The Decline of Fertility and Its Impact
on the Social Security System In Japan

Takako Sodei, Ph.D.
(Transcript of a speech delivered on April 3, 1997, at Ochanomizu University, Japan)

Introduction

Let me introduce our honored guest this morning. This is Professor Sodei from the Ochanomizu University in Tokyo. Professor Sodei is a professor of gerontology with the Department of Social Science and Family Studies, and that department is located at the university in the School of Human Life and Environmental Science.

We are very honored to have Professor Sodei today. The professor is going to speak with us about changes in social policy in Japan. I hope her comments will be very useful and helpful to you. We are very honored to have you this morning. Thank you so much for coming.

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Good morning. Actually, this is my first visit to Kansas City. I did not know where Kansas City was located. I started my trip in Washington D.C., where I stayed for four days, and then went to Miami to give a lecture there. Miami was actually very hot, but the air-conditioning was so cold that I caught a cold. I am sorry if sometimes it makes it difficult to listen to my lecture.

I did not know where Kansas City was located, and so I looked it up in the map. How many hours does it take from Miami?

I would like to talk about some social changes and some social security reforms in Japan. It is such a broad subject, I would like to focus on long-term care, especially the long-term care of the elderly at home.

If you have any questions, I will answer, if I know the answers. I brought some data and statistics. I will mostly talk about elderly care, but I can also explain about pensions, disability, and such.

I. Socio-Economic Background

First I would like to explain how Japanese society has changed and some of the socio-economic background of social security reform. Now facing population aging, we really need to change our forms of services, such as our social security system. I would like then to explain the present state of elder care in Japan, explain the reform of, or a new, elder care system in Japan proposed by the Ministry of Health and Welfare, and to predict the future of elder care in Japan.

(1) Population Aging

First I would like to explain the social change in Japan, and to begin with, population aging. Population aging is the most serious problem now facing the Japanese. Now the Japanese life expectancy at birth for males is a little over 76, and for women is 83, which is the highest in the world, and still rising.

The proportion of the elderly, which means those 65 years or older, was 7% in 1970; 14% in 1994; and is now 15%, which is lower than most advanced nations. Of course, it is lower than in the United States, but the pace or speed of aging is particularly fast in Japan. The rise in the proportion of the elderly population from 7% to 14% took 115 years in France, 85 years in Sweden, 75 years in the United States, and 45 years in Great Britain, while it took only 24 years in Japan. Recently I found that the rate of aging population growth in Korea or other Asian countries, such as Singapore or Hong Kong, is much greater than in Japan. The next century's aging problem will be quite serious in Asian countries. Also, in China, because of the one-child policy, the growth of aging is quite rapid in that country.

Based on the 1995 National Census, the Institute of Population Problems, Ministry of Health and Welfare, predicted that nearly one out of four will be over 65 in 2015. In 2050, one out of three will be over 65, which is scary, to imagine that one out of three people will be over 65. With population aging, the dependency rate has also been growing. In 1970, nearly 10 working people supported one elderly person, whereas this ratio was 5 to 1 in 1995, and will be 1.7 to 1 in 2050. In the middle of the next century, fewer than two working people will have to support one elderly and, plus, there will be children, so the dependency rate including both children and the elderly will be 1 to 1, or less than 1. The future will be very difficult.

The rapid aging of the Japanese population has been caused by sharp falls in the fertility and mortality rates. Equally, the decline of fertility is a crucial factor in population aging. The total fertility rate, which means the average number of children born to a woman who survives to age 50, was 5.1 in 1925 and 4.5 in 1947. The year 1947 started the baby-boomer generation. Right after World War II, many people suffered from unemployment, homelessness, and starvation. Reducing the number of children was necessary to cope with these difficult conditions. The government tried to introduce birth control and legalized abortion. Abortion was illegal before the war, but it was legalized after the war. Thus the birth rate dropped drastically in the 1950s. The Eugenic Protection Law, which legalized abortion, was enacted in 1948, and the number of legal abortions in 1949 was about 250,000. It reached its peak of more than 1 million in 1955, but it has dropped since then. It was 390,000 in 1993. Of course, there must be many illegal abortions, but in Japan, abortion is rather easily available and very cheap.

