, then they can later provide proof of insurance from their company. It’s all on one big computer anyway.

    7. Doug Says:

      Howdy Hoofin

      Reading your last post we probably agree more than we disagree. I would imagine if we had a couple of cold beers we would have more in common than not.

      The private insurance in Japan is technically not deductable (although some people do deduct it). In that effect it is not a tax exempt or tax free benefit.

      As for the international school teachers, if they stop teaching in Japan there are some cases (honestly many where insurance will not carry over (in those cases my previous point would be moot) but there are other situations where it will carry on.

      In my specific case my family and I are self insured so it will carry on…I would hate to have to reapply after being here in Japan as some things that have happened would be considred “pre existing conditions”.

      What I would really like to see is the government lay down a rule that is clearly written when we (NJ) apply for a visa. That way we really would not have solid grounds to complain (as I am) and we would know what we are getting into before we start. I think allowing certain conditions for folks choosing another option would probably be reasonable.

      The insurance companies definitely have issues and a system solely reliant on them is certainly far from perfect and maybe not tolerable (there is a profit motive…I am a capitalist..but in civilized countries we should take care of the health of everyone). Basically people should not be denied coverage for pre existing conditions and we certainly can come up with a mechanism to accomplish that.

      I think it would be fair to require a regulator in Japan to review the policy and pricing and then make approvals based on their review (I know my policy would pass muster as I have several Japanese employees…but I cannot speak for all).

      Things are a heck of alot more complicated than they used to be and there are more Japanese not paying into the system as well (I have a friend that is a doctor).

      Your idea of a “foreigner mutual aid society” is interesting to me … it is not a “mainstream” way of thinking and probably would not take hold with the government here in Japan but I think the real solutions in Japan (and my home country..the US) are probably somewhere quite a ways “out of the box”.

      Kimberly…I understand your points but I do not think most international school teachers ar making more than the average Japanese salary man ( I employ a few) after all expenses are factored in.

      I was doing a job for a large Japanese auto company in Nagoya about a year ago. As part of the project I had to ask someone from Canada to come over and help (I am American). We had a great discussion one night at dinner…his point from the Canadian point of view is that “I will help my neighbor when he is sick and some day he will help me”. I am actually for that type of system. Interestingly enough though alot of the Canadian friends I have had in Japan have not paid into the Japanese system but opted for a private insurance supplement when they were here and wanted nothing to do with the Japanese system.

      Anyway things have changed over the years and this is an issue that will have to be addressed in Japan and many other countries as our economic systems continue to change.

      Good blog and a really cool discussion (definitely aided by the Grateful Dead live DVD at Alpine Valley CA circa 1989 my brother in law provided me – check out Jerry on “I know you Rider”).

      Have a great night all!

    8. level3 Says:

      Kimberly @5 says, “paying into a system that helps children, the elderly, the handicapped, pregnant women etc. ”

      While I understand the rationale, and it is usually valid for being part of a society, it is only really valid for LONG-TERM residents and citizens, isn’t it?
      Yes, when you are young, healthy and single, you pay disproportionately high compared to what few benefits you need/receive at the time. BUT it is with the rational expectation that you will likely one day be old, or have kids, or perhaps become disabled (and not get kicked out of the country because you can’t work, and thus get no work visa renewal). The young and able pay “more” now, expecting that they will be a beneficiary one day. Just as in pension systems. (Which is also quite the issue for gaijin.) If you have nearly zero chance of ever becoming a net benficiary, because you won’t be here anymore, there’s nearly zero incentive, little moral obligation, and certainly no economic sense in it. It is not a rational option. I don’t like being forced into irrational options (personally, I am enrolled in NHI).

      If you do feel a moral obligation to support health costs for strangers, give to a charity and leave out the government middleman’s huge chunk.

