Things are always more complicated than they appear to be. In the past, I was always very much behind the idea of socialized medicine, but learning a few things about medical care in Japan have cooled my ardor for it over the past year or so. I still think it's better than the situation with private insurance in the U.S., but I think a lot of care should be taken when developing a universal health care system given some of the problems I've been made aware of.
One of my students is married to a doctor and occasionally she offers me some insights into the business of practicing medicine in Japan. For instance, when I mentioned the recent news that yet another pregnant woman was turned away at multiple hospitals, she told me that part of the problem in Japan is that being a specialist, as opposed to a general practitioner (GP) isn't profitable. It costs more to become one and you get less business.
This particular student's mother and husband are both doctors and her mother ran a clinic as a GP which her husband later took over. Running such a clinic allows her husband to operate fast food medicine for people who want their coughs checked and their stomachaches medicated. He spends about 2-5 minutes with each patient and gets a cut of the sales of the prescriptions he makes. For the record, if you visit a Japanese doctor, you will (almost) always be given at least 3 kinds of medicine and one will always be a powder.
The average Japanese person goes to the doctor 14.4 times a year. Most of these visits are with GPs. The only way a person will visit a specialist is if that person is deemed to have a serious enough illness to require added care. This is why being a specialist in a particular area of medicine is less profitable than being a GP. My student further told me that being an obstetrician is the least desirable specialty. If you consider that the birth rate in Japan is low, this also makes sense. Not only are you a specialist, but your client base has been eroding for quite some time. This is one of the reasons why pregnant ladies are finding "no room at the inn" signs up when they are taken to the hospital.
This all relates to socialized medicine because the prices for services are fixed. The only way for a doctor to make more money is through volume rather than quality of care. Being a specialist not only limits your customer base, but it also increases the time you may have to spend with each patient because it's easier and faster to take a temperature and look at a throat then prescribe medicine for coughs than it is to deal with cancer.
A lot of people praise the health care system in Japan and there are good points to it for certain. It is better on the whole than the U.S. system, but it certainly is not perfect. The benefit is that people with common problems who want to be checked regularly can get what they need and health maintenance is affordable. The down side though is that emergency treatment and quality of care are vastly inferior to that in the U.S. Also, the system is certainly overused and abused by people who could just as easily wait out a cold, a headache, or a sore throat and get better on their own, but they don't hesitate to run to the doctor because costs are so low.
If you don't believe the latter statement, I can tell you something that my student wrote in a sociology paper she did for a recently completed college course which surprised me. This particular paper was comparing universal health care to a private system where medical care is treated as a commodity (the current U.S. model). She wrote that if she has a headache, the cost of buying aspirin is higher than going to a doctor so it is more economical to go to the doctor than to buy a bottle of aspirin over the counter. If this sounds absurd to you, then you've never bought a box of aspirin in Japan. Typically, a small box with 10-20 tablets will cost about $6-$8. A visit to the doctor, because only 30% of the tab is paid by the person and the other 70% is picked up by the taxpayers, may cost between $2-$3 with a small additional cost for the prescription. If you're retired, the cost to you is only 10% with the other 90% of the bill being covered by insurance.
The main problem is that the system should somehow reward people for not overusing the system for minor problems or at the very least fail to make it more economical to go to the doctor for every pimple and stubbed toe rather than buying and popping an OTC pill or buying some zit cream. The trick is to not penalize people for regular check-ups and for going when it is necessary such that they stop using the system as it is intended for health maintenance. Right now, Japan doesn't ration health care at all, but I have to believe that there should be some sort of limit on casual visits. Going to the doctor on average more than once a month per capita seems like far more than what is required for health maintenance for an average person.