The total fertility rate was 2.3 in 1955 and remained a little over two until the middle of the 1970s. Then, after middle of 1970s, the fertility rate dropped again. It was 1.43 in 1995, meaning an average woman would have fewer than two babies. This figure is lower than that of the United States, which is a little over two, and a little higher than that of Italy and Germany. The figure of Italy and Germany is 1.3. We are not sure why. As you may know, Japan, Germany, and Italy were united and fought against the Allied Forces, including the United States. Why did Japan, Germany, and Italy's birth rates drop so drastically? One demographer said it may be a rebellion of women against the patriarchal power, because these three countries have a tradition of a patriarchal family.

The first drop occured, in the 1950s. After the baby-boom, the birth rate dropped suddenly, mainly caused by married couples having fewer children because of financial difficulties. However, the second drop, after the middle of the 1970s, has been caused by a decline in the marriage rate among young people. In 1980, about one half of men and a quarter of women in their late twenties were unmarried. But in 1995, two-thirds of men and one-half of women in their late twenties were unmarried. Twenty years ago, 25 years old of age was the deadline for women to get married. Thus, women over 25 years old were often called "left over Christmas cake," which means nobody wants to buy it. Since 25 years was the deadline for women, they were in a hurry to get married before they reached 25.

Now we say the deadline is around 30. We call it "noodle of the New Year's Eve." In Japan, traditionally we celebrate New Year's Eve eating Japanese noodles, not spaghetti. The Japanese noodle has to be eaten as soon as it is cooked. If it stays longer, it spoils the taste. New Year's Eve is on December 31, and women over 31 would be "spoiled." Of course, this is a kind of sexual harassment. Yesterday I met a Japanese gentleman, and he was serious when he said that he had to be very careful when he talks to women. I understand that in this country, it is very difficult for Japanese men. Fortunately or unfortunately, Japan is a still a male chauvinistic country. Now we put 30 or 31 as the deadline for women to get married. However, there is no limit for men. It is discrimination, I think.

There are not many who stay single for life, but many postpone marriage in order to enjoy single life. When society allowed women little capability for economic independence, marriage meant a lifetime career. Recently, however, the career opportunities for women have increased together with their opportunities for hobbies, sports, and travel abroad, resulting in a large number of women choosing to delay marriage. In addition to that, the opportunities for arranged marriages, which were common before the war, declined, together with the number of persons who help young people to find a mate. If you saw the musical or movie "Fiddler on the Roof," there was a scene saying young girls should get married by arrangement. Understanding the role of elders, in any society, there were many so called "go-betweens," but in Japan now there are not too many who try to take the role of "go-between." So the chances are getting fewer and fewer. Moreover, the new norm of love marriages causes free competition in the marriage market, and those who lack ability to compete are excluded from the competition as well as the opportunities for marriage.

(2) Changes in the Family

Now I would like to talk about changes in the family.

Many seem to believe that the Japanese elderly still live with their children and grandchildren. However, the ratio has been decreasing steadily. The proportion of shared living arrangements was almost 90% in 1960, 80% in 1970, 70% in 1980, and 60% in 1990. Now it is a little over 50%, gradually declining year by year. Of those living with their children, the majority used to live with their first son's family, but those living with their daughter's family and those living with unmarried children have been increasing. For those living with unmarried children, the children are usually the breadwinners. Thus, when elderly parents need care, they face difficulties in accommodating both care and work. Older married couples and single-person households have been increasing, also. Of single-person households, the gender ratio is nearly two males to eight females. More female elderly are living alone.

The drop in the proportion of shared living arrangements has been caused by first, a decrease in the number of children per family; second, an increase in geographical mobility from rural to urban areas (especially in the 1960s, the period characterized by technological innovation and high economic growth, many young people moved from rural areas to urban areas, and they got married in urban areas, so their old parents were left behind); and third, changes in attitudes toward living arrangements.

The traditional Japanese family was a patrilineal and patriarchal stem family, in which the first son lived with his parents. The first son has the right to inherit the entire family property. In turn, he was obliged to support his parents financially as well as physically when they became old and weak. He (actually his wife) was obliged to take the role of caregiver in the spirit of filial piety. The wife had to take care of them, and she had to be very obedient to them, be very nice and very kind to them. After World War II, however, the patriarchal stem family system changed to the more egalitarian conjugal family system under the guidance of GHQ (General Headquarters Office, headed by General MacArthur). After the war, American military operations took over the country, Japan, and they had control. According to the revised civil code, not only the first son but also other children, regardless of their sex or birth order, have equal right to inherit family property, as well as an equal obligation to support elderly parents.

