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Yeah, and the system is deeply in the red in Japan and everyone knows it. Seniors only pay for 10% of the cost and go way more to get medical care than salarymen, so there's no one to pay the bill in the end. It's not sustainable at all. You know that an injection of a typical cancer drug costs like 150 000 JPY and it's once every 2 weeks or so? And you have chronic conditions like Psoriasis or RA where biologic treatments cost more than 100 000 JPY per month/patient, and potentially for dozens of years as patients remain on treatment. This represents massive costs for the healthcare system.


> 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.

It really doesn't seem particularly deep in the red. 284 billion ¥ annual deficit for 32 million people, that would be covered entirely by raising everyone's premiums 750¥ (less than $7) per month.

Your calculation is wrong. That's a deficit for a single year. There is a lot more deficit coming from multiple years piling up.

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.

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