> the government decides the costs of all procedures and medicine
That's a simplification. There are rules for pricing. Drugs in Japan will typically be priced somewhere between EU pricing and US pricing because the PMDA benchmarks across different countries, so Japan drug prices can't be massively cheaper or something. Companies know that very well and on purpose do not let Japan get a first approval for any kind of major drug, as benchmarking vs EU/US will enable them to secure higher prices in Japan. There are whole teams working on optimizing the rollout of drugs worldwide just based on maximizing pricing strategies.
Plus, the article clearly mentions:
> The relatively low incomes of those covered by government insurance make it difficult to raise premiums
The ones who benefit the most from large healtchare payments have close to no income (retired people), so they can't bear any cost at all basically. This means massively increasing premiums for a minority of the population.
Per capita healthcare costs in Japan are still less than half of the costs of the US. Because of the age heavy demographics in Japan, that should be more difficult to handle than the US.