Participant Profile
Yuri Okina
Other : Chairperson of the Japan Research InstituteOther : Chairperson of the Government Tax CommissionOther : CouncilorFaculty of Economics GraduatedGraduate School of Business Administration GraduatedBorn in 1960. Graduated from the Keio University Faculty of Economics in 1982. Completed the master's program at the Keio University Graduate School of Business Administration in 1984. Received a Ph.D. in Economics [Ph.D. (Economics)] from Kyoto University in 2011. Specializes in financial systems, social security, and economic policy. Having built a career as an economist, she also holds numerous government positions, including serving as a member of the Cabinet Secretariat's "Council for New Form of Capitalism Realization" and a member of the Financial System Council of the Financial Services Agency.
Yuri Okina
Other : Chairperson of the Japan Research InstituteOther : Chairperson of the Government Tax CommissionOther : CouncilorFaculty of Economics GraduatedGraduate School of Business Administration GraduatedBorn in 1960. Graduated from the Keio University Faculty of Economics in 1982. Completed the master's program at the Keio University Graduate School of Business Administration in 1984. Received a Ph.D. in Economics [Ph.D. (Economics)] from Kyoto University in 2011. Specializes in financial systems, social security, and economic policy. Having built a career as an economist, she also holds numerous government positions, including serving as a member of the Cabinet Secretariat's "Council for New Form of Capitalism Realization" and a member of the Financial System Council of the Financial Services Agency.
Kohei Itoh
Other : PresidentBorn in 1965. Graduated from the Department of Instrumentation Engineering, Keio University Faculty of Science and Technology in 1989. Received a Ph.D. from the University of California, Berkeley in 1994. After serving as an assistant, full-time lecturer, and associate professor, he became a professor at the Keio University Faculty of Science and Technology in 2007. Served as Dean of the Faculty of Science and Technology and Dean of the Graduate School of Science and Technology from 2017 to 2019. Member of the Science Council of Japan. Appointed President of Keio University in May 2021. Specializes in solid-state physics, quantum computing, etc.
Kohei Itoh
Other : PresidentBorn in 1965. Graduated from the Department of Instrumentation Engineering, Keio University Faculty of Science and Technology in 1989. Received a Ph.D. from the University of California, Berkeley in 1994. After serving as an assistant, full-time lecturer, and associate professor, he became a professor at the Keio University Faculty of Science and Technology in 2007. Served as Dean of the Faculty of Science and Technology and Dean of the Graduate School of Science and Technology from 2017 to 2019. Member of the Science Council of Japan. Appointed President of Keio University in May 2021. Specializes in solid-state physics, quantum computing, etc.
2025/01/06
The Challenge of a Declining Birthrate and Aging Population
Happy New Year. Today, I am pleased to welcome Yuri Okina to discuss the theme of "Japan's Outlook with an Eye on the Next Generation."
Ms. Okina was appointed Chairperson of the Government Tax Commission in January last year and also serves as a Councilor for Keio University, providing tremendous support for the future of Keio University.
Keio University is a place of learning that provides opportunities for many future generations and is engaged in research and education aimed at leading the whole of society—specifically, for the happiness and development of society. However, in Japan, where the birthrate is declining and the population is aging in addition to the low economic growth known as the "lost 30 years," the relative number of elderly people is increasing. Consequently, some young people feel that policies and national budget allocations for urgent issues are prioritized, while policies based on medium- to long-term visions for the prosperity of the next generation of Japan are limited.
In today's dialogue, while maintaining a brightness and a sense of optimism appropriate for the New Year, I hope to talk with Ms. Okina about Japan's choices for the next generation and the future of Keio University.
Thank you for having me. As you mentioned, for a long time, Japan was said to be in the "lost 30 years," but I believe the economic tide has changed slightly now. After the COVID-19 pandemic, labor shortages became apparent, wages began to rise, and prices have also gone up. Conversely, geopolitical risks have increased, making things difficult, but the Japanese economy is recovering with strong corporate earnings, and negative interest rates were lifted in 2024.
Regarding domestic capital investment, TSMC (Taiwan Semiconductor Manufacturing Company) has entered Kyushu, and there are movements to revitalize capital investment by domestic companies. Stock prices have finally reached their highest levels in 30 years, giving me the impression that things are becoming a bit more energetic.
