associations had become insolvent: between the end of the war and the Mission’s report
in 1948, the number of local health associations declined by half and the number of
persons covered by National Health Insurance diminished by a third (SCAP PHW 1951:
18). Consequently, the Mission’s report focused on improvements to the administration
and financing of the existing system. Separate programs for industrial workers,
government employees, and the self-employed would remain, but local administration
would be simplified, central oversight strengthened, and a system of grants established to
provide fiscal stability to the roughly 5,000 local health insurance associations providing
care to a mostly rural population (ibid.: 6-8).
However, opinion among the members of the Social Security Mission was far
from unanimous precisely on the question of comprehensive health insurance reform.
Barkev Sanders, a statistician from the Social Security Administration, submitted a
minority report to SCAP and PHW in November 1947. In it, Sanders wrote,
“The majority of the Mission advises the Japanese against the adoption of
a program at this time which would undertake to provide prepaid medical
service to the whole population. In my opinion this advice is
unwarranted…If, through their elected representatives, the Japanese
people should be ready to enact such a program, I can see no technical or
practical consideration of sufficient moment to make it inadvisable for
them to take that step now” (Sanders 1947).
Sanders went on to dispute the Mission’s various arguments for postponing
comprehensive reform, such as the status of the Japanese economy or the administrative
capacity of the Ministry of Health and Welfare. Instead, Sanders urged SCAP to seize
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Convention