"Hurry Up and Die": Japan & the Cost of Eldercare

Former Japanese PM and current Finance Minister Taro Aso has a novel way of dealing with Japan's increasing health care tab that may not resonate so well with their (obviously aging) electorate:

"Heaven forbid if you are forced to live on when you want to die. I would wake up feeling increasingly bad knowing that [treatment] was all being paid for by the government," he said during a meeting of the national council on social security reforms. "The problem won't be solved unless you let them hurry up and die."

Although the phrasing may be very politically incorrect, Japan's tab for caring for the elderly is pronounced and will become only more so given its demographic profile:

To compound the insult, he referred to elderly patients who are no longer able to feed themselves as "tube people". The health and welfare ministry, he added, was "well aware that it costs several tens of millions of yen" a month to treat a single patient in the final stages of life.

Cost aside, caring for the elderly is a major challenge for Japan's stretched social services. According to a report this week, the number of households receiving welfare, which include family members aged 65 or over, stood at more than 678,000, or about 40% of the total. The country is also tackling a rise in the number of people who die alone, most of whom are elderly. In 2010, 4.6 million elderly people lived alone, and the number who died at home soared 61% between 2003 and 2010, from 1,364 to 2,194, according to the bureau of social welfare and public health in Tokyo.

Inarticulacy aside, I think Aso is on to a number of worthwhile points of debate here: First, what he really is addressing that The Guardian and the rest fail to latch on to is the question of prolonging a person's life when they can no longer continue to function in a meaningful way as "tube people." Especially with so many Japanese elders living alone, who makes the decision to (sorry--this may be my Taro Aso moment for the day) pull the plug? Or, can family members veto the decisions of public physicians to do so? Second, the Asian version of the "greedy seniors" argument is more contentious insofar as we are still obligated to care for them instead of, say, following the rather abhorrent American-style habit of putting Mom and Dad out to pasture in some old folks' home. They raised you--and you put them in an "assisted care" facility in return. Such gratitude. That is, do strained national and household finances erode such values? Third, and this is often overlooked, Japan's fiscal woes are inextricably tied to the longevity of seniors. While advances in health care are well and good, there are fiscal implications for people living longer who no longer contribute economically on the public purse.

There are no easy answers, but fumbling for them is probably better than ignoring these questions altogether like certain North Americans who specialize in hiding their heads in the sand.