On the other hand, as you said, Japan is currently rushing into a declining birthrate and aging population, with the total fertility rate in 2023 at 1.20. In 2024, the number of births may fall below 700,000. In 2015, there were 1 million babies born every year, so I think this is a very serious problem for Keio University as well.
It is inevitable that the population decline will progress to some extent, but within that, we need long-term initiatives to create a vibrant society and suppress the rapid decline in the birthrate. I believe this has become a very important period for Japan.
Many companies are now significantly raising starting salaries for new employees, so that kind of news is a bright topic for young people. In addition, I think all the points you just pointed out are important.
Advice from a Graduation Speech 18 Years Ago
Actually, the moment I was surprised by Ms. Okina and thought, "This person is amazing," was at the undergraduate graduation ceremony in March 2007. Ms. Okina delivered a congratulatory speech as the representative of the Keio University alumni on stage, and I was listening as one of the people on the floor.
In that talk, you mentioned that 1982, when you graduated, was the final stretch of high growth, just as the bubble was approaching. Based on the assumption of lifetime employment, your classmates also joined companies with the feeling of entrusting their entire lives to them. However, when the bubble burst in the 1990s, some of your peers lost the premise of dedicating their lives to a company.
At that time, it had been exactly 25 years since your graduation, and in your speech, you stated, "Our generation has certainly become tougher compared to 25 years ago and is working hard in various parts of society," and then gave the graduates the following three pieces of advice.
1. To have expertise through work that allows you to be called a professional in at least one thing. 2. To be persistent and not give up even in the face of adversity. 3. To lead a life rich in spirit.
I don't know if you remember the speech from 18 years ago, but how do you feel about these three pieces of advice you gave back then?
Thank you. If I had the opportunity to speak to young people today, I think I would say the same things. First, I believe we are entering an era where professionalism and expertise are increasingly required. In terms of work styles, rather than being a generalist, we are gradually combining job-based roles, and we are in an era where seniority alone no longer works.
Also, persisting without giving up in the face of adversity is important in any era. Since you will inevitably face difficult situations once you enter society, I believe how you handle those times determines your life thereafter.
I think the third point is also exactly right.
I see. First, regarding the first point, "having expertise through work that allows you to be called a professional," you went on to say, "The era of the so-called 'company man' ended a long time ago." Even if you are fortunate enough to feel an attachment to the organization you joined, that alone is not enough. At the same time, you want them to have both attachment and pride in the expertise of their own work. Today, the term "job-based" is used, but is it correct to say that having pride in one's own expertise becomes a source of mental support and leads to strength as a member of society?
Work styles are changing significantly now, and having skills and expertise is becoming more important than ever, and young people have a very strong orientation toward that. Looking at awareness surveys by Recruit Management Solutions, people in their 20s and 30s are thinking deeply about their own autonomous and proactive career development. The number of people who want to consider changing jobs if there is an opportunity is increasing, and I feel the world is changing.
In the era when the lifetime employment system was the norm, conversely, even if you tried to demonstrate professionalism, you had to align with company policy, and because you didn't know which department you would be transferred to, there were times when you couldn't demonstrate your strengths. But that has changed, hasn't it?
Yes. That is also a very good thing for women. When labor mobility increases, the desire to secure good employees also strengthens on the corporate side, so they start providing not only wage increases but also good work environments and opportunities for growth. I think that virtuous cycle will work.
Labor shortages are also becoming serious, so I think the era is gradually becoming one where those entering society can choose companies more strictly than before.
Also, young people—husbands and wives, and various partners—are starting to help each other. Various forms are emerging, such as women working independently and husbands helping them, even following their wives on job transfers.
Even in companies I know, there are increasing cases where the husband temporarily quit his job when the wife was assigned to work in the United States. It feels like a different world compared to before.
So, it's fine as long as everyone can feel happiness. However, even if it feels like a different world to us, young people probably feel there is still a long way to go.
I think many people probably feel that way. In particular, not a few women who are active today are playing pioneering roles and face various hardships. I think many still have anxieties about whether they can continue to successfully balance work and family.
Expertise to Overcome Adversity
How to shape the family in the coming era is a major theme.
Now, regarding the second point, "to be persistent and not give up even in the face of adversity," you continued, "When you enter society, you may face difficulties that cannot be helped by individual strength alone. (...) There is no one without adversity. But please hold on at that time." In fact, the Lehman shock came after this.
Okina: There was the Lehman shock, and there was the Great East Japan Earthquake. Japan has many natural disasters, and I think things that cannot be resisted by individuals will happen.
