Yukio Sakurai, Dr
Collaborative researcher, Yokohama National University
ABSTRACT
This article examines the current status and challenges of Japan’s hereditary succession system, focusing on the hereditary succession of politicians and medical practitioners. It argues that hereditary succession in these two professions has negative impacts on the political and social structures of Japan and proposes some reforms to address this issue. The following two conclusions were reached through the study. First, the hereditary succession of politicians is undoubtedly one of the root causes of the stagnation in politics, which discourages the young generation from engaging in politics. The time has come to rethink whether this is the right thing to do about hereditary succession from a voter perspective, which is a crucial issue in democracy. Second, the hereditary succession of medical practitioners is due to the three factors pointed out in this article. These factors contribute to the social effect of fixing part of the structure of society, which is undesirable as an obstacle to free occupational choice and equal opportunities for young people. It is, therefore, necessary to change the medical education route from a single track to a multiple track and decrease the proportion of hereditary succession so that a diverse range of people with humanity and compassion may become candidates for medical practitioners. This article suggests some possible ideas for reforms to achieve this goal. It is time to reconsider the hereditary succession of politicians and medical practitioners in Japan because the people need those who have humanity and compassion in their mission spirit to contribute to society over time.
KEYWORDS: Hereditary Succession, Politicians, Medical Practitioners, Equal Opportunity.
Introduction
Hereditary succession refers to the transmission of a specific position, such as an official rank or peerage, occupation, or property, from one generation to the next. This phenomenon is prevalent in Japan, as evidenced by the imperial family system, court nobility, traditional culture, such as the tea ceremony and flower arrangement, as well as traditional crafts, arts, sports, medical practice, pharmaceutical practice, the legal profession, diplomatic profession, executive corporate management, merchandising, priesthood, and agriculture and forestry.
Hereditary succession is part of the traditional authority defined by Max Weber as one of the legitimate forms of rule. The imperial family system is legitimised by the Constitution of Japan, which states that “[t]he Emperor shall be the symbol of the State and of the unity of the People, deriving his position from the will of the people with whom sovereign power resides” (Article1), and “[t]he Imperial Throne shall be dynastic and succeeded to” (Article 2). This is the public system by law. Others mentioned above are private systems, which are categorised as a unique skill, privilege, or property handed down from generation to generation or a traditional family-run business.
In the previous Civil Code (1898–1947), succession in households was considered of paramount importance to Japanese people. Consequently, the primogeniture heritage system may be considered part of the hereditary inheritance system. This suggests that Japanese people have practised a hereditary succession system for a considerable period of time. The abolition of the family system in the Civil Code in 1947 did not result in the eradication of the hereditary nature of certain traditions and businesses. This suggests that these traditions and businesses have retained a unique cultural identity that has remained unchanged over time.
The value of inheriting traditional skills or businesses through hereditary succession is widely recognised, and one unique example in Japan involves kabuki actors. Kabuki actors are practitioners of Japanese traditional performing arts whose stage names have been handed down from grandfathers to fathers and from fathers to children for four hundred years. Nobody complains about hereditary succession in kabuki actors. It is said that 70% of Kabuki actors and 90% of Bunraku actors, another traditional art form, are products of hereditary succession.
[Kabuki is a traditional Japanese popular drama with singing and dancing performed in a highly stylised manner. A rich blend of music, dance, mime, and spectacular staging and costuming, it has been a major theatrical form in Japan for four centuries (Britannica, 2023). Bunraku is a Japanese traditional puppet theatre in which half-life-size dolls act out a chanted dramatic narrative, called jōruri, to the accompaniment of a small shamisen (three-stringed Japanese lute) .] (Britannica, 2023).
The other unique example is traditional family-run firms (Mehrotra et al., 2013). There are about 40,000 business corporations and shops in Japan that have been in business for more than one hundred years family-run businesses based on heredity succession. Of these, about forty companies have been in business for more than two hundred years. Japan can be called one of the world’s leading countries with long-established businesses.
