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To the Editor.—Japanese social reformers clearly have the same problem as their US counterparts. Both are unable to separate social problems from medical system problems, and both want to put the onus for visible support of social problems on the nation's physicians (and the invisible support on the nation's other taxpayers). This tendency to burden the backs of its physicians with the nation's social problems is clearly stated in the last sentence of the article by Dr Ikegami¹: "To what degree the public in general, and physicians in particular, is willing to deal with these issues is a challenge for the 21st century."

On occasion, a partial solution to social problems may require the purchase of medical services, but physicians are not and never will be primary players in legislative decisions to fund long-term care (LTC) whether in the United States or Japan. The LTC legislation is unequivocally . . . [Full Text of this Article]