At those times, support through social systems becomes essential, and the capacity to help each other also becomes important.
That's right. Of course, the national and local governments provide support, but NPOs and Keio University are also providing various types of support. Mutual aid by various people is important alongside public aid. I think it would be good if people can become independent and overcome adversity by successfully layering public and mutual aid on top of self-help.
In your speech, you said, "What supports you from the outside are the family and friends surrounding you, and the support from within is the professional expertise you have worked hard to build." I had the impression that family was 'within,' so the words that everything other than oneself is 'outside' and 'within' is one's own expertise had a huge impact on me.
When I was young, I think it was an era when it was difficult for salaried workers to have expertise. But even then, there were people who honed their expertise and took on challenges, playing active roles during times like the financial crisis and making great leaps forward afterward.
I was active in the Industrial Revitalization Corporation of Japan for about four years starting in 2003. There, people like bankers, accounting firms, lawyers, and analysts gathered with the desire to contribute to overcoming Japan's financial crisis, relearned based on their expertise, and carried out the revitalization of various companies. Having gone through such a place, I think I felt the importance of honing expertise and taking on challenges particularly strongly.
Responding to Environmental Changes
2007 was exactly the time when the internet revolution was happening and the digitalization of transportation cards like Suica was progressing rapidly, wasn't it?
Yes. I think everyone started using the internet around 1997 or 1998, but now smartphones are a matter of course, and I think the times have truly changed significantly.
There were parts very similar to the current AI revolution, but on the other hand, the world situation was relatively stable back then.
Geopolitically, the Soviet Union had collapsed, and democracy and capitalism were thought to be the only winners. It was an era when everyone thought it would become like Francis Fukuyama's "The End of History and the Last Man."
China was also still in the development stage at that time, and it was an era when many people optimistically thought that if it became a major power, it would surely join the democratic camp. That is a big difference from now. At that time, the Chinese economy was just beginning to grow, and when I spoke about "(regarding the economy) coming out of the tunnel and the view opening up," it was when overseas demand was becoming large.
The full protection of deposits that had been in place during the financial crisis ended completely in 2005, and companies had become quite lean. Then China and Asia gradually began to rise. It was an era when people started calling it the era of Asia. But unfortunately, Japanese wages remained low for a long time after that.
From the late 1990s through the 2000s, bad debt disposal was carried out and banks were integrated to that extent. What would have happened if that hadn't been done?
At that time, bank integration proceeded quite drastically; what used to be 11 city banks is now like 5 banks. With the population decreasing, I think integration is a natural flow in the long term. However, compared to overseas, Japan changed very slowly, and I think the response to the financial crisis took a lot of time compared to places like Northern Europe. Of course, there is the aspect that by taking the time to process it thoroughly, the soundness of the financial system improved afterward.
I think countries like those in Northern Europe, partly because they are small, completely aligned with the capitalist methods of the time, such as those in the US, but in Japan, it naturally takes a process to change things. In fact, I have been asked if we can really fight on like this.
I think the reason they were able to integrate drastically was that Northern Europe and the US had a foundation where information disclosure was solid. In Northern Europe and elsewhere, it was also significant that politicians could look straight ahead and say that public funds were necessary to save the financial system.
On the other hand, Japan was very late in information disclosure, and as described by the "convoy system," financial administration was conducted slowly to match the weakest points. Because of such things, I think the processing was delayed.
18 years ago, did you feel like you were "in the gap" working with your peers in their late 40s in the prime of their careers, the seniors who supported the high-growth period, and the juniors who joined after the bubble?
Yes. The high-growth period is said to have lasted until about the oil shock in 1973, but the economy was still growing in the 80s. When we entered the 90s, the world changed tremendously with the bubble burst. On the other hand, there were many bosses who had the success stories of the Showa era.
I think that kind of feeling still remains somewhat today. Unless we keep what should be kept and change what should be changed, the speed of environmental change is very fast, so a gap will open up between companies that can respond and those that cannot.
In the past, there was the main bank system, and banks had a great influence on corporate management. That gradually changed from around 2000 as overseas shareholders increased, and currently, overseas shareholders have the top shareholding ratio in listed companies on the Tokyo Stock Exchange. In that way, the environment surrounding companies has changed significantly. While systems like corporate governance have been well-established, I feel that requests for reform from the capital market are also strengthening.
Has the "100 Million Total Middle Class" Consciousness Transformed?