In contrast, people tend not to support hereditary succession in public office. A typical example is hereditary political succession. This type of hereditary succession is seen not only in National Diet members but also in local assembly members all over Japan. In fact, seventy-five per cent of respondents in a 2022 nationwide opinion poll said that the hereditary succession of politicians in Japan is “problematic” (Nohara, 2023). The role of politicians is of such importance that they must possess the requisite professional ability to contribute to society. However, it is assumed that hereditary succession politicians may not necessarily possess such ability. Nevertheless, why are there so many hereditary politicians in Japan?
Medical practitioners are considered to be professionals with high social status, along with lawyers-in-attorneys. Medical practitioners include general, specialist, and dental practitioners who run clinics or hospitals or work for clinics or hospitals as employees. A survey of Japanese occupations with a high proportion of hereditary succession finds that dentists rank first, followed by medical doctors, and religious persons come third (Tachibanagi and Sannabe, 2016). Why are so many hereditary successions of medical practitioners seen in Japan?
In contrast to politicians, medical practitioners have passed the national qualification examination for medical practitioners. Nevertheless, instances of parents making substantial financial contributions to facilitate their children’s enrollment in private medical schools, as is currently being investigated at some medical school in Tokyo, have been documented. The issue with hereditary succession in medical practitioners is that it represents an obstacle to the freedom of choice and the principle of equal opportunity as perceived by young people with regard to the profession of medicine.
The objective of this study is to examine the current state of hereditary succession in politicians and medical practitioners in Japan. In particular, it aims to elucidate the underlying reasons for the perpetuation of this practice and to assess its advantages and disadvantages. Additionally, it seeks to identify potential avenues for reform.
Research Framework
This article discusses hereditary succession, particularly focusing on politicians and medical practitioners, and argues about their professional characteristics and impacts on politics and society in Japan. Although previous studies separately analyse hereditary political succession as part of topics on political science and hereditary succession of medical practitioners as part of sociological science, there is no article in Japan based on the social science studies that discusses these two topics together in one article.
At a glance, politicians and medical practitioners tend to be thought of as two unrelated professions, but they do have one thing in common: they are often based on hereditary succession. Certainly, hereditary politicians are mainly found in the ruling party, the Liberal Democratic Party (LDP), while hereditary successions of medical practitioners are prevalent among private clinics or hospitals.
A study of social mobility in Japan revealed that individuals of samurai descent account for 5% of the country’s population. Despite the loss of their legal privileges in the late 19th century, the majority of these individuals continue to occupy positions within the social elite (Gregory and Ishii, 2012). The term samurai refers to a member of the Japanese warrior caste. The term samurai was originally employed to designate the aristocratic warriors, but it subsequently came to be applied to all members of the warrior class that emerged to prominence in the 12th century and continued to exert considerable influence over the Japanese government until the Meiji Restoration in 1868 (Britannica, 2024).
The aforementioned study results indicate that opportunities for social mobility are not particularly prevalent in Japanese society. Hereditary succession has a negative impact on social mobility, and opportunities for social mobility are becoming increasingly scarce, which may risk weakening the vitality of society. In this sense, the hereditary succession of professions needs to be addressed by the entire society.
The article is based on a literature survey of interdisciplinary studies in English and Japanese from political science and medical policy perspectives. These sources are subjected to critical analysis through the lens of disciplines within the social sciences, including political science and medical policy studies. Previous studies on the subject of hereditary succession have primarily drawn upon Japanese literature, as English-language sources are limited in number.
The author conducted research on the topics of this article at the Graduate School of Yokohama National University from October 2018 to September 2022 and at the Graduate School of Tokyo Medical and Dental University from April 2023 to the present and has published an essay based on the research. This article is an extension of a previously published short essay regarding “Hereditary Political Succession in Japan” (Sakurai, 2023).
The primary limitation of this study is that it is a literature analysis and does not include a fact-finding survey or interview to investigate the distinctive social relations and local customs that surround the hereditary succession of these two professions. Therefore, the study does not clarify the other side of hereditary succession in depth. However, this limitation does not negate the importance of academic analysis of the research question.
The following section will provide a brief overview of the concept of hereditary succession in Japanese history, with a particular focus on the Tokugawa shogunate. This will enable us to gain insight into the Japanese people’s perception of hereditary succession. We will then examine the cases of politicians and medical practitioners, respectively, to ascertain the backgrounds associated with each. Finally, we will reach a conclusion.
