Editorial: Japan parties must solve social security crisis amid aging society

The Mainichi

08-07-2025

As Japan's birth rate falls and society ages rapidly, political parties must face tough choices and thoroughly debate how to ensure the sustainability of the nation's social security system.
Public pensions and health care are funded largely by the working-age population. After World War II, against the backdrop of economic growth and population expansion, these public services were continually enhanced. However, prolonged economic stagnation coupled with the diminishing population is placing an increasing burden on the current generation of workers.
In the ongoing House of Councillors election, the state of social security has emerged as a key issue closely intertwined with economic policy.
Opposition forces Nippon Ishin (the Japan Innovation Party) and the Democratic Party for the People argue for reducing social security premiums to increase the net incomes of the working-age population. On the other side, the ruling coalition parties Liberal Democratic Party (LDP) and Komeito advocate maintaining the existing level of benefits and services. Thus, the election debate portrays clear positions representing either the working-age generation or the elderly beneficiaries being supported.
Postponement is political irresponsibility
A dire pension-related issue is raising the basic benefit levels. Without intervention, pension payments are projected to shrink by about 30% in approximately 30 years, leaving many -- particularly those from the "employment ice-age generation," who faced limited job opportunities during an economic slump -- with insufficient levels of retirement security.
Yet, the implementation of measures to raise pension benefit levels was postponed in the revised National Pension Act passed this June. These measures necessitate more than 2 trillion yen (around $13.69 billion) in additional tax revenue in the future, and the ruling LDP, fearing potential negative repercussions in the upper house election, chose to waver on the proposal.
Another pressing obstacle facing Japan's nursing-care services is a lack of workers. This shortfall is expected to reach 570,000 people in 2040, when the elderly population will approach its peak. The greatest pressure will fall on home care providers that support elderly people living independently in their own homes.
Low wages are the primary cause of this shortage. Care workers earn on average about 80,000 yen (some $548) less each month compared to workers across all industries, and that wage gap continues to widen as other sectors' wages increase.
The LDP has pledged wage hikes that can bring levels up to compare with other industries, and the Constitutional Democratic Party of Japan also calls for lifting care workers' wages to match the national cross-industry average.
However, raising wages necessitates increasing caregiving service prices and leads directly to higher tax and premium burdens. Despite this, neither party seems to be sincerely attempting to win public understanding for additional burdens through sufficient explanations.
Controlling the continued swelling of medical costs is another urgent priority. The government in response considered reforms to the High-Cost Medical Expense Benefit system -- a program designed to cap individual payments and ensure therapeutic support for patients with severe illnesses such as cancer or refractory diseases. However, the proposed revision, which in some cases would increase patients' out-of-pocket expenses by more than 70%, was scrapped during this year's regular Diet session following strong opposition from patients' associations.
Consequently, the government is now examining an alternative approach: removing public health insurance coverage for so-called "OTC-equivalent medications," whose effects and ingredients are similar to over-the-counter medicines commonly sold at pharmacies.
Such medications, including fever reducers and medicated plasters often used by patients with minor symptoms, have been pointed out as driving unnecessary clinic visits since they cost significantly less with insurance than when bought from drugstores.
Seeking a fair contribution from people suffering colds and other minor ailments may seem sensible, but it remains vital not to adversely impact patients suffering from intractable diseases.
Protect the idea of helping others
Tatsunosuke Daito, 23, a company worker from Saitama Prefecture, suffers from a refractory skin disease. Not only does he experience constant pain and itching, he has difficulty regulating his body temperature. He needs large quantities of moisturizers -- applying them whenever his skin becomes dry, not just morning and night. While similar creams can be purchased at pharmacies, removing insurance coverage would vastly increase his financial burden.
In June, his mother, Tomoko, 47, submitted to the health ministry an online petition containing around 86,000 signatures calling for continued insurance coverage of OTC-equivalent medications.
Public subsidies for costs associated with intractable diseases and childhood medical expenses are premised on the treatment being covered by health insurance. If medication is not covered by insurance, such support is not available. Medical services can mean the difference between life and death. Revising such critical systems must involve careful discussion that pays attention to the voices of patients.
There are no simple solutions when it comes to cutting social security expenditure and ensuring sufficient funding.
Recently, there has been growing public sentiment favoring a system where each person's share of the burden is based on their ability to pay. In particular, affluent elderly citizens are being asked to shoulder a greater share.
This sentiment may be a result of frustration among working-age people who perceive the elderly as receiving overly favorable treatment. Nevertheless, it remains vital to ensure this does not erode the core social security principle of mutual support shared throughout society.
Ultimately, the challenge is balancing contributions and benefits in a fair and effective way in line with the changing times. It is the responsibility of politics to present a blueprint that will satisfy the majority of the public.