In addition to institutional changes after the war, industrialization, modernization, urbanization, and the influence of American democracy changed people's attitudes from an extended-family orientation to a nuclear-family orientation. Firstly, the younger generation preferred more privacy and chose to live separately from their parents after they got married. Later, the older generation has voluntarily come to choose separate living arrangements when both husband and wife are in good health. However, when they become sick or one dies, they prefer to live with their children. Though shared living arrangements have been decreasing, the number of elderly living close to their children is increasing. They seem to prefer "intimacy at a distance," rather than interfering with each other.

(3) Changing Roles and Attitudes of Women

Next I would like to talk about the changing roles and attitudes of women.

Today nearly 90% of caregivers at home are females. If the frail elderly is male, his wife is the primary caregiver, while if the frail elderly is female, her daughter-in-law or daughter takes on the role of caregiver. Most caregivers are middle- aged housewives. However, greater labor force participation by middle-aged married women and changes in their attitudes toward the family and the elderly make home-care difficult.

Our female labor force used to be characterized as young and single, but it is now characterized as middle-aged and married. The proportion of married females to total female employees was nearly one-third in 1962, a little over a half in 1975, and nearly two-thirds now. Now two-thirds of employed women are married. This figure includes divorcees and widows. Those over 40 years old accounted for less than one-third in 1970, but reached one-half now. Among women aged 15 years and over, the proportion of the employed was 30% and that of full-time homemakers was 40% in 1975, but both figures were 32% in 1984, and since then the proportion of the employed has exceeded that of full-time homemakers. Now most of the middle-aged married women are employed.

Many middle-aged women work as part-time workers. The Bureau of Statistics, Management and Coordination Agency, defines part-time workers as those who work no more than 35 hours a week regardless of their status or their term of employment. The number of female part-time employees was 1.3 million in 1970, 2.6 million in 1980, and 5 million in 1990. Of female part-time workers, one-third were aged between 35 and 44, one-third were between 45 and 54; 15% were over 55. So most of the part-time workers are over 35.

Middle-aged married women prefer to work part-time because they wish to work without cutting back their household duties, and they want to be home before the children come back from school. Moreover, if their annual income does not exceed 1,030,000 yen, which is a little less than 10,000 U.S. dollars, they do not have to pay any tax; they can be covered by their husband's health insurance and can receive their old-age basic pension without contributing to the system. When their husband dies, they will receive two-thirds of their husband's old-age pension as their survivor's benefit, which often is higher than the old-age pension for working women because of the income difference between men and women. The average income difference between men and women is one-half, which is worse than that of the U.S. Moreover, their husbands can qualify for a special tax deduction for full-time homemakers and can also receive a spouse allowance from their employers. The number of such women is estimated to be a little over 12 million now. Many working women are trying to abolish this type of system, not because they feel it to be unfair, but because if these married women pay their premium, it would solve the financial difficulties of the social security system, or at least postpone the arrival of higher premiums and lower benefits. Many Japanese housewives are enjoying this privilege as full-time homemakers. Actually they are not full-time homemakers, but called full-time homemakers if they do not earn much money.

II. Present Status of Elder Care in Japan

Next I would like to explain the present status of elder care in Japan.

(1) Care Recipients

First, the care recipients.

In advanced industrial societies, women live longer than men. Thus, there are more women in the older population. Because women live longer than men, they have a higher risk of becoming senile or bedridden. Additionally, women usually marry men older than themselves, and their chances of being institutionalized are higher than men, whose spouses generally outlive them.

Many people, including the Japanese themselves, still believe that the Japanese elderly are taken care of by the family at home, but today more bedridden elders are in institutions. In the United States, among the elderly who needed long- term care, 80% were at home, while in Japan the ratio of bedridden elders at home is 40%, in nursing homes 20%, and in hospitals 40%. Among the bedridden elderly in Japan, about 60% are in institutions. However, nearly two-thirds of the senile elders are at home. Taking care of senile elders is much more difficult than that of the bedridden elders, thus, many nursing homes do not accept severely demented patients.

