The medical fee revision for fiscal 2026 is moving toward a 3.09% increase, which reportedly requires additional funding of approximately 1.5 trillion yen. As the expansion of medical expenditures is frequently discussed in the media, many people likely take a keen interest in this topic. While the Nippon Ishin no Kai, a member of the ruling coalition, advocates for lowering social insurance premiums, under conventional thinking, it seems inevitable that either premiums will rise or the out-of-pocket burden at the counter will increase.
Amidst this focus on health insurance finances, Professor Kazumasa Oguro of Hosei University published a paper through the Tokyo Foundation on November 6, 2025, titled “Introduce a ‘Macroeconomic Slide’ to Medical Expenditures.” As he had previously contributed an article with a similar title to the Nikkei Shimbun, many readers are likely familiar with his stance. The “macroeconomic slide” is a complex system, but put simply, it is an adjustment mechanism intended to keep the total public pension benefits below a certain percentage of nominal GDP. His argument is essentially that a similar mechanism should be applied to medical costs.
Now, I am not an expert on medical management or the realities of the medical field, nor am I well-versed in the administrative intricacies or statistics of public health insurance. However, I believe the direction of this debate is flawed. In my view, this kind of “balancing the books” regarding money is irrelevant.
This is because, as I have stated repeatedly, Japan’s capacity for government bond issuance is immensely large, given that we are a nation with a 30-trillion-yen current account surplus and 500 trillion yen in net foreign assets. A trivial amount like 1.5 trillion yen is a mere rounding error; there is absolutely no problem with using government bonds as a funding source. I would go so far as to say we should simply declare that the public health insurance system is “secure for the next 100 years.” Doing so would eliminate future anxieties, increase consumption among the elderly, and start moving the economy in a positive direction.
The critical issue is not balancing the financial books, but rather the supply system for medical services—specifically, whether a sufficient number of medical service providers (doctors, nurses, etc.) can be secured. For example, if hospitals are overcrowded with elderly patients to the point where medical services do not sufficiently reach workers, the self-employed, or students, then we would be forced to increase the out-of-pocket burden for the elderly to curb usage. The situation likely varies by region. This is a discussion independent of macroeconomic indicators.
Furthermore, what if there are many doctors and nurses who actually want to work in the medical service industry but have exited the labor market due to low wages? If we procure funds through bond issuance and raise wages through treasury disbursements, GDP will increase. This is a textbook example of the government’s role.
The same logic applies to the field of long-term care. What matters is not balancing the books, but whether we can assemble the personnel to provide care services. If there are many license holders available, it is simply a matter of raising their wages via bond issuance.
Since I am not an expert in the medical or long-term care sectors, I will refrain from making definitive pronouncements here. However, I must emphasize that as long as we hold a massive current account surplus and net foreign assets, balancing the financial books is utterly meaningless. The point is whether we can organize the supply system.
Incidentally, Professor Oguro is a former Ministry of Finance official, and I recall him being a fairly rigid advocate of austerity in the past. However, the paper I discussed this time seems relatively moderate. A paper he published on productivity a few years ago was also quite good. I hope he continues to offer various opinions to the world without being bound by his background as a former MoF official.
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