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Friday, October 12, 2007

The "Harsh Side"

In response to the debate over SCHIP, this is intended as a comment on attitudes toward social insurance:

Death Reveals Harsh Side of a ‘Model’ in Japan, by Norimitsu Onishi, NY Times: In a thin notebook discovered along with a man’s partly mummified corpse this summer was a detailed account of his last days, recording his hunger pangs, his drop in weight and, above all, his dream of eating a rice ball...

“3 a.m. This human being hasn’t eaten in 10 days but is still alive,” he wrote. “I want to eat rice. I want to eat a rice ball.”

These were ... the last words of ... a 52-year-old urban welfare recipient whose benefits had been cut off. And his case was not the first here.

One man has died in each of the last three years in this city in western Japan, apparently of starvation, after his welfare application was refused or his benefits cut off. Unable to buy food, all three men wasted away for months inside their homes, where their bodies were eventually found. ...

In a way that the words of no living person could, the diary has shown the human costs of the economic transformation in Japan. As a widening income gap has pushed up welfare rolls in recent years, struggling cities like Kitakyushu have been under intense pressure to tighten eligibility.

The fallout from the most recent death has shown just how far the authorities in Kitakyushu went to achieve a flat welfare rate.

Japan has traditionally been hard on welfare recipients, and experts say this city’s practices are common to many other local governments. Applicants are expected to turn to their relatives or use up their savings before getting benefits. Welfare is considered less of an entitlement than a shameful handout.

“Local governments tend to believe that using taxpayer money to help people in need is doing a disservice to citizens,” said Hiroshi Sugimura, a professor specializing in welfare at Hosei University in Tokyo. “To them, those in need are not citizens. Only those who pay taxes are citizens.”

Toshihiko Misaki, head of the city’s welfare section, ... defended the system.

“On the one hand, there are people who’ve done their utmost to remain standing on their own feet,” Mr. Misaki said. “On the other hand, there are those who’ve gotten into trouble because they’ve led idle lives and are now receiving welfare. That’s taxpayers’ money. We get criticized by people who are trying their best, so we have to find the right balance.” ...

Like the diarist, the other two men were sickly, and they seemingly starved after their applications for welfare were rejected. One, 68, was found lying face down in his apartment, where the gas and electricity had been cut off half a year earlier.

The man reportedly told neighbors that he had been denied benefits even though he had prostrated himself before a city official. At his death, he had lost about a third of his weight and had only a few dollars.

The application of the third man, 56, was rejected twice even though a city worker trying to collect an unpaid water bill reported seeing him weak and crawling on his apartment floor. Neighbors who last saw him said his legs had withered to the size of bamboo poles. His mummified corpse was discovered four months after his death.

Between 2000 and 2006, as Japan’s welfare rate grew to 1.18 percent from 0.84 percent, Kitakyusha’s rate grew microscopically — to 1.28 percent from 1.26 percent. That ranked it toward the bottom among major cities even though its economy was doing poorly.

To the central government — which bears 75 percent of welfare costs, began cutting benefits in 2003 and plans to rein in more — that made the city a model.

“We were the so-called honor student,” Mr. Misaki said in an interview.

He added: “Other cities came here to learn from us — how we did things. And the Welfare Ministry also showcased Kitakyushu’s methods.”

Applicants first had to undergo an interview with a welfare official who then decided whether to hand them a one-page application form. In 80 percent of the cases here, applicants could not obtain a form.

After becoming ill and unable to work as a day laborer, another man, 56-year-old Hiroki Nishiyama, tried to apply for benefits twice last year but was told by the same city official to turn to his relatives for help.

“He was arrogant, his way of speaking,” Mr. Nishiyama said. “He was like, ‘What do you want? Go home quickly.’”

Desperate, eating only bread for months, Mr. Nishiyama tried to hang himself. He finally qualified for benefits this year after calling a hot line run by Tateyasu Takaki, a human rights lawyer who helps the needy apply. He hopes to resume working.

“This is, after all, shameful for me,” he said of the $930 he receives monthly.

In response to the deaths of the first two men, the city this spring made applications available inside interview rooms, though it is still expected that the interviewer hands out the form. ... But a policy of removing recipients from the rolls as quickly as possible went unchanged. The diarist, a former taxi driver, qualified last December after receiving diagnoses of diabetes, high blood pressure and a bad liver brought on by alcohol abuse. He lived in a dilapidated row house whose walls and roof had partly collapsed. Electricity and gas had been cut off.

According to city documents, the man’s case worker began pressing him to find a job within weeks of his receiving benefits. Tadashi Inagaki, a professor at the University of Kitakyushu who is leading a committee to investigate the three deaths, said the case worker’s goal, in keeping with the welfare office’s practice, was to get the man off welfare within six months. ...

In his first year as a case worker, [former caseworker] Mr. Fujiyabu recalled, a woman in her 50s, smelling of alcohol, asked for assistance. “I was told by my supervisor, ‘You know, don’t you think someone like that is better off dead?’”

Perhaps out of shame, the man with the diary did not turn to his relatives or neighbors for help, even though he had lived all his life on the block.

“2 a.m. My belly’s empty,” he wrote on May 25, some 45 days after his benefits were cut. “I want to fill my belly with rice balls.”

He added: “Weight is also down from 68 kilograms to 54 kilograms” — from 150 pounds to 119. ...

“Now I’m filled with regret,” said Yoshikazu Okubo, 65, a neighbor who remembered playing with the dead man when they were boys. “If he had just asked me for one drink, I would have said, ‘Sure, drink up, then.’”

But the dead man’s next-door neighbor, Yoshiaki Kita, 72, said the city had handled his case appropriately.

“He may have starved to death, but I believe he reaped what he sowed,” Mr. Kita said. “He was still young, so he could have taken on any job to feed himself.” ...

    Posted by on Friday, October 12, 2007 at 03:15 PM in Economics, Health Care, Social Insurance | Permalink  TrackBack (0)  Comments (29)

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