Why are there so many older people in institutions, especially in hospitals? First of all, the financial burden to the family is less than home care and nursing home care. Actually, the hospital care costs about 500,000 yen, a little less than 5,000 U.S. dollars, a month. Nursing home care costs about 300,000 yen, a little less than 3,000 U.S. dollars, a month, and home care costs less than 100,000 yen, a little less than 1,000 U.S. dollars, a month. This figure does not include caregivers' labor costs. If the labor cost of caregivers is not counted, home care is the cheapest. However, the cost of hospital care is covered by the national health insurance, and costs of nursing home care are subsidized by the government (central and local). The average payment for hospital care is about 30,000 yen, a little less than 300 U.S. dollars, a month, and that for nursing home care is about 40,000 yen, a little less than 400 U.S. dollars, a month. Nursing home care used to be free, but now the elderly and their families have to pay a certain amount in accordance with their income. If the elderly receive only the welfare pension for the elderly, (which means pensions for those who were too old to contribute to the system when the national pension scheme was started in 1961) and have no family to depend on, they are not required to pay. If the elderly lived alone before they were institutionalized, often children are not asked to pay for their parents. Thus, obedient children who live with their parents have to bear more financial burden. For instance, my mother is now in a nursing home, and my elder brother is paying for her care because he used to live with my mother before she moved to the nursing home.

Compared with institutional care, the financial, as well as the physical and psychological, burden of home care is much heavier. If we include the health care cost for caregivers and the opportunity cost of caregivers who cannot work due to elder care responsibilities, the gap between institutional care and home care expands further.

The Ministry of Health and Welfare has set the ceiling for government subsidies for elderly patients so that after a three-month hospital stay, the hospitals receive a flat rate regardless of treatment. However, there is always a way around such measures. After three months, elderly patients are transferred to the next hospital and stay three more months. Then they are transferred to another hospital. This process is repeated again and again. Now the Ministry of Health and Welfare is trying to reform the whole medical system drastically so that the ever-increasing medical expenditures will be reduced. Otherwise, the same process is repeated again and again, and the government will lose a big amount of money.

Secondly, many Japanese still feel that it is shameful to send elderly parents or parents-in-law to a nursing home. Generally speaking, hospital care is inferior in terms of living conditions. Usually rooms are much smaller in hospitals than in nursing homes. Moreover, many hospitals use restraints such as overmedication and binding. However, many people are still prejudiced against nursing homes because before the 1963 Welfare Law for the Aged, they used to be institutions for poor elders with no family. Many Japanese people still think it is a place where only those poor elderly go.

Thirdly, although people have gradually come to understand what a nursing home is and want to send their parents or parents-in-law there, there are not enough nursing homes. The nursing home shortage is crucial in urban areas, where the cost of land is quite expensive, and sometimes there is a two-year waiting list.

Fourthly, housing shortages are another reason why so many old people cannot stay at home. If they are living in a three-generation household, they often have to vacate their room to provide a study room for grandchildren. In Japan, the competition for entrance examinations is quite tough. They have to start studying at an early age. Getting into college used to be difficult. Now they have to start earlier, sometimes in elementary school and also sometimes before elementary school or before kindergarten. There are special preparatory schools for kindergartens. Children have to study, study, and study, so they need their own rooms. In addition to the housing shortage, poor housing conditions make it difficult for the impaired elderly to stay at home. Because Japanese houses have a lot of barriers, such as stairs and tatami floors (which are very slippery), it is dangerous for the impaired elderly.

Fifth, poor community service is also an important factor which makes it difficult for old people to stay at home. Although the Ministry of Health and Welfare promises to subsidize the salary of home helpers or home attendants, local governments are expected to be responsible for half of the salary, and some have little financial funds. In some areas, also, it is not so easy to find persons to work as home attendants. There are many depopulated villages where nearly half of the residents are over 65. In those areas, it is very difficult to find a person to work to care for elderly people.

(2) Caregivers

Next is about caregivers.

As is common all over the world, caring for babies, the sick, the handicapped, and the frail elderly is almost always the role of women. In contrast to most of the Western nations, where daughters are usually primary caregivers, in Japan daughters-in-law are usually the primary caregivers. This is common in countries with the tradition of a patrilineal stem family system, like Korea and Taiwan.

Although daughters-in-law still form the core of caregivers, the number who want to be cared for by daughters-in-law in their old age has been decreasing. Many women now want to be cared for by their husbands, though it seems to be difficult. With increase in labor force participation by middle-aged married women, more women face difficulties in accommodating both work and care- giving. The Survey of Working Caregivers by the Ministry of Labor in 1991 shows that, of 1,400 full-time employees who had care recipients in their family for the previous three years, 44% were females and 56% were males. Although 43% of females who had care recipients were primary caregivers, only 7% of males in the same situation were primary caregivers. And 64% of females and 27% of males took leave, with average length being 138 days. Apparently women were more affected by providing care than men.