      Short term residents who are younger and able-bodied will typically never enjoy the flip side of the situation that citizens and long-term residents will in any nationalized health system. It’s analagous to bringing a rental car to the dealer for a tune-up and oil change. Sure, there’s a miniscule chance the mechanic will discover you have a radiator leak and will save you from breaking down on the highway, but it’s nuts to do it. Eespecially if you already have a nice, reasonably-priced auto club membership.

      Or joining a really expensive 3-year term life insurance plan when you’re 22. You can feel good knowing your high premiums will go to other people, but there’s a 99.9% chance that you’re screwing yourself, or, if the government forces you into such a plan, that you’re getting screwed.
      Are these analogies making any sense? 😉

      As for the main issue. OF COURSE private insurers funded the campaign to stop the rule. I’m glad they did. Would we all prefer there never be any well-funded opposition camapigns to government plans? Think about that one long and hard, or imagine a future time when the political party you don’t like is in power and proposing new laws.
      I’d rather have choice than no choice. And that goes both ways, as people like debito have campaigned to get NJ the right to join NHI where it was denied them beacuse they “weren’t citizens”

      The J government could help the issue by offering amnesty to NJ (even if only for a limited period). Normally I’d expect such a policy would be laughably impossible under the old guard. Maybe the DPJ can propose it, they’re giving away money to everyone else anyway. 😉

    9. level3 Says:

      oops, by amnesty, I mean amnesty on back payments.

    10. Hoofin Says:

      Re amnesty, as I posted today, , I think it’s fair to at least ask companies like HealthOne to refund the money for past premiums (up to 2 years).

      Ideally, the government should compel any company doing an insurance business in Japan to forfeit money and pay a fine, since it’s clear there is a lot of misleading and sometimes outright bad behavior going on. As one example, that “National Health Insurance Watch” site, which questions the soundness of the government programs and coaches people on ways to lie to get out of kokumin kenko hoken.

      This is the toughest part: a lot of people want to “come clean” and join the kokumin system or get into their employers’ real ones. But their money is already out the door. Equitably, equitably, I believe they deserve special consideration by the government. Since the Old Regime let the matter get out of hand.

      But people have to organize to demand this. You can’t expect that certain “man of the people” who was so concerned about the insurance welfare of this fellow expats to do this. His clients already got the dough, and don’t want to give it up.

    11. Kimberly Says:

      Re. #8 “While I understand the rationale, and it is usually valid for being part of a society, it is only really valid for LONG-TERM residents and citizens, isn’t it?”

      But where do we draw the line? National Health insurance for the first year is only about 1000-2000 yen a month, go to the dentist a couple of times and you’ll break even, so those who are REALLY here for a very short time won’t lose a lot of money on the deal, and if you never attempt to renew that first one-year visa you’d never have to show that proof of insurance anyway.

      And what if you come, EXPECTING only to stay for 5 years or so… but end up loving it here, or marrying a citizen, or getting a job too good to leave behind, or whatever. On the flipside, I’m sure there are Japanese citizens who have paid into the system while young and then end up moving overseas for whatever reason and never reap the benefits. It’s unfortunate for the individual but it’s a SOCIAL insurance system, and if you are only here for 5 years, you are still a part of the society for those 5 years.

      What you’re suggesting is akin (to me) to someone not paying residence tax because they’re too old for the daycare center and too young for the senior center, never use the city gym or culture center and don’t have a car to drive on those roads that are being maintained. That isn’t the point… those things are THERE if the person CHOOSES to use them. If they choose not to, it’s really not the city’s fault. I’d say thesame applies to health insurance. You can go get your teeth cleaned or get a new prescription for your glasses or get some of that nasty powdered medicine if you’ve got a cold. If you choose NOT to do those things, that’s your prerogative but they’re there if you want or need them.

