When you start looking at birthing options, you'll notice that most of the hospitals work with mid-wives. In the USA, mid-wives are virtually synonymous with ?natural delivery.? But that's not necessarily so in Japan. In most hospitals, mid-wives work with mothers prior to the delivery (mainly making them comfortable), but doctors delivered all the babies. Many mid-wives have confirmed that doctors monopolize control of the birth process in most situations. The lack of empowerment can really weaken the role (and, in some cases, the abilities) of mid-wives.



The nurses in Japan also work under the doctor's firm authority. Once you check into the hospital, and ask the nurses questions about the birth process, some of the answers could be alarming, because they could completely contradict what you hear from the doctor. Despite their confident show of authority, it does prove how little the nurses are actually empowered.

Through its universal health insurance program, Japanese bureaucrats are charged with the responsibility and power to ensure a ?minimum standard of care for all.? Rules of the game, and in particular what is covered and how doctors get paid, are mainly set by the central government in Tokyo.

Sound familiar? It should, as this is the direction we would be headed in within the U.S. if recent state level universal coverage proposals and federal prescription drug purchases for Medicare beneficiaries are enabled. The Journal article lists many of the downsides to the system, particularly in light of cancer coverage:

? ?Japan saves by requiring less training of doctors and paying them less?

? Japanese ?doctors say they have little time for patients?

? Until recently, many Japanese cancer patients weren't even told that they had the disease?family members ?often felt it was cruel to burden the patient with information? about the cancer diagnosis.

The Journal article further indicates that new classes of chemotherapy drugs and the spread of the Internet have ?spawned a new class of activist cancer patients.? This patient activist movement has grown largely in response to the central government's reluctance to embrace and approve a new class of promising cancer drugs. The article mentions that ?a movement for more drugs and better care culminated in May 2005 when 2,000 patients and family members packed a hall in Osaka for the first national convention of cancer patients.?

Now is the time to consider how this type of system would play out in the United States. People need to ask themselves how they would feel about the state or federal government telling them that a promising new cancer drug is, by law, simply not available to them or their loved one who is dying of cancer.