Next is the point about "leading a life rich in spirit." In your speech, you mentioned, "Recently, scandals at food companies and gas equipment companies have been repeatedly reported," and scandal reporting hasn't changed even now. Moreover, you said that those occurred as a result of "the people involved themselves making judgments while closing their ears to the voice in their own hearts somewhere." I think this is exactly the same even today.
You went on to ask, "What is the best way to keep listening to the voice in your heart?" and after declining by saying, "To be honest, I don't know either," you said, "Do not forget family, friends, hobbies, and various small joys." I also think this is very important now.
Thank you.
In the 1970s, the term "100 million total middle class" emerged. In response to the question "What do you think of your standard of living?", more than 70% of people chose "middle" among the choices of upper, middle, and lower, which is why it was called the 100 million total middle class. I believe this was a very happy thing for Japan.
However, even now, looking at the 2023 Cabinet Office "Public Opinion Survey on the Life of the People," more than 80% of people choose "middle."
That's right.
However, there was also something like this. At a Keio University scholarship award ceremony, a Keio student representing the scholarship recipients, who grew up in a single-mother household and faced great hardships with a sibling who also has a disability, gave a wonderful speech. What struck me in that speech was the phrase "In Japan, which is said to be '100 million total poverty'," and the young people in the audience were nodding. Even though the survey says it should be the 100 million total middle class, the young people nod at 100 million total poverty.
That might be not only in economic terms but also in terms of the heart. For example, it might be related to whether they have hobbies they like or whether they are satisfied with every day. In short, what you said in your speech—"living a rich life without forgetting various small joys and without letting the water vein of the heart run dry"—might be becoming difficult for today's youth.
That might be so. With the recent high prices, people are losing their leeway. Looking at the income side, it is symbolic that wages have unfortunately not risen, and the economic situation has not improved compared to 30 years ago. The Gini coefficient, an indicator of income inequality, has not widened as much as overseas, but looking at the relative position in the world, Japan has indeed fallen.
One factor is the weak yen, but it cannot be said that the income environment is in a good state. Nevertheless, if people have a middle-class consciousness, there are about two possibilities. One is that Japan is easy to live in, and compared to overseas, you can eat delicious things cheaply. In that sense, I think there are a fair number of people who feel they can live relatively satisfied lives if they are in Japan.
The other, which can also be confirmed in the same public opinion survey, is that a relatively large number of people are able to live with leisure time. While the income environment is tough, it is possible that relationships with family and friends, hobbies, etc., are helping to enrich their lives.
Even if it's tough in terms of income, there are people who feel various kinds of happiness, such as feeling happy coaching a child's baseball team on weekends.
The Necessity of a "Social Bridge"
On the other hand, I also think some people feel a gap from seeing the posts of some wealthy people and feeling that it's a different world. That area is difficult, but how can each individual feel happiness? Of course, there are issues like child poverty, and I think the government should help there.
I think many people working for major listed companies are able to spend their time with relative leisure. However, I think there are issues like the gap between regular and non-regular employment. For those in the employment ice age generation who wanted to become regular employees but couldn't, I don't think Japan has been able to support them that much until now.
I believe one of the most important things for Japan is investment in people. Not only reskilling for those working in companies, but we should also reach out to those who had no choice but to remain in non-regular employment or those who are working at their current companies in an unintended way but want to make a leap someday. The term "social bridge" exists in Europe, and I believe it is the role of the government—the nation and local municipalities—to provide support for smooth transitions to the next job.
Despite the concept of equal pay for equal work, it is said that even if they do the same work within a company, there is a wage gap between regular and non-regular employees. Also, I feel very strongly that respect for essential workers is thin.
That's true. Starting with doctors and nurses, we were truly helped by essential workers during this COVID-19 period.
Firefighters, police officers, and those who clean for us are also included.
Since the salary levels for childcare workers and care workers are often low due to public pricing, it won't be sustainable unless we raise the wages of such people. I think such policies are very important.
Progress in Solving Social Issues
In the latter half of your speech, you suddenly bring up, "Currently, global warming is becoming serious globally." This was just after former Vice President Al Gore released "An Inconvenient Truth," wasn't it?
That's right. Mr. Gore's foresight was truly remarkable.
Furthermore, he stated that "in order for companies to operate in the future, fulfilling social responsibilities such as environmental consideration and support for child-rearing is essential." About 18 years have passed since then; what are your thoughts on these matters now?
