Seems completely unnecessary though, just wrap that in the taxes and be done with it.

It's about to stop working out very well for Japan. The costs in their system are exploding higher rapidly and putting everything at risk. Their system won't remain intact for much longer at the rate healthcare costs are outpacing economic growth.

Here's the relevant chart: https://i.imgur.com/s97bp9R.jpg

"Health-Care Paradox Threatens to Add to Japan’s Debt Problems"

"Japanese seniors, who enjoy the world’s longest life expectancy, pay as little as 110 yen ($1) out of pocket for specialist appointments. While these visits may help prevent expensive-to-treat diseases, they’re becoming unaffordable in a country where almost 1 in 7 people is 75 years or older, and annual health-care expenditure grew at a pace 40 times faster than the economy from 2000 to 2016."

https://www.bloomberg.com/news/articles/2018-12-13/health-ca...

Japan has a very unique healthcare crises based on it's aging population. The median age in Japan is over 9 years older than the United States and the population is continuing to get older. This crises would be very hard to deal with in any health care system, and it compounded by other pressures of taking care of an older population. Pensions programs are being stressed as the relative number of young workers are decreasing. Additionally the older population is likely to prefer economic policy that reduces inflation (to make pensions stretch further), making the working generations fight harder in international trade.

Japan's healthcare system doing so well given current stresses is a testimony to it's strength.

It's not "very unique". Germany has a similar median age (47.3 vs 47.1) and low inflation rate, and much of Europe is not that far on both.

> pay as little as 110 yen ($1) out of pocket for specialist appointments

In the UK we pay nothing. I think this article is biased by American thinking.

Not strictly true - we do pay a nominal fee for prescription drugs and NHS dentists (although some classes of people, eg students and retired people, are exempt).

Additionally, a lot of long-term care in the UK is provided by charities (Cancer Research, Macmillan, Heart Foundation, etc) which can be expensive but IIRC doesn't appear in the NHS budget.

True enough. I was thinking of specialist Doctors appointments, which are covered. It seems crazy, in a kind of roll your own adventure way, to pay for diagnosis, per specialist.

I sort of imagine conversations going like:

Doctor A: You might have this other nasty thing, but I'd have to send you to doctor B to check. Doctor B will cost you a hundred bugs. Patient: I don't have a spare $100 Doctor A: we'll just hope it isn't that then. Me: WTF?

No prescription fees here in Scotland!