Lawmakers from the Liberal Democratic Party and Nippon Ishin (Japan Innovation Party) discuss reviewing the social security system on Nov. 21. (Yotaro Hamada)

EDITORIAL: Balance needed in reform for an equitable social security system

（社説）社会保障の協議　高齢期の安心　誰のため

Since almost no one can work their entire lives, those who are young now will someday become old and become increasingly reliant on the social security system. 

Because dialogue, rather than confrontation, between generations is necessary, an important role of politicians is to create momentum for discussions of reform of this system.

The Liberal Democratic Party and Nippon Ishin (Japan Innovation Party) have begun working-level discussions for reviewing the social security system that was included in the coalition agreement signed by the two parties.

A major policy direction will be reducing the social insurance premium burden of the working-age generation that has been pushed by Nippon Ishin.

As such, the focus of discussions will be the premiums paid by senior citizens as well as increasing what they pay whenever receiving medical or elderly care.

One immediate topic for discussion will be creating a framework to reflect financial income, such as from securities, on insurance premiums and what is paid out of pocket.

Another topic is reviewing insurance benefits for medicine that have similar ingredients and uses as over-the-counter drugs but which require a visit to the doctor.

The coalition agreement also called for reviewing the differences by age groups in payments made at medical clinics and other facilities.

Currently, those under 70 make, in principle, out-of-pocket payments of 30 percent of the total cost, but that ratio is reduced to 20 percent for those between 70 and 74 and to 10 percent for those 75 and older.

Including financial income in the base when deciding premiums is logical since it follows the principle of shouldering a burden according to ability to pay.

If infrastructure can be constructed to allow for accurate calculation of income, it could lead to fairness among all age groups in terms of premiums as well as the tax burden and benefits.

But if out-of-pocket payments are increased, that will directly hit the pocketbooks of patients who need care and medicine for illnesses or injury.

Senior citizens use medical institutions more frequently than younger generations.

Even if each visit may have a lower payment amount, the total cost will become much higher.

Since it will be difficult for the elderly to work to increase their incomes, they will face greater concerns about a rise in unavoidable expenditures.

There will be a need to carefully determine exactly how much of an additional burden each individual will have to shoulder.

Nippon Ishin Lower House member Satoshi Umemura is the party’s point man for discussions with the LDP.

On the party’s official social media site, he posted a comment that said since the medical care system deals with the lives of the people, discussions should not be about seeking an all-or-nothing conclusion, but should create a base that will reassure the public.

That is a proper recognition.

Japan’s social security system has been described as one in which benefits center on senior citizens while the burden is focused on the working-age generation.

But that is only one aspect of the issue at a certain point in time.

Over the course of a person’s entire life, many people will not need medical care while they are working, but will face increased expenditures for medical and elderly care when they are more advanced in age.

An important role for social security is to average out that burden.

Of course, there is a need to place a top priority on dealing with expenditures related to child care that is a heavy burden on the working population.

Reform should move toward creating a sustainable social security system that balances the burden and the benefits of the working-age population and senior citizens.

--The Asahi Shimbun, Dec. 1

ほとんどの人は一生、「現役」でいられるわけではない。今は若くても、いつかは老いる。世代間の対立ではなく、対話が欠かせない。この機運をつくりだすことこそ、政治の大切な役割だ。
　自民党と日本維新の会が、連立政権の合意書に盛り込んだ社会保障制度の見直しに向けて、実務者協議を進めている。大きな方向性は、維新が掲げる「現役世代の社会保険料負担の軽減」だ。「高齢世代」の保険料や、医療や介護で払う窓口負担を増やすことが主眼となる。
　当面は「株式などの金融所得を保険料や窓口負担に反映する仕組みづくり」と、市販薬と同様の成分や使い方だが医師の診察が必要な薬である「ＯＴＣ類似薬の保険給付の見直し」について、話し合う。「年齢で差がつく窓口負担の見直し」も合意書に盛られている。いま７０歳未満は原則３割だが、７０歳以上は２割、７５歳以上は１割で、いずれ議題となるだろう。
　保険料を決めるベースに金融所得も含めることは、「能力に応じて負担する」という原則に沿い、理にかなう。所得を正確につかんで活用するインフラが構築できれば、すべての世代について保険料や税の負担と給付を公平にするのに資するはずだ。
　一方、窓口負担を引き上げれば、病気やケガで治療や薬が必要になり、いま苦しい思いをしている患者の財布を直撃する。高齢者は、若年層に比べて医療機関の利用頻度が高い。１回あたりの自己負担は安くても、合計すれば高くなる。働いて収入を増やすことが難しいなか、避けがたい支出が増える不安は大きいだろう。誰が、どのくらいの負担増になるのか、慎重に見極める必要がある。
　維新側の責任者である梅村聡衆院議員が、党の公式ＳＮＳにこんな趣旨のコメントを残している。「人の命がかかっている医療制度には、１００ゼロといった乱暴な議論ではなく、国民に安心いただけるベースをつくる」。その認識はまっとうだ。
　日本の社会保障はよく「給付は高齢世代中心、負担は現役世代中心」と評されるが、一時点の断面に過ぎない。一生をみれば、多くの人は現役期にあまり医療を必要としなくても、高齢期になれば医療や介護の支出は増えていく。その負担をならすのは、社会保障の大切な役割だ。
　当然、現役期に負担が重い子育て関連の支出は、最優先で対応する必要がある。現役期と高齢期の負担と給付をバランスさせ、持続可能な社会保障へ改革を重ねたい。

(2025年12月01日)

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EDITORIAL: Balance needed in reform for an equitable social security system
（社説）社会保障の協議　高齢期の安心　誰のため