I suppose initiatives are finally getting into full swing. Regarding measures against global warming, European investors in the financial markets began to move significantly around 2015. That international movement became a groundswell, and companies that cannot respond to environmental issues are now being evaluated as not sustainable. While the global trend has grown, the possibility of Donald Trump becoming president again is increasing uncertainty slightly.
I am a member of the government's Council for New Form of Capitalism Realization, and its philosophy is to improve long-term corporate value by treating the resolution of social issues as an opportunity. In other words, it is a way of thinking that increases corporate value alongside solving social issues through growth strategies. This has been discussed in the U.S. since around the 2010s by people like BlackRock CEO Larry Fink and at the Business Roundtable, and Japan is moving in that direction as well. I agree with this way of thinking.
Regarding child-rearing, paternity leave has become mandatory and is growing significantly. I think there is still a long way to go, but I believe it is very important.
In your congratulatory address, you also mentioned, "Leading a life with a good work-life balance requires effort." You concluded by saying, "I hope you will lead a good life while making efforts to have a spiritually rich time while contributing to society," so "spiritual richness" has become a major keyword.
I was also in a dual-income household, and my husband supported me a lot, but when the children were small, I had little mental leeway and was doing my best just to balance work and family. However, looking at it over a lifetime, the period of child-rearing is surprisingly short, and after that, I was able to have time for myself again. When that happens, you can take up hobbies outside of work. It feels like things become much easier after about 10 years, so I hope those who are currently struggling to balance everything will successfully overcome the difficult times and spend their lives richly in the long term.
In your generation, and also the generation slightly after, almost all married women who are active in their careers have the support of their partners, don't they?
That is very important. I believe that being able to help each other makes balancing home and work much easier. In fact, looking at OECD countries, the gap in unpaid labor between men and women is largest in Japan, with men's housework and unpaid labor averaging only 40 minutes a day. It is truly short, and the birthrate is declining more in such countries. Therefore, now that we are shifting significantly to an era of "working together and raising children together," I would like to see companies provide support in a way that fits this, and for society as a whole to successfully and richly navigate this era of labor shortages while also raising children. I hope people will put effort into such initiatives. As the President mentioned earlier, most people in their 20s are in dual-income households, aren't they?
That's right. I also reflect on how well I have understood and worked on this until now, but without a doubt, young couples today are trying to approach it that way, so adults of the parent and grandparent generations should not get in their way.
Exactly. There is a Cabinet Office questionnaire that looks at opinions by age group regarding the so-called gender-based division of roles, where men work outside and women support them. Over 40% of those in their 70s and older and over 30% of those in their 60s are positive about this, but for those in their 20s, it is less than 20%. I believe that the management generation shifting their mindset will ensure the sustainability of this country.
How to Respond to the Arrival of a Super-Aging Society
The burden of medical and nursing care costs is not a problem that can be solved simply by pushing it onto young people. Also, how should we view education costs and investment? Regarding the burden of medical costs, I recently read an article (Nikkei Shimbun, morning edition, August 27, 2024) stating that the current working generation is essentially sending about 70,000 yen per person per year to those aged 75 and older.
In 2025, everyone in the so-called baby boomer generation will become late-stage elderly. From here on, it will truly be the era of a super-aging society, and until around 2040, there will be a labor shortage, making these next 15 years particularly difficult.
If the population continues to decline along with aging, a problem arises where the ratio of elderly people remains unchanged thereafter. If the population increases, the ratio of elderly people gradually decreases, but as it stands, it will not decrease and will level off at nearly 40%, so I think measures against the declining birthrate are crucial.
Within that, the percentage of voters aged 18 to 30 has currently dropped to about 15%.
This is what is known as "silver democracy." This is a major issue, as policies aimed at the elderly inevitably take priority. Also, in terms of productivity, it is said that aging has a negative effect because younger people are more likely to innovate. There is also the aspect that elderly people take time to get used to new technologies.
While digitalization is slow to progress, reforms are moving forward, such as using health insurance cards linked to My Number Cards to record vaccinations, making maternal and child health handbooks viewable portably, and integrating medication handbooks.
However, in places like the U.S., management is handled via Social Security Numbers, and from the time you pay into your pension through a part-time job, everything is totaled throughout your life, and you receive "push-type" notifications saying that as a result, you have the right to receive this much pension regardless of where you change jobs. In Japan's case, it inevitably becomes application-based.
