Breathing Lessons, the Healthcare Debate Revisited

February 12, 2010

What with all the brouhaha about healthcare in the US, or more precisely, access to affordable healthcare in the US, I would like to share an eye-opening (and nose-opening, for that matter) personal experience with healthcare in Japan. Each year in early spring, as the plum blossoms explode in a riot of snow-white all over Tokyo, my nasal passages go on strike, refusing passage to even the tiniest trickle of life-giving oxygen. Naturally, when this happens, I take to breathing through my mouth, at which point my throat becomes dry as paper, prompting endless coughing which is rendered “productive” (a medical term which apparently means “viscous”) by prodigious post-nasal drip. This is then followed by a sore throat and aching chest muscles. And, just about the time the final blossoms drop from the plum branches, the cherry trees burst forth in a crescendo of, well, cherry pink, and the whole process repeats itself. For four or five weeks, assuming that I seek no treatment, I look like a zombified drug addict with a bad head cold, and feel as though I am on the verge of pneumonia, or at least what I perceive the verge of pneumonia to feel like.

So, last spring, bleary-eyed and sleep-deprived from allergy, I decided to seek the help of a professional. Before departing for the Mysterious East, I had purchased a travel insurance policy, having been duly warned about the ridiculous expense of healthcare in the Rest Of The World. So, with my trusty policy tucked into my backpack, and a list of English speaking doctors in metro Tokyo, I embarked on the search for a primary care physician who could either treat my allergies or refer me to a specialist. “What is a primary care physician?” one of my friends asked. “You know, like a GP,” I replied patiently. Clearly that was not on her program, and she phoned an ear/nose/throat specialist she had visited on occasion as a child. It turned out he was still in business, and so I asked her if I could make an appointment. No, as it turned out. I could not. Because he didn’t take appointments—you simply walked in anytime during his office hours, and he would see you on a first come, first served basis. Wait a minute, you can do a walk-in to see a specialist? What color is the sky in this strange world?

Later that afternoon, with my friend in tow as translator, I turned up at the doctor’s office, filled out some abbreviated paperwork, and hunkered down for the long wait to see the doctor. Except that it wasn’t a long wait at all; it was only about ten minutes. The nurse ushered me into the doctor’s office, and efficiently dealt with the preliminaries: blood pressure, temperature, was I allergic to any medicines (“No, basically all I seem to be allergic to is Japanese flora…”). Moments later the doctor stepped in, and it turned out that he even spoke pretty decent English. “Looks bad,” he opined drily. He stuck a couple of probes a short distance up my nose, and then twiddled some dials on a magical machine that released the elixir of life into my clogged nostrils. Almost immediately, I could breathe again. It was amazing; I want to buy the home version! I was kept on this fine machine for about twenty minutes, during which time the doctor devoted his entire attention to me; no other patients intruded. Then I was directed to a second machine, where more tubes were put into my nose, and a gentle clean aroma, like cool mountain air, wafted its way toward my brain, clearing out passages that had been sealed off for decades, as nearly as I could figure.

All in all, I spent the better part of an hour in the specialist’s inner sanctum, roughly half of it face to face with the good doctor, to the exclusion of anyone else. When it was all over, he handed me prescriptions for four medicines: eye drops for the smoldering orbs, antihistamines for breathing relief, a strong decongestant, and a nose spray to be used just before bedtime. I went to the front office to pay the bill, having liberated about $500 from my bank account, just in case. The office lady went over the bill, clucking and murmuring in Japanese, then pushed the form across the desk to me: 7900 yen. About $70 at the time, and that included all four prescriptions! Really? Really. A visit to a specialist, with no appointment, a half-hour’s face time with the doctor, two breathing treatments, and four prescriptions, all for $70. Oh, and I never even turned it in to the insurance company, so this was the price for a totally uninsured patient!

How can they do it? No idea. Why can’t we do it? Once again, no idea. But one thing that is quite definitely the case: in a city widely regarded as the most expensive on the planet, reasonably priced medical care is available on a moment’s notice, even to the uninsured. How cool is that?

Epilogue: two weeks later, I needed a follow-up visit, so I went back and repeated the whole routine (see above), including refills of the scrips, and this time it cost only 2900 yen ($25), as I had already done the time-consuming (ten minutes) and expensive (fifty bucks) initial paperwork. I didn’t turn that one in to my insurance company either.