LDP and Ishin resume talks on elderly medical copays, aim to settle by year-end

The Liberal Democratic Party and Nippon Ishin no Kai held working-level talks on social security reform on 21 October, Mainichi Shimbun reported, in a meeting inside the Diet. Nikkei described it as a resumption of talks. The main focus was the review of out-of-pocket payments for elderly medical care. Both Mainichi and Nikkei said the parties have agreed to draw up a reform roadmap by the end of the year, and headlines from Tokyo Shimbun, Nishi-Nippon Shimbun and Yomiuri Shimbun also said a conclusion is to come within the year. [ 2 , 3 , 4 , 5 , 7 ]

Mainichi reported that Ishin demands a principle of 30 percent copays for the elderly, while the LDP has not dropped its cautious stance. It said the focus towards year-end will be whether the parties clarify a path to a principle of 30 percent. Nikkei reported that Ishin also argues for eventually abolishing the outpatient special provision, which caps monthly outpatient costs for people aged 70 and over. Ishin sees the fixed monthly amount as encouraging casual visits to medical institutions and swelling costs that feed into working-age premiums. The LDP is cautious because abolition could lead elderly people to avoid seeing a doctor. [ 4 , 5 ]

After the talks, the LDP's Norihisa Tamura (田村憲久), described by Mainichi as acting policy chief, told reporters, as quoted by Mainichi, that prices and pensions are starting to rise and that he wanted to find the answer to a difficult simultaneous equation. Nikkei quoted him as saying the party could not take responsibility if higher elderly copays left people unable to get by, but that the burden on younger people could not be raised either. Ishin policy chief Satoshi Umemura (梅村聡) said it would be appropriate to discuss public funding, copays and overall control of medical costs together. [ 4 , 5 ]

Nikkei reported that around 40 percent of medical benefit costs for people aged 75 and over is covered by premiums paid by working-age people. Single people with an income of 3.83 million yen or more are treated as having working-age-level income and pay 30 percent. Public money covers about half of benefit costs for those paying 10 or 20 percent, but nothing for those paying 30 percent, so premiums fill the gap. The Federation of Health Insurance Societies estimates this at about 580 billion yen. Nikkei said both parties agree that expanding public funding is needed to reduce working-age premiums, but how to find a stable source has yet to be decided. [ 5 ]

The two parties compiled a 13-item reform outline in July, which Mainichi said was included in the government's economic and fiscal policy guidelines approved by the cabinet that month. For elderly copays it called for a truly fair burden based on ability to pay regardless of age, compared with the working-age principle of 30 percent. On 21 October they agreed to settle the copay issue first and then take up the other 12 items. Nikkei said Ishin has ideas such as keeping 30 percent for people now in their 60s after they turn 70, and adding new tiers of 15 or 25 percent, but the talks did not go into concrete proposals. Mainichi added that the Ministry of Health, Labour and Welfare's social security council panel is also continuing its discussions towards year-end. [ 4 , 5 ]