Now most of the big firms have the family care leave system with no salary. I think you have the same system in this country. It is mostly women who take the family care leave. The family care leave law was enacted in June 1996, but the application of the law to every firm is postponed until 1999 because it will burden small firms with weak financial bases too much in such a financially difficult time.

III. A New Elder Care System

I will now explain a new elder care system, a reform of the elder care system.

The Ministry of Health and Welfare has been trying to establish a new elder care system in order to overcome the difficulties each family as well as the society will face in the society with fewer children. It is very difficult for each family, or society as a whole, to take care of the elderly. Until the middle of the 1980s, most services to the elderly were free. For instance, the cost of a hospital stay for people over 70 used to be free, but became 400 yen a day in 1987 and 800 yen in 1995. But I think it is still cheap, only about 7 U.S. dollars. Meals in hospitals used to be free, but 600 yen a day has been charged since 1994. It is still cheap, only about 5 U.S. dollars. The new elder care system asks the elderly to be more independent physically, psychologically, and financially, which means that they are asked to pay for medical and welfare services. The sole purpose is to establish generational equity so that the younger generation will not have to suffer burdens to support the older generation.

Everyone is likely to face the question of elder care in the aged society, and once it happens, no one knows how long it will last and how much it will cost. The elderly person may die tomorrow, or he may live for more than 10 years. (I know of one case. She is my friend. She took care of her mother for 26 years. It is amazing. She said she could do it because it was her mother. She said she might have given up if it was her mother-in-law. She was lucky that her daughter took care of her; 26 years is too long.) Different from child care, the unpredictability of elder care makes the burden much heavier. In order to share such a burden socially, the Ministry of Health and Welfare is planning to introduce a new social insurance system for elder care. They call it "public insurance for elder care." The idea came from a German system started last year, but it is not the same. There is no government fund in the German system, but in Japan, a half of our system will be funded by both central and local governments. The premium of those over 65 will automatically be deducted from their pension, and that of those between 40 and 64 will be deducted from their salary, together with the premium for health care insurance. You might wonder why the age range between 40 and 64 was chosen. At the beginning , they planned for 20 to 64, but the plan got a lot of criticism. Young people may not want to pay premiums for elder care, because elder care for them is a long time away. The Ministry of Health and Welfare changed the age. Those over 65 will be qualified for such in-home services as visiting nurses and home attendants, as well as day-care services, when they are in need. (The amount of services will be based on their physical conditions judged by a special committee.) But those between 40 and 64 will be qualified only when their symptoms are solely caused by aging, like stroke, dementia, and osteoporosis. But it may be a problem: Nobody knows if the specific problem or the specific symptom is caused by aging or not. When this system starts, there may be some confusion or forgery. The recipients will pay 10% of the cost of services they receive.

According to the Ministry of Health and Welfare, local governments will be responsible to manage the whole system, but small towns and villages are rather reluctant to take responsibility because of the shortage of funds and staff. The employers' association is also strongly against the system, because employers have to be responsible for a half of the premiums of their employees, which will be a burden in this financially difficult time. The employers are responsible for so much. For instance, they are now paying a half of the premiums for pensions and paying some portion of child allowance. Also, companies have to pay penalties if they do not hire a certain percentage of elderly workers (over 55) and handicapped. Since employers are paying so much, they are saying, "No! No! No more!" They are refusing to join this system.

The Ministry of Health and Welfare hoped that a law for the social insurance for elder care would be enacted last year, but it failed. It will take more time until a new system is introduced, though many admit something should be done in order to solve the problem of elder care. The Ministry of Health and Welfare, is hoping to start this system in the year of 2000, but nobody knows. Many people are still against it or discussing this problem.

IV. The Future of Elder Care in Japan

Lastly I will explain about the future of elder care in Japan.

Looking over the past and present state of the elder care system in Japan, the following characteristics should be mentioned:

(1) From Institutional to Home Care

First, from institutional care to home care.

Home care has been stressed, not because of financial reasons, but because of welfare for the elderly themselves. The government has just recently realized that housing is an important factor in improving home care. If housing conditions are poor, rehabilitation cannot be effective. Many elderly patients just go back and forth between the hospital and their home because their conditions deteriorate when they stay at home with so many barriers. Thus, both national and local governments are now trying to put more money into constructing or renovating housing for the elderly.

In addition to housing, living environments for the elderly are full of barriers. Even if the elderly can move in a wheelchair, Japanese causeways are not safe because of the many steps and holes, and many roads are without sidewalks. In addition to improving the quality and quantity of home care services, living conditions should be improved in order to promote the well-being of the elderly.