The Tokugawa Shogunate: Hereditary Succession Principles
When Japanese people consider the topic of hereditary succession, the first example that comes to mind is the Tokugawa Shogunate period. The Tokugawa family was a powerful clan that ruled Japan as shoguns for a total of 265 years (1603–1867). The Tokugawa period represents the final phase of traditional Japanese society, characterised by internal peace, political stability, and economic growth under the Shogunate (military dictatorship) established by Tokugawa Ieyasu (Britannica, 2023). The Tokugawa shoguns established a hereditary succession system based on three fundamental principles:
- Primogeniture: The eldest son of the shogun was typically designated as the heir unless he was deemed unfit or died before his father. For instance, Tokugawa Ieyasu, the first shogun, selected his third son, Hidetada, as his successor, as his eldest son, Nobuyasu, was executed for treason, and his second son, Hideyasu, was adopted by another clan.
- Adoption: The shogun was permitted to adopt a son from a collateral branch of the Tokugawa clan or from another loyal daimyo (Japanese feudal lord) family in the event that he had no biological son or wished to strengthen his political alliances. To illustrate, Tokugawa Ienobu, the sixth shogun, was adopted from the Kofu branch of the Tokugawa clan, while Tokugawa Yoshimune, the eighth shogun, was adopted from the Kii branch.
- Abdication: The shogun could retire and transfer his power to his heir while still retaining influence as a retired shogun (also called ogosho in Japanese). This allowed the shogun to ensure a smooth transition and avoid succession disputes. For example, Tokugawa Ieyasu abdicated in 1605 and became ogosho, but continued to oversee the affairs of the Shogunate until his death in 1616.
The founder, Tokugawa Ieyasu, established numerous branches of the Tokugawa family in various regions with the intention of ensuring the succession of the shogun. He also adopted sons from the Tokugawa main line as the shogun’s successors when necessary. Consequently, he established kinship groups, including the Tokugawa Gosanke (comprising three main branches) of Kii, Mito, and Owari, and the Hitotsubashi family. The three principles of hereditary succession enabled the Tokugawa clan to maintain their dominance and stability for 265 years in Japan until the Meiji Restoration in 1868, which restored the power to the emperor.
The Tokugawa Shogunate was a samurai government that ruled Japan for 265 years. During this time, there was no civil war, but apart from disasters such as epidemics, famine, earthquakes, and fires, Japan was able to live in an era of peace. For this reason, even now, TV dramas and novels are being produced with the theme of the Tokugawa family and the Tokugawa era.
During the Tokugawa shogunate, the country of Japan was divided into approximately 250 to 300 feudal domains. Since that time, the region has been reorganized into the current administrative system of 47 prefectures and 1,718 municipalities. It is asserted that numerous foundations, including those with an administrative function, were established during the Tokugawa Shogunate.
It is said that the reason the Tokugawa shogunate lasted for so long was, in part, due to its hereditary succession policy. This principle enabled the smooth succession of Shogunate powers from generation to generation without conflicts. Although the Tokugawa family stepped down from the shogun in October 1867, their descendants still preserve the Tokugawa family’s cultural heritage through the Tokugawa Memorial Foundation (Tokugawa Memorial Foundation, 2024). In other words, the Tokugawa family is still respected by Japanese people.
It is evident that the Tokugawa family’s governance through hereditary shogunate positions provided the Japanese people with a perception of political stability. However, it is also true that Japan’s modernization was significantly hindered due to the Shogunate’s isolationist foreign policy from 1635 to 1854. During this period, the feudal regime continued to exist under the Shogunate system.
The Hereditary Succession of Politicians
Who are Hereditary Succession Politicians?
A review of the hereditary succession of politicians in Japan reveals that there are approximately 35,000 political officeholders in Japan (Statistics Bureau of Japan, 2021). Of these, 713 are members of the National Diet, comprising 465 members of the House of Representatives and 248 members of the House of Councillors. Furthermore, there are 47 prefectural governors, 1,718 municipal mayors, 2,598 prefectural assembly members, and 29,423 municipal assembly members. In this study, we focus on members of the House of Representatives (the lower house).
