This book is a comparative study of World War II's impact on the health insurance systems of Japan and the United States. Takakazu Yamagishi argues that the main reason Japan emerged from the war with a public health insurance system, and the United States with a predominantly private health insurance system, was that the two countries experienced the war in different ways. Both countries began the war with largely unformed health insurance systems, sought to strengthen their war-making capabilities by expanding health care, and used war conditions to legitimize greater state intervention in public welfare. But in Japan, wartime mobilization was more rapid and more penetrating, and its duration more uncertain, than in the case of the United States. Consequently, the Japanese government undertook more radical changes in its health insurance system than the United States did, employing war-related justifications to promote the radical shift to near-universal public health insurance. Although many American statesmen supported universal public health insurance, rapid war mobilization of uncertain duration did not last as long as it did in Japan (pp. 89–91). This enabled the opponents of public health insurance in the United States to campaign more vigorously against its advocates, making more radical reforms politically impossible. Yamagishi summarizes his argument as follows: “If the government projected a rapid increase of mobilization and was not sure how long the war would last, the more that government preferred radical reform. The longer and deeper war mobilization became, the more power the government had at its disposal to realize its policy preferences” (pp. 133–34).

Yamagishi recognizes the influence of other factors upon health policy, such as the degree of political centralization, interest group activity, and cultural differences. But his emphasis is on war-related causes. Moreover, the operative concept of “war” here is the event of World War II, and the book does not treat, except tangentially, other ways in which military concerns might influence health policy. The study's treatment of war is mainly constructivist in nature, that is, it addresses the war as the participants perceived it, not as a set of objective facts.

The comparative aspect of the study is one of its strengths. Yamagishi gives equal time to the two countries, and although they are treated mainly in separate chapters, he draws comparisons between them often enough to make the similarities and differences clear. The inclusion of the United States makes this a difficult task, since on some points each American state adopted its own policies.

Although the ostensible centerpiece of the study is war and not the activities of interest groups, one of the most compelling aspects of the work is its detailed description of the roles of the Japan Medical Association (JMA) and the American Medical Association (AMA) in debates over public health insurance. Clearly doctors in both countries have been more concerned with their incomes and autonomy from external regulation than they have been with the well-being of their patients. The considerable impact of war on the policies of both countries was due largely to the fact that governments were able to use wartime conditions to overcome the objections of the medical profession. Although Yamagishi may underestimate the significance of regime differences between the two countries (Japan having a military-bureaucratic regime, the United States a democratic regime), one reason that Japan was able to push health reform further was that its military government did not hesitate to reorganize the JMA into a compulsory tool of official policy during the war (p. 67).

Another intriguing aspect of the Japan-U.S. comparison is Yamagishi's treatment of policies immediately after the war. The U.S. Occupation of Japan brought America's health insurance debate into Japan's public discourse. Both Japan's Ministry of Health and Welfare and the Occupation's General Headquarters advocated that Japan adopt a single national health insurance program to replace its segmented system (pp. 118–21). But opponents of public health insurance in the United States, including the AMA, strove to dissuade the Occupation forces from standardizing Japan's public health insurance system because they believed that its success might empower advocates of public health insurance at home. The book's treatment of U.S. Occupation policies related to health insurance is the best I have read in Japanese- or English-language sources, offering a rich account of the organizations and individuals involved.

In sum, War and Health Insurance Policy in Japan and the United States makes a strong, original contribution to the study of war and social policy and adds an important dimension to the comparative study of Japanese politics and modern history. Its treatment of the medical associations of the two countries and its account of health insurance policy during the U.S. Occupation of Japan are especially noteworthy.