Health care systems in Japan and Germany provide facts, not theories

Germany and Japan are touted as models for health care reform in the United States, largely because of perceived cost-savings and near-universal insurance coverage. Both systems have been in place longer than U.S. Medicare and Medicaid. Both countries spend less of their gross domestic product on health care than does the U.S. Both are government mandated but at least partially administered through the private sector; in both systems the medical societies have taken on a quasi-governmental role. Both have expanding costs, multiple tiers of care and artificial separation between general and specialty care, short visits because of poor physician reimbursement, and lengthy hospital stays. Despite claims to the contrary, neither system would succeed in the United States.