The National Diet members are often a group of people who ascend to office through hereditary succession. From 1970 to 2000, about 25% of members of the House of Representatives were hereditary politicians (Tamura, 2007: 93). The remaining 75% were ex-bureaucrats, representatives of trade unions or some industry groups, celebrities (in entertainment, sports, etc.), and former members of local parliaments.
Like a kabuki actor, the position of a hereditary politician in the National Diet is typically inherited from their father, who in turn may have inherited the position from his grandfather. There are also cases where the politician’s position is inherited by an adopted child or a son-in-law. The politician’s position is taken over by one generation, sometimes even two generations after the succession. There are cases in which children run for office in the House of Representatives single-seat constituencies within the constituencies in which their fathers or relatives are members of the House of Councillors (Tamura, 2007: 88).
The Prime Minister, Fumio Kishida, is a third-generation hereditary politician. His cabinet members comprise between eight and twelve ministers, out of a total of twenty, who are themselves hereditary politicians. Kishida appointed his son as the Executive Secretary to the Premier, but he was later removed from this post due to a personal scandal. Former Prime Minister Yoshihide Suga is not a hereditary politician and has highlighted this as a distinctive aspect of his background. In other words, the proportion of non-hereditary politicians among the ministers appointed from the members of the LDP in the National Diet is low.
The late former Prime Minister Shinzo Abe (1954–2022) was a typical hereditary politician. Abe’s father was former Minister of Foreign Affairs Shintaro Abe (1924–1991), his grandfather was former Prime Minister Nobusuke Kishi (1896–1987), and his great-uncle was former Prime Minister Eisaku Sato (1901–1975). His brother Nobuo Kishi is the former Minister of Defense. Abe’s profession was part of a family business.
Abe was first elected to the House of Representatives in 1993. Following his tenure as Deputy Chief Cabinet Secretary, Secretary-General of the LDP, and Chief Cabinet Secretary, Abe served as Prime Minister from 2006 to 2007 and from 2012 to 2020. His second tenure as Prime Minister spanned eight years and eight months, which remains the longest in post-war Japan. On 8 July 2022, Abe was fatally shot by a gunman while delivering a speech in support of a candidate for the House of Councillors election in Nara Prefecture, Japan (US Congressional Research Service, 2022).
Current Status of Hereditary Succession Politicians
The number of hereditary politicians is not reflected in official statistics, but it is included in media and private research. The number of politicians who have inherited their position depends on the definition of hereditary succession. In a narrow sense, a hereditary succession politician is defined as a person whose parent, stepparent, or grandparent is a member of the National Diet or who has a member of the National Diet among relatives within the third degree of kinship and who runs for political office from the same constituency.
Some 91 National Diet members (i.e., 79 in the House of Representatives and 12 in the House of Councillors) are hereditary politicians, which is equivalent to 14% of the total members (i.e., 20% in the House of Representatives and 5% in the House of Councillors) (Blog, 2021). This shows that the ratio of hereditary politicians in the House of Representatives has slightly decreased from 25% in 1970–2020 to 20%.
Out of the 91 hereditary members, 46 are second-generation members, 28 are third-generation members, and 3 are fourth-generation members. Two female members succeeded their late spouses, and 12 others succeeded their relatives, including a son-in-law. The number of hereditary members by the National Diet faction is 78 LDP members and 9 Constitutional Democratic Party members. There are no hereditary members representing Komeito, a coalition ruling party, and the Communist Party.
In a broad sense, hereditary politicians are defined as “those who inherit the influence of politicians in elections, as well as those whose relatives are politicians, who are motivated to become politicians” (Ando, 2022: 102-103). This definition encompasses a narrow sense of hereditary politicians, as well as those who are not directly related to politicians but are nonetheless influenced by them. This definition indicates that “approximately 40% of the elected members of the House of Representatives in 2012 and 2014 were hereditary members” (Ando, 2022: 106-107).
It is evident that the majority of hereditary politicians in the House of Representatives belong to the Liberal Democratic Party (LDP) (Jain and Kobayashi, 2018). They typically occupy the office of the prime minister and ministers. Indeed, among the 33 prime ministers in post-war Japan, 16 have been hereditary politicians, representing 48% of the total number (Nakagawa, 2022). In particular, since the death of Emperor Showa in 1989, 11 of the 18 prime ministers have been hereditary politicians, representing a rate of 61%. This has led to the perception that Japanese political officeholders are predominantly chosen through hereditary succession.
