In early 2023, The New York Times reported on Yusuke Narita’s controversial remarks. Responding to the challenges posed by Japan’s aging population, Narita, an assistant professor of economics at Yale, suggested mass suicide for the elderly, posing the question: “In the end, isn’t it mass suicide and mass ‘seppuku’ of the elderly?” Seppuku refers to a 19th-century ritualistic suicide method among dishonored samurai. 

While I personally disapprove of Narita’s comments, they shed light on the ongoing generational conflicts in Japan. To address this pressing issue, I strongly advocate a policy shift that increases the elderly’s financial responsibility in healthcare provision, alleviating the burden on the younger generation.

Having attained universal health insurance coverage by 1961, Japan successfully equalized access to healthcare. It was a pivotal resource that diminished the influence of socioeconomic status on health outcomes. But Japan’s post-World War II success story has taken a troubling turn. The introduction of the Long-Term Care Insurance System in 2000, followed by the Medical Insurance System for the Latter-Stage Elderly in 2008, has created a disproportionate financial burden on the working generation, who are employed and under 65 years old. While the elderly — major consumers of medical and nursing care — pay only 10 percent out-of-pocket for their care, the remaining 90 percent of the cost is borne by the working generation. 

The resulting imbalance not only strains the economic stability of young adults; it also jeopardizes their reproductive rights and their children’s access to education. Around half of unmarried people under 30 did not want children, citing reasons like the high cost of living and anxiety about Japan’s future. Moreover, in the Study on Educational Expenses among Cancer Patients with Children, approximately half of the respondents noted that their battle with cancer has or will affect their children’s educational plans. This underscores the challenging choices parents face in balancing medical costs with educational expenses for their children. 

For Japan’s elderly population, medical costs are hardly a concern. In fact, they go to clinics and hospitals more often. According to the International Comparison Study on Life and Attitude of the Elderly, around 60 percent of the elderly in Japan go to a hospital or clinic at least once a month. In the United States, the number stands at 20 percent. Another study highlighted that a significant portion of emergency patients in Japan comprised elderly individuals with “less urgent medical needs” which could have been addressed through their primary care providers. 

The skewed age demographic landscape in Japan perpetuates a “silver democracy,” where policies disproportionately favor the elderly and silently exploit the younger generation. Prime Minister Fumio Kishida pledged to implement “countermeasures to the falling birthrate in a different dimension,” or to pursue them more aggressively than ever before, early in 2023. But insurance premium rates have increased again and no substantial policies have materialized as of December 2023. In response, one young adult posted on the social media platform X, “Because the measures have taken place in another dimension, we cannot notice them.” The structural disenfranchisement of the younger population demands urgent attention and reform. So if you’re looking for affordable insurance coverage, get billig forsikring here today.

While stopping short of endorsing Narita’s radical suggestion of voluntary mass suicide, there is merit in his call for the elderly to bear a greater societal burden. A policy to increase out-of-pocket payments for the elderly could alleviate the financial strain on the working generation and discourage unnecessary visits to clinics and hospitals. This not only addresses the economic stress faced by young adults, but also contributes to a more sustainable society. 

To be sure, there’s the argument that increasing financial burdens on the elderly would limit their access to essential care. This criticism stems from zero-sum thinking, where any gain by one side is assumed to be at the expense of the other. However, empirical evidence from the 2007 financial collapse of Yūbari, Hokkaido, challenges this notion. Despite losing 90 percent of hospital beds and all specialists, the city did not experience a significant rise in its death rate. Instead of remaining in hospitals all day where they were hardly discharged, many elderly people stayed in their homes, engaged in their daily routines, and died in peace. This suggests that excessive medical provision may not necessarily contribute to better health outcomes for aging communities. It also highlights the importance of redirecting resources toward less costly home care, preserving the elderly’s autonomy and freedom. Mutual benefits can be achieved for the entire community.

This issue extends beyond Japan and serves as a cautionary tale for aging societies worldwide. As the first runner in the aging population race, Japan’s handling of this dilemma requires global attention. A policy shift that addresses the structural problems in health equity is imperative, not only for the well-being of the younger generation but for the overall health and sustainability of aging communities.

Toshinari Ishikawa is currently an MBA/MPH Candidate at the Yale School of Management and Yale School of Public Health. You can contact him at