      It is unbelievable to me that we are here, clamoring for equal rights in so many areas…. and then not wanting equal responsibility. Either you want to be a full and equal member of this society, or you don’t. I understand that some individuals benefit from the system, and others don’t. But by saying “Expats don’t need NHI because they have travel insurance/insurance in their home countries,” you are asking the law to treat Japanese and non-Japanese differently. Or maybe you are just asking it to treat PR and non-PR differently, or three-year visa hodlers and six-month visa holders differently. But if that is okay when we stand to benefit from it, what is there to stop it being okay when a realtor won’t rent to someone if they don’t have a Japanese spouse, or a bank won’t issue a credit card to someone with a good income and perfect credit history because they don’t have PR? If you’re going to fight for equality it has to be EQUALITY, not “equality when it suits us.”

    12. AjiNoTokedai Says:


      Very well put. I couldn’t agree with you more.

    13. Gareth Says:

      I would be happy to have Japanese health insurance BUT if you go with this you are forced to pay for a pension which I personally will never use. If they were to serparate the pension and health insurance I would gladly pay for it.

    14. adamw Says:

      i agree with kimberley,its a non issue and was surprised it was even on here.
      you cant demand equal rights and then decide which bits of society you want to be a part of.

      this whole thing of im only here short term so i dont have any responsibilites is also especially annoying and detrimental to those of us who are trying to be seen as long term residents and treated accordingly.
      i also find the post about “its about free choice” and this “is not what health care legislation in us is like”particularly irksome.
      sorry but nobody cares what the us is doing.the us is the last example anyone should take for health care.the fact that japan is not copying the us system is probably proof that the japanese system is a good one.

    15. Simon Says:

      Kimberly: What AjiNoTokedai said. :-)
      Adamw: Likewise.

    16. Hoofin Says:

      I agree with Kimberly @5 and @11. Couldn’t have said it better myself.

      My won beef, and “motive” I suppose, is I tired of people in Japan doing this: there is a set rule, and then someone decides there should be a different rule, usually involving the NJ community. And only when someone with an angle or the power is getting a benefit out of it.

      I’ve seen this in the job world, I’ve seen this in the housing world. It seems to go on more than it should.

      Yes, everybody might like the chance to bend a rule if it would work to their favor. But here in Japan, it seems, the bending is almost perpendicular and done as sport.

      These are my common themes on my blog: “What is the rule?” “Is this a con?” “What is supposed to be?” Of course, I lighten up too.

      Call me old-fashioned. I like to think I’m very modern, and that certain values of integrity and honesty live on–even to these days!

    17. chuckers Says:

      To Doug @7

      “The private insurance in Japan is technically not deductable (although some people do deduct it).”

      Umm…what? I don’t think I know what you mean by that.

      I pay into private gap insurance in Japan (Tomin Kyousai to cover possible hospital expenses in addition to paying into the Japan National Health Insurance (or rather a commercial carrier provided by company) as a salariman. Every year in November or so, I get little forms from Tomin Kyousai showing how much I have paid into the plan and soon after, my company gives me forms to write down those numbers so that I can get a tax break and some money back in my December paycheque. Same goes for the earthquake insurance I pay on my house.

      How is that “not deductible”?

      And does supply those proof of payment as well? If they don’t, it won’t be deductible because you have to provide proof for it.

      Tomin Kyousai seems to provide better coverage based on cursory glances over both plans. I really ought to do a side by side comparison but I still think Tomin Kyousai is a “better” deal (for various definitions of “better”.)

    18. Hoofin Says:

      Responding to Chuckers @17:

      I am not certain that so-called “Tomin Kyousai” payments are deductible. What the Japanese tax agents give out in English, here: say (on page 8 of the real form and page 11 of the PDF) that there is a deduction for social insurance premiums, of which I don’t think tomin kyousai is included. After all, you can’t deduct actual out-of-pocket medical expenses uttil they reach a certain level, and then only for a certain amount.

      Otherwise, everyone in Japan who has regular medical expenses would buy a 100% coverage Tomin Kyousai policy and use that as a vehicle to get tax-deductible medical payments.

      If the company sends you a slip at the end of the year, that doesn’t mean it’s deductible. Just that they sent you a slip.

      The slip helps make the whole thing “like regular health insurance”.