In other Asian countries, hereditary succession in top political positions is observed in North Korea, India, Singapore, Thailand, and the Philippines (Thompson, 2012). If cases where governors or mayors and local assembly members are relatives are considered in Japan, the number of hereditary politicians is even greater than that in the National Diet. Hereditary succession politicians can be found both in the National Diet and local assemblies, which is a rare phenomenon in other countries of the worl.
What are the Impacts of Hereditary Succession on Politics?
Hereditary succession is a system that places the highest priority on blood and family ties rather than on the capabilities and efforts of politicians. It is based on pedigree legitimacy, which was seen in samurai society before the 19th century. This system is closely related to the traditional culture of Japanese rulers and rules.
In hereditary succession, politicians inherit the support groups and individual supporters of the single-seat constituency system. In general, this method serves to reinforce the vested interests of both politicians and their supporters. The ties between politicians and their supporters resulted in the distribution of wealth from the centre to the periphery. Such a mechanism has been a fundamental aspect of LDP politics since the LDP was founded in 1955.
As hereditary politicians are so influential, they often have the backing of inherited support groups and individual supporters during elections. Consequently, out of the eight House of Representatives elections that have been held since October 1996, only about 20% of the 8,803 candidates who have run for single-seat constituencies are newcomers (Nikkei, 2021). Consequently, hereditary succession politics impedes the emergence of new politicians who are not related by blood or family to past and present officeholders.
Hereditary succession politics may contribute to a distribution mechanism during economic growth. However, an analysis suggests that the attraction of subsidies to local industries by hereditary succession politicians has weakened the industrial competitiveness of the region overall (Asako et al., 2015). Japan is undergoing a demographic transition with an ageing population. This presents challenges for the social system, industrial structure and working environment. In this context, the ability of politicians to demonstrate wisdom and leadership is more important than their hereditary background.
Crisis in Democracy
In the post-war period, hereditary politicians have played a significant role in Japanese politics. They share the mission spirit of political professions that have been passed down from generation to generation. They commonly emphasised humanity and compassion in their mission spirit, which was to contribute to society over time. Upon the succession of one generation by another, the new hereditary politicians appear to lose the mission spirit in relation to their duties and instead become content with their position in the National Diet.
One notable behavioural pattern observed in hereditary Prime Ministers in Japan is their tendency to disregard the constitution and the National Diet debate. They frequently demonstrate a lack of concern for ethical leadership principles, such as accountability, honesty, and fairness. Instead, they often adopt a self-interested and unscrupulous approach to governance. A significant proportion of these politicians are hereditary politicians. In light of the aforementioned attitudes exhibited by hereditary politicians, it is imperative to undertake a comprehensive review of the ethical standards expected of politicians and the electoral system employed in Japan (Nakagawa, 2022).
The current crisis in Japanese democracy can be attributed, in part, to the limited mobilisation of capable human resources into politics. This is due, in part, to the fact that at least 20% of the House of Representatives is comprised of hereditary politicians. Consequently, the younger generation perceives politics as being out of their reach and irrelevant. This is not merely a state of anomie or apathy but a crisis.
The Hereditary Succession of Medical Practitioners
Japan’s Medical System and Medical Education System
Prior to examining the hereditary succession of medical practitioners, it is necessary to consider the fundamental aspects of Japan’s medical system and medical education system. Japan’s medical system is based on public health insurance, which is characterised by three key features: universal health insurance, free access to medical institutions, and in-kind payment for medical services. Public health insurance covers medical services that are recognised by the insurance policy, including some aspects of dentistry. Furthermore, drug prices are set at official prices.
The Japanese medical care provision system is a mixture of public and private medical institutions. Large-scale medical institutions are public medical institutions run by universities, governments, etc., with a capacity of 20% for medical care provision. Clinics and small and medium-sized hospitals run by individuals or medical corporations are private medical institutions with a capacity of 80% for medical care provision.
Given the distribution of medical practitioners throughout Japan, a total of 81 national, public, and private universities with medical schools in 47 prefectures provide medical education. The annual enrollment capacity gradually increases annually, reaching 9,384 students in 2023. However, this number is annually determined by the Ministry of Education of Japan. Medical students receive six years of education at a medical school, after which those who pass the national qualification examination for medical practitioners become trainees for two years and finally become professionals.