(2) More Independence of the Elderly

Second, more independence of the elderly.

Both home care services and institutional services were free when they began. However, payments for services have been required since the 1980s because (1) both national and local governments suffered from financial difficulties, (2) the needs for services expanded with population aging, and (3) the financial ability of the elderly improved as a result of higher pension benefits.

In addition to the requirements of financial independence of the elderly in the 1980s, psychological independence is required in the 1990s. In the new elder care system, decision-making by the elderly themselves is emphasized. From the outset, elder care programs, as well as other welfare programs in Japan, were created from a supply side perspective; that is, the Ministry of Health and Welfare ordered local governments; and welfare agencies of local governments decided to whom, how much, how long, and in what way services should be provided. With the expansion of service recipients, the requirements on the demand side should be respected more in return for payment for services.

Independence of the elderly is required not only for their well-being, but also for alleviating the burden on their families, as well as the younger generation. Securing equity between generations is the most important purpose of social security reform in order to keep the younger generation in the system. (Now, I think it is the same in this country, many young people saying that there will be no pension when they get old. We have to reform the social security system so that the younger generation will not lose their hope for their future.)

(3) More Independence of Local Governments

Third, more independence of local governments.

Different from the United States, Japan has been a nation with a strong centralized government. Although GHQ (headed by General MacArthur) tried to decentralize, it did not work. Both decision-making power and money were concentrated in the national government, which has deprived local governments of the ability for self-management. In 1989 the Ministry of Health and Welfare asked local governments to take responsibility for health and welfare services for the elderly. Each local government was asked to make its own plan for promoting health and welfare services to the elderly by the end of fiscal 1993. Each local government organized a special committee consisting of government bureaucrats; specialists, such as doctors, nurses, and journalists; and community representatives. In addition to that, a special committee to promote decentralization of the governmental power was started in 1995, two years ago. (I happened to be a member of this Special Committee for Daily Life and Welfare.) The committee plans to establish a basic rule of decentralization in areas related to all ministries. Decentralization of government authority seems to be related to the deregulation of governmental control over economic activities, now that the Japanese government is being pressured by the U.S. government. Through these measures, a nation with centralized power will eventually come to an end, I hope.

(4) More Privatization in Elder Care

Fourth, more privatization in elder care.

Emphasis on contractual relationships, rather than orders by governmental authorities, will inevitably exclude bureaucratic intervention. Today the so- called "silver service market," which aims at selling such goods and services for promoting the health and welfare of the elderly as wheelchairs, lifts, special beds for nursing care, home care services, and retirement homes, is expanding. Some local governments entrust the private sector with home care because they are more effective and cheaper than services provided by government employees. Recently there was a study comparing the cost of services between the public sector and private sectors. They found that the private sector is cheaper. In the private sector, the cost is one-third. Although most services are still expensive and not many people can afford them, costs will be reduced if a new social insurance can be used to buy such services. Needless to say, for those who are unable to afford them, governmental assistance is necessary.

(5) From Household to Individual

Lastly, from household to individual.

In Japan the unit of social services is the household rather than the individual. Therefore, eligibility for receiving services or payments for services is based on household income. In the case of elder care, their children's family income is counted. So it happens that a daughter with no income would be asked to pay for her mother in a nursing home because her husband is earning handsome salary. Sometimes this causes some conflict between man and wife. The new elder care system clearly mentions that everyone can receive service whenever one needs it regardless of one's income or living arrangements. In order to achieve this ideal (this is an ideal), the service unit should change from the household to the individual.

If the individual is to be the unit of the social security system as well as the tax system, the elderly should contribute to the system in accordance with their income, even if they are receiving pension benefits. Also, full-time homemakers should also contribute to the system if they earn any money. This is my opinion, as well as that of many professional women in Japan. However, many male economists and older male politicians are still against this idea. Some of them still insist that the family should be the unit of the society. We have to evaluate important issues, such as the so-called family values in this country. Some older politicians and elder scholars are still hoping that the traditional Japanese family will be back again. I think that is impossible.

Questions and Answers

Q: In the old system, you talked about how the eldest son and his family received the property and he is responsible for taking care of the elderly. In the new program, does he still get all the property, or does it get to be divided between all of the children in the family Does the family get to decide that, or does the government decide that?

A: The family decides. It's divided equally among the children, as a rule, but there are some conditions. Some of the children may have special contributions to increase the family property. He will receive a little more than others' share. Basically, it is divided among them equally.

