[opportune]

I don’t like “exceptionalism” arguments in general, and I think “muh homogeneity” is bunk as well, but Japan has a very strong and unique culture that results in outcomes that the rest of the world would not see in the same conditions.

See for example Japan having very few public trash cans but also very low amounts of litter, or even very low wage workers taking pride in their jobs, or Japan having both extremely low unemployment and also low/no wage inflation for very long periods of time. Japanese business culture is one of seeing a duty to the public/consumer in a way that most other capitalist countries do not. They have a cultural aversion to screwing people over and ripping them off, and in working very many extra unbilled hours because it’s expected of them - they’d never have the same healthcare failure modes as in other countries

[dkh]

This. You see this effect to some extent in Switzerland as well. Switzerland, many seem to feel, is "similar enough" to the United States that the existence of its universal healthcare system "seems" like a goal should be similarly within our reach. But this is to discount cultural differences, among other things, and the mindset of the average Swiss is I think quite different than that of the average American.

Some time ago I read 2 different books on healthcare systems, both very detailed, the authors having compared in-depth the many styles of healthcare systems in existence in addition to having relocated for some time to some of the locations to get a personal look. And despite all the complexities involved in such comparisons, both came to the same very basic conclusion: Healthcare systems are a reflection of the mindset of the country's citizens; Americans won't get universal healthcare until the average American believes that other Americans deserve it.

[seanmcdirmid]

The Swiss are big into responsibility: you must buy health insurance because we don’t want to pay for your healthcare when you need it (and lots of other mandatory insurance, eg bike and gun insurance, things that hardly exist in the USA ). They will give subsidies to those that can’t afford premiums, but otherwise you must buy it or else you are being a burden to your neighbors. It isn’t about people “deserving” healthcare than it is forcing people to take responsibility. The market is made even by disallowing group plans; you aren’t allowed to get it as a benefit at work and must pay for your premiums with post tax money.

The USA is weird in comparison: you get immediate healthcare even if you can’t afford it, with everyone else just paying for those who can’t or don’t want insurance. If Americans don’t want universal healthcare because they don’t think some Americans don’t deserve healthcare, they are doing that really wrong.

[dkh]

Interestingly, despite the burden of uninsured/unpaid medical costs, many in America view universal health coverage as antithetical to "forcing people to take responsibility." Given how many people are provided insurance by having (or being married to someone who has) a full-time job (half the population), there are many who feel that not being covered means you don't have a proper job, and perhaps you should, and why should I pay into a system so that you can get coverage easier? This is, of course, completely absurd, but you'll have no trouble finding people who think this way.

In case you're wondering why having to foot the bill for all those uninsured hospital visits doesn't make the "taking responsibility" thing super obvious, it's because most people aren't aware of how much they are paying for it. Like many things here, uncompensated medical care is ultimately paid out of a combination of many different local, state, and federal sources. While we are all paying for it somehow, it is not obvious to an individual how many of their dollars went to it. Therefore, while unfortunate, many believe that an increase in monthly healthcare premiums (they know exactly how many of their dollars go to that) means they will be paying more overall, not the same or less, because they are either unclear on how much of their money is going to the uncompensated costs now, or they don't trust that their tax bills will actually decrease.

We're once again at a place where most Americans believe healthcare coverage should be guaranteed, but are miles apart on who they trust to actually handle it. [1]

[1] https://news.gallup.com/poll/468401/majority-say-gov-ensure-...

[dangus]

Exceptionalism is still a terrible argument.

These examples heavily downplay the public health, safety, and behavior progress the West has made. In the US, litter, graffiti[1], and smoking were all greatly reduced over the past half century. The male smoking rate in America is half of the male smoking rate in Japan.

I think the idea that the Japanese form of capitalism is more benevolent than the rest is also a bit rosy-eyed. Statistics on hours worked aren’t great for Japan. It’s arguably not a good thing that low wage workers are prioritizing work. You say that there’s an aversion to screwing people over but in the same sentence you’re saying that low wage workers are being exploited and convinced to work unbilled hours.

[1] Jusr do an image search for “New York Subway 80s”