Why Are There So Many Medical Practitioners with Hereditary Succession?
A recent survey examined three potential factors contributing to the high hereditary succession rate of medical practitioners: (a) the medical education system, (b) the financial burden of becoming a medical practitioner, and (c) tax benefits as a medical practitioner (Higa and Goto, 2022: 6-13).
Firstly, it takes at least eight years for an individual to complete the requisite process of medical education. This implies that once one enrols in this educational process, there is a high probability that they will become a medical practitioner. Under such an educational system, one is expected to be a medical student at a medical school at the age of 18 or later. Parents who are medical practitioners may play a significant role in motivating their children to pursue a career in medicine at an earlier age, such as during their primary school years.
Secondly, in order to be admitted to a medical school, students are required to prepare for admission examinations from their primary school days (Matsuoka, 2019). Therefore, parents must have the financial resources to fully fund their child’s education. The profession of a medical practitioner provides this opportunity.
Thirdly, the establishment of a medical business necessitates a considerable financial investment in the purchase of land, buildings, medical equipment, and other materials. By inheriting this business through a sole proprietorship or medical corporation, the inheritor may enjoy tax benefits compared to closing down a clinic or hospital in one generation. The same tax methods can be applied to business succession for small and medium-sized business owners. The Japanese tax system is punitive towards individuals, yet medical corporations are afforded preferential tax treatment in exchange for their contribution to the community in the form of medical care. This is a significant factor in medical practitioners’ decisions to ensure their children succeed them, thereby increasing the probability of hereditary succession.
Furthermore, children of medical practitioners are socialised to view their parents’ sense of mission as an inherent aspect of noblesse oblige and high social status within the medical profession. Consequently, their professional ethics and sense of mission are naturally inherited from generation to generation. However, unless the aforementioned three factors are met, it is assumed that hereditary succession cannot be materialised.
How Does Hereditary Succession Affect Medicine and Society?
Both positive and negative effects appear in the hereditary succession of medical practitioners. First, a positive aspect is that there is a system in place where the succession of medical practitioners creates human resources, and they may engage in the busy profession of being a medical practitioner, which requires advanced knowledge and extensive clinical experience. Moreover, particularly in rural areas, clinics or hospitals run by medical practitioners’ families who are well-known to local residents may give them a sense of security when receiving medical care.
A negative aspect is that people choose the profession of a medical practitioner simply because they are the children of medical practitioners, even though they are not qualified to be medical practitioners. This may pose a risk of causing negative consequences for both the person concerned and the patients. In addition, there is a risk that it will hinder the entry of other people who are qualified to be medical practitioners. This is the same aspect as was previously pointed out regarding hereditary succession politicians.
From a broader social perspective, a group of medical practitioners may become entrenched in society and form an establishment group. In the case of private medical practitioners, the Japan Medical Association (JMA, 2024) exerts significant political influence over the determination of medical fees and drug prices under public health insurance. The JMA is a public-interest corporation of medical practitioners but is not analogous to the General Medical Council (GMC, 2024) in the UK, which is subject to Senate control. In this sense, a group of medical practitioners can be considered an interest group in Japan.
In such a situation, the public nature of medicine intersects with the commercialism of medical practitioners, creating a complex picture. The current medical care system in Japan is a rigid system that is immobilised by both the medical care provision system, which is controlled by a mixture of market mechanisms and the government, and the public health insurance system, which is fully controlled by the government. This is believed to be one of the reasons why the Japanese medical system was unable to respond flexibly to the COVID-19 pandemic outbreak for years.
Reforms to Meet the Needs of an Aged Society
Japan has become a super-aged and even ageing society, with 29.1% of the population aged 65 and over, and the proportion of elderly people is expected to continue to rise, reaching 38.4% by 2065 (Cabinet Office of Japan, 2022). The increasing number of elderly people is significantly increasing the cost of medical care and aged care.