    19. chuckers Says:


      Reading a little bit further, I came across this:

      There is a life insurance aspect to the “Tomin Kyousai” insurance. That part *is* deductible at the end of the year. The Children and Elders version of the “Tomin Kyousai” is fully deductible.

      That is probably what I was confusing.

    20. Hoofin Says:

      Chuckers @19,

      Do all the “Tomin Kyousai” offer a life insurance policy with the coverage? At HealthOne, it sounds like this is optional, and then only for accidental death:

      Do you think that people would be confused by a policy with a life insurance aspect, thinking they could also deduct the gap insurance portion as well?

    21. AWK Says:

      Who cares how long one wants to stay and what one chose. We should have choice. If you want NHI, cool go for it. I hate it and I want to have private and it should be OK too. I spoke with 2 weeks ago with a woman who wanted to take NHI and they calcluated her 2 years back which was 600,000!!! She told them f**up and renewed her private which is about 100 something thousands a year. She will soon have surgery here and will be 100% covered as other ppl I know. NHI -> hospital = broken account. NHI = no cancer cover, no maternity, no bed and food in hospital, only part of heart operation(case from JTV, Japanese patient won in court) plus every time you visit doctor 30% Thank You

    22. chuckers Says:

      Hoofin @20,

      It does look like all “Tomin Kyousai” (or “Kenmin Kyousai” or “Fumin Kyousai”) offer an inclusive life insurance policy.

      is the starting point for all of the “Kyousai” and just looking at some random sites (Hokkaido, Aomori, Osaka) they all seem to charge the same rate and offer the same sort of coverage.

      While people might get confused as to WHAT they are deducting (as I was) the amount that they can deduct is spelled out quite clearly in the proof of payment forms that are delivered and when they fill out their forms at the end of the year (or during March tax season) they will still only get the deduction they are entitled to which is upto a max of JPY 50,000 per year (or was it JPY 100,000 per year? I don’t have my forms on me to check but it is on there.)

      The “Kyousai” offer health coverage if you are involved in a traffic accidents. HealthOne won’t go anywhere near you if you were driving and involved in an accident.

    23. Hoofin Says:

      Repsponding to AWK @21:

      You tell us there was someone who wanted NHI. You said, she was asked to pay back-enrollment of 600,000 yen a year.

      So that is 300,000 for each year.

      Kokumin kenko hoken has a usual charge of about 8% of taxableincome a year. So 300,000 divided by .08 is 3,750,000 taxable yen a year.

      If anyone knows anything about Japanese taxes, the actual income and the taxable income are different. I happen to know that, 3,750,000 yen taxable income is about 5,800,000 yen gross income a year—and that’s if you don’t do nenkin and you don’t deduct your ersatz total insurance coverage.

      So a woman who made about $60,000 US could not pay the $3,000 a year? But could pay $1,000 to $1,999 a year for gap? Oh, interesting. Tell me another one.

      Then, there’s what NHI covers. I don’t believe NHI won’t cover cancer. I want proof. I think they do cover cancer. I know there is some special rule about maternity, but I also hear that maternity in Japan is one of the cheapest in the developed world. No bed in hospital? Doesn’t make sense. Why should they be paying for food? Do they pay your food when you are well?

      The heart operation I don’t know about, but I have a hard time seeing gap insurance covering something like that. Or any insurance at $1,000 to $1,999 US a year.

      The fact is there are a number of people who just want to cheat the system, and like the eternal cheater, they have every excuse. So keep dreaming them, and good luck.

      The motto of HealthOne is “making insurance affordable”. And sure, it is, when they cap the amount of coverage and can easily force you into “NHI” if you are going to hit the cap.

    24. Ryan Says:

      @ Gareth #13

      It is possible to pay for kokumin hoken without paying for kokumin nenkin; I know several Japanese citizens who do so. (I also know several Japanese citizens who don’t pay into either.) They want the health cover, but don’t trust the pension system. They’re legally supposed to pay into both, but you can definitely choose to pay into one and not the other.