Q: Does the Japanese medical care system keep terminally ill patients on life support?

A: We do not have the law to allow discontinuing resuscitation. Thus, care for terminally ill patients costs a lot. That is why our government is trying to reform our medical system. It costs too much to just keep on going for elderly persons, to stay in hospital, and, especially when they are dying, it costs too much money. Now we are discussing it, but it is quite difficult to reach consensus about when to stop treatment.

Q: Would you repeat the difference between pension for widows and working women? Is it true that widows can receive more than working women?

A: A surviving widow receives two-thirds of the husband's pension. A working woman can receive her own pension. Average pension of working women is about one-half that of a man, which is less than a survivor's pension a widow gets. When a husband dies, the wife can choose whether to receive her own pension or two-thirds of the husband's pension. Usually two-thirds of the husband pension is higher, and the wife gives up her own pension. We protect married women more than single women.

Q: You mentioned the competition to enter universities. I am curious to know why? Is that due to lack of space? Isn't there enough openings? Why is that, especially if the birth rate is decreasing?

A: Of course, we have a lot of universities if you don't care which university you go to. In Japan, if you want to be an employee at a big company or in a prestigious company, or have a job in central government, you have to graduate from a certain university, like Harvard or Yale. If you don't care, there are many openings for junior colleges and community colleges. If you want to go to a specific university, the competition is quite tough. The most difficult university to enter is Tokyo University, and the next is Kyoto University. It is very tough. Children have to start very early. My university has a very prestigious kindergarten. My school is very old, more than one hundred years old. We have from kindergarten to university. The most difficult part to get in is the kindergarten. Once you get in to the kindergarten, you can go up to the university. There is a special preparatory school to get into the kindergarten.

Q: What type of test for kindergarten?

A: They will be asked certain questions and just play, with some toys, find same shapes, colors, etc. They are just like games, but they are special tests.

Q: Japan and the U.S. seem to have similar social problems. Are there any?

A: Most Japanese women are still very family-oriented. They would like to stay at home, or they do not want to disturb their family life because of their employment. They get so much benefit for being so-called full-time homemakers. In Japan, the most difficult situation is for single women. In Japan, usually in the government sector, women are promoted, and the salary goes up. However, in the private sector, women's salaries stop rising at 30 years old or 35 years old, and they do not go up much higher after that. Of course, a single woman does not get the full-time homemaker tax deduction or allowance. In Japan, as I told you, still they protect full-time homemakers.

Q: Would you explain the status of single women and single mothers?

A: The percentage of unmarried mothers is about 1%. Only about one percent of babies are born from single mothers because of social pressure. We have a funny system, which I should not say is funny. In Japan, family registration is very important. If you do not get married legally, which means your marriage is not registered in the family registration, you will be deprived of so many previleges, including the special tax deduction. One would lose so many privileges. Therefore many women do not want to be a single mother.

Q: Who takes care of people such as the mentally ill or homeless?

A: The government takes care of them. Usually the local government.

Q: Are they institutionalized or put in residential care?

A: Usually they are put in a nursing home. The cost is paid usually by the local government. No specific institution is defined for such cases.

Q: How is the amount of the contribution to the public pension plan determined? Is the premium for the insurance based on the salary?

A: They have not decided yet. In Germany it is 1%. Our government has not decided yet.

Q: Does this pension go to the individual account?

A: I do not know. They have not started yet. It may be individual.

Q: Is the tax rate high in Japan?

A: I think they are about the same. The social security premium is combined. The percentages for the U.S. and Japan are about the same.

We have to thank your people. We did not have this system before. The U.S. Occupation Forces introduced the social security system to Japan and liberalized the country. Before World War II, women could not get higher education and we did not have any pensions or health insurance. American people tried what they could not do in the U.S. Now we have a very good system, similar to the Canadian system. We must thank your people. For instance, ERA. According to our constitution, men and women are equal under the law. At the beginning, there was some confusion over men and women being equal under the law. One of the troubles we are facing is due to being too good. The government is paying too much. Just like Santa Claus. For people over 70, everything used to be free. Now our government is facing a huge amount of debt. That is why they want to reform. Actually the national health insurance works well as long as the economy is good and as long as population is not aged.

Q: Has the feeling of respect or the attitude toward the elderly people been changing?