The public insurance system is applied to health care and aged care, but under the current system, medical care and aged care insurance premiums cannot cover actual demand, and a huge amount of tax money is invested. Although Japan’s medical system is excellent for consumers, it is a financial drain (Hue and Yamada, 2017). Medical practitioners are the ones who absorb the benefits of the current medical care system. Japan’s medical care and aged care systems need fundamental reform, and failure to do so will result in higher costs down the line.
The government makes some efforts. For example, first, the government tries to shift to the gatekeeper model where you need to see a family doctor first before seeing a specialist. However, it is a challenge to change what people take free access for granted, and the shift has not been successful. Second, the government eventually announced that it would abolish paper health insurance cards in 2024 and replace them with a digital ID, “My Number Cards,” but few people have implemented this policy so far.
Third, the government continues to reform the health insurance system so that patients’ co-payments for medical expenses are set according to their financial resources, and people are asked to pay their proportionate share of medical expenses. However, these are not fundamental reforms of the health insurance system but an amendment within the current medical policy framework.
The Japanese medical system has expanded to such an extent that it is placing significant strain on the nation’s financial stability. Consequently, there is an urgent need to reform the welfare state policy, particularly in relation to medical care, aged care, and public pension systems. However, despite the necessity for reform, public awareness among the elderly remains unchanged, and there are strong opinions opposing the reform.
An interest group comprising 80% of medical service providers, the JMA exerts considerable influence over the LDP and typical medical service users, the majority of whom are older people. Consequently, politicians are reluctant to reform the system for fear of a backlash from the elderly in elections. It is reasonable to suggest that Japan has been facing its most significant social security crisis since the end of the Second World War. Medical practitioners belong to a group that benefits from the current medical system, which is based on hereditary succession. One might inquire as to the fairness of this system to society at large.
More Emphasis on Humanity and Compassion
In any profession, it is of the utmost importance to have the right person in the right place. Some individuals enrol in medical school with the intention of becoming medical practitioners, while others pursue a bachelor’s degree or later and subsequently embark on the path of becoming a medical practitioner.
In order for a diverse range of people to find suitable occupations and make their lives most fruitful, it is important to take multiple routes to become a medical practitioner rather than the current single path (Higa and Goto, 2022: 39-41). This will result in a more appropriate allocation of medical human resources and benefit consumers.
In an ageing society such as Japan, the provision of medical care will extend beyond the treatment of acute illnesses to encompass the care of elderly patients who have lived with chronic conditions for years. Medical practitioners will be expected to demonstrate a greater emphasis on humanity and compassion than on the mere application of medical technology. It is therefore considered essential to train medical practitioners who can respond to such humanistic demands and who are mission-minded rather than focusing on just commercialism.
Conclusion
This article examines the current status and challenges of Japan’s hereditary succession system, focusing on the hereditary succession of politicians and medical practitioners. It argues that hereditary succession in these two professions has negative impacts on the political and social structures of Japan and proposes some reforms to address this issue. The following two conclusions were reached through the study. First, the hereditary succession of politicians is undoubtedly one of the root causes of the stagnation in politics, which discourages the young generation from engaging in politics. The time has come to rethink whether this is the right thing to do about hereditary succession from a voter perspective, which is a crucial issue in democracy. Second, the hereditary succession of medical practitioners is due to the three factors pointed out in this article. These factors contribute to the social effect of fixing the structure of society, which is undesirable as an obstacle to free occupational choice and equal opportunities for young people. It is, therefore, necessary to change the medical education route from a single track to multiple tracks and decrease the proportion of hereditary succession so that a diverse range of people with humanity and compassion may become candidates for medical practitioners. This article suggests some possible ideas for reforms to achieve this goal. It is time to reconsider the hereditary succession of politicians and medical practitioners because the people need those who have humanity and compassion in their mission spirit to contribute to society over time.
This article elucidates the historical, social, and political structure of professional succession among politicians and medical practitioners, with a particular focus on the rarely addressed topic of hereditary succession. However, the analysis does not encompass the distinctive social relations and customs that surround the hereditary succession of these professions in depth. A fact-finding survey is required to explore the other side of hereditary succession, an area that requires further investigation. Moreover, while the article proposes reforms to reduce hereditary succession, the specifics of these reforms, including electoral reform for politicians and multi-track medical education, require further examination and comparison with other developed countries. This is also an issue that will require further attention in the future.
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