      My main problem with the requirement to join national health in order to extend one’s visa is that is singled out non-Japanese for enforcement. Numerically, far more non-Japanese are not paying into the system, yet there is no comparable mechanism to enforce compliance. Thus, I personally saw the guideline as discriminating again non-Japanese; force the non-Japanese to join but leave the Japanese citizens alone.

    25. Kimberly Says:

      As far as I know NHI covers everything, except obviously optional things like cosmetic surgery, but by “cover” they only mean 70%. So if you were hospitalized because you had cancer, they’d cover 70% of that, just like they cover 70% of going to the doctor for a cough… the main difference of course being that most people can afford to pay for 30% of their cough medicine in cash, most people CANT afford to pay 30% of major surgery.

      Maternity is much better than it was, and depends on which hospital you use. It doesn’t work the same way as illness and injury coverage, but as of spring 2009, 15 pre-natal checkups are “free” (the basics are covered and if you want the 3D ultrasound or if your doctor wants to do more than the bare minimum bloodwork etc you pay the difference) and you get a lump sum of 380,000 yen upon birth, stillbirth, or miscarriage after the first trimester (used to be 350,000). People say this doesn’t cover enough… ot would probably cover ALL of a home birth, or birth at a public hospital with 6-8 people to a room. My first child was born at a fancy private hospital with French dinners and that was 500,000 but I didn’t have to give birth there… “foreign-friendly” (what does that mean? All of my doctors were friendly to me) hospitals will charge an arm and a leg but you don’t have to give birth there if you can’t afford it.

      The food kind of gets me because they MAKE you buy it, three meals a day even if you don’t need them. Hospitals will let people bring in food for you, but they’ll bring the hospital meal too even if you specifically tell them you’re family’s bringing Mosburger or whatever… and charge you for it. So its not optional but not covered… that’s a lousy deal but it’s only about 300 yen a meal or something so unless people are bringing food every day it’s not a big deal.

      Anyway… that still has nothing to do with whether or not we should OBEY THE LAW, but especially regarding maternity it bothers me when people say it’s not covered… from the time thy introduced the 15 free pre-natal checkups and raised the lump sum for birth to the time my son was actually born, I probably spent no more than $500 in hospital fees… it’s not such a raw deal as a lot of foreign residents make it out to be.

    26. Simon Says:

      >AWK Says:
      >Who cares how long one wants to stay and what one chose. We should have choice. If you want >NHI, cool go for it. I hate it and I want to have private and it should be OK too.

      Good for you, mate. Unfortunately _the law_ states that if you reside in Japan you must pay into the public health system. And you =do= have a choice! You can choose to go home and buy your own health insurance in some other country!

    27. Joe Says:

      “NHI -> hospital = broken account. NHI = no cancer cover, no maternity, no bed and food in hospital, only part of heart operation(case from JTV, Japanese patient won in court) plus every time you visit doctor 30% .”

      Every. Single . Assertion. Wrong.

      Well done!

      — I think it’s about time we had sources for both sides of these claims.

    28. Charles Jannuzi Says:

      Yeah, this is one I’m dead-set against. Sure, some very wealthy people might be able to buy coverage from services overseas (usually in UK and Denmark). But I’m a strong advocate of we foreigners fighting for health insurance in the national plans, and for making everyone a part of those systems. Working members paying the fees keeps costs down overall. That is what socializing health care costs is all about. It’s not about gaming the system and getting lots of medical care for others to pay for. For those who say they can get private cover, they should be made to certify that they will not become wards of the state when their private company fails them (even though as a humane socialist I would still say they should not be denied health care if they got some sort of catastrophic illness or injury and their provider failed to provide).

      The other aspect of all this, though, is fighting the national government over this constant neoliberal drive to make people pay for more while getting less coverage. There by the way is one of your sources of deflation–so much money getting spent on stupid supplemental policies (which bandit companies like AIG used to specialilize in).

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