A: Recently there was an interesting study conducted by the Youth Bureau of the Management and Constitution Agency in Japan. They asked a question to youngsters aged 18 to 24: "Would you take care of your parents when they become old and weak?" The percentage of "yes" in Japan was lower than that of the U.S. It was unbelievable. Many people were shocked. The highest was Korea. I can understand that. In Korea, more than 70% of people said they would take care of the elderly. I do not remember the figure, but the lowest was Sweden. I can understand that, too, because they have a quite good social service system. The second lowest was Japan. Japanese young people are not willing to take care of the elderly, but many of them answered, "It depends," so they are very smart about it. They are not willing to. Many people said this is maybe because we have so few children, usually one or two children per family, and they are spoiled. They depend so much on parents. They do not want to try by themselves. They think everything comes from heaven. This made many people worried. They spend so much money on children. In Japan, when they send their child to college or university, the family pays one-quarter to one-half of their household income. This type of things happens only in Japan and Korea. In Korea, it is more extreme. Sometimes they sell their house in order to send their child to school. In Japan, children have not been taught anything about social security and aging until recently. Now they are learning how important this issue is. Maybe, I hope, the attitude will change.

Q: Is there any racial problem in Japan?

A: Basically our government does not allow too many immigrants. There are some. We have many Korean people. During wartime, we took them and brought them to Japan for cheap labor. Now their second generation, third generation, and maybe even fourth generation are living there. Sometimes there are some conflicts among teenagers, because they do not know the history; they may say, "Why don't you go back to Korea?" It is not their fault. They did not want to come to Japan. Sometimes this type of things happens, but not so often.

Q: Do they consider that more immigrants to Japan in the future will contribute to the social security program to keep it running?

A: Basically we accept only foreign immigrants who are specialists. Manual labor people can not get into Japan. There are some disputes over the future labor shortages, especially the future shortage of manpower in caring for the elderly. Some young male economists suggested to get workers from other Asian countries. One guy tried to bring nurses from China because the nurse shortage is very critical. It is not so difficult to find home attendants, because everyone can be a home attendant, a homemaker can be one. However, nurses must be trained and need special education. We don't have enough nurses, so one guy tried to import nurses from China. There was a group discussing this program with the Ministry of Health and Welfare. The Ministry of Health and Welfare said, "Maybe it is a good idea. How about 3,000 or 30,000?" The figure got bigger. Finally, China mentioned, "How about 3 million? We will send 3 million girls to Japan." Then, they said, "No! No! We do not need them." Actually, it is not legal, it is illegal, but some nursing homes or hospitals introduced Chinese or Filipino nurses and girls. We call them "trainees," and they stay for six months to one year, and then they go back. They cannot stay for a long term.

In addition to my teaching, I am a member of a feminist group called the "Women's Group for Better Aging Society," just like the "Older Women's League" in the U.S. We organized this 15 years ago, and I am a founding member. We say, "Why don't men participate in caregiving to solve the problem? Now, many Japanese retired men don't find anything to do. They spent a lot of time just playing golf or fishing or doing nothing. We suggested retired persons can be good home attendants.

Q: Did you say the chances of women over 30 getting married are very low? Are these women single women in work force, like an unprivileged class? There should be a lot of them.

A: Yes, but now it may be changing. A girl has a chance until 35. One of my subjects is elder workers. One time, an employment agency operated by the government said they set up a special section for older workers because they have a more difficult time finding a job. I visited there and asked the guy at the office several questions. I asked, "How old are the older workers?" He was laughing, looking at me, and said, "After 35 years is old for women. That's old for women. For men it is after 55 years old. " They consider women over 35 years old as old.

Q: What is the divorce rate?

A: It is not so high. Compared to the U.S., it is about one-third, but it is increasing. Especially among middle-aged women, the divorce rate is increasing. The divorce rate is highest in women in their forties now. Because it is not so difficult to be economically independent, and also, I think, the long life expectancy is related to their attitudes. Once I met a middle-aged woman who decided to get a divorce. She was married to her husband for nearly 30 years. I said, "You stayed with him for 30 years. Why can't you stay more?" She said, "It's enough." Because now the life expectancy for women is 83, but those who live more than 50 years live until 85 or 86 years old; 40 or 50 is just a middle of a whole life.

Q: Do they still get benefits and allowance?

A: Yes, and they get a child allowance from the government, even though it is not a big amount of money. Some local governments offer some money for divorced women to start their own business.

Thank you very much.

(The above article is offered for reference purposes and does not necessarily represent the policy or views of the Japanese Government)

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