Parts of the pension can now be viewed, and since job changes have increased and My Number has become widespread, it would be good to have a society where you can always check your future pension on the Myna Portal. The pension system is complex and difficult to understand in some areas.
Especially for young people and those in financial need, it would be good to have push-type help where, if something happens like during the COVID-19 pandemic, they receive money automatically based on their income rather than having to apply for it.
I truly think so. If data linkage reveals that a person is in trouble, local governments can respond immediately. I believe we need to make the convenience of such digital infrastructure much higher.
Instead of distributing 40,000 yen to all citizens, I believe that if the government responsibly manages and makes it visible who needs what, the necessary support can be provided.
I have also made various statements regarding the future of higher education. If someone from a low-income household wants to go to university, I think there should be a system where they receive a push-type notification saying, "No matter which university you go to, you will receive this much support every year," whether it is a public or private university.
I agree. In a digital age where everyone has a smartphone, push-type support is very important. The key is data linkage.
In Japan, when trying to grasp each individual's disposable income, the jurisdictions for taxes, insurance premiums, and allowances are all separate. When combined, the burden rate for young people with low incomes is heavy. Social insurance premiums in particular have become high, and the burden rate for young people with incomes slightly above the welfare level is high even by international standards. I think we must support the young demographic with annual incomes around 2 million yen.
So those young people with an annual income of 2 million yen are in a state of sending money to the elderly.
I believe we should be more considerate.
Various reasons for why things cannot be done come up, such as "this cannot be done because of personal information protection."
Even with My Number Cards, if there is a small mistake, the media makes a fuss. However, health insurance is also moving forward with My Number Cards as a major trend. I think this is important.
Ultimately, we want to ensure that those who need help can receive it through push-type support. For those who have money, we ask them to accept that this flow will be monitored to some extent. That is what mutual aid is about.
We want to make it so that young people and those in need can receive such support.
Wise Spending is Necessary
Regarding national financial resources, you have mentioned at every opportunity that it is important to suppress the issuance of government bonds as much as possible and for the current working generation to bear a reasonable burden.
The population of our children's and grandchildren's generations will decrease significantly. In that context, if we continue with a large public debt, in a world with interest rates, we will have to allocate expenditures to interest payments on the debt, so we won't be able to use as much for the social security of future generations.
Expenditures necessary for the current generation should be covered by the current generation as much as possible. We already have debt amounting to 250% of GDP. Of course, I don't mean everything must be covered by the current generation; I believe that issuing government bonds is necessary for things with a large social return.
If it is an investment for the future, then.
That's right. Regarding fiscal expenditure itself, I would like to see "wise spending" with a large social return.
There were benefits during COVID-19, but benefits need to provide concentrated support to the people who truly need it. About 10 trillion yen has already been used for electricity, gas, and gasoline subsidies. It is necessary to firmly support businesses and households that are truly struggling, but is uniform support necessary even for high-income earners? I believe wise spending is important. Gasoline also has consistency with policies to reduce CO2 in the future. In such areas, I wonder if we can use money in a way that better serves the future.
I agree. But reflecting the voices of future generations is difficult because, as I mentioned earlier, they represent a small percentage of voters, and young people from overseas do not have the right to vote.
In the field of economics, there is a discussion about introducing a system where parents of children without the right to vote can vote on behalf of their children, but I feel this is difficult in reality.
One overseas example that serves as a reference is the initiative of independent fiscal institutions, where independent organizations within the parliament or government issue ultra-long-term fiscal projections for the benefit of future generations. These exist in many OECD countries. There is also a discussion that such organizations and functions are necessary in Japan. The fact that the Cabinet Office finally began issuing economic and fiscal projections up to 2060 in early 2024 is a first step.
Three scenarios have been presented, but the growth case is quite optimistic. Ultimately, it is important to suppress the increase in expenditures such as medical care in a well-modulated way. We must maintain universal health insurance, but how we do it is the question. Especially, what should be the scope of insurance?
Toward a Sustainable Medical System
If anything, they are currently trying to balance the books by suppressing drug prices.
I think it's a problem if it hinders innovation. Digitalization is important in medical care, and I believe we can improve efficiency by advancing it to check for excessive medical treatment and duplicate prescriptions. At the same time, I think we must also review the medical care delivery system.
For example, Keio University Hospital takes pride in being the last resort for patients with intractable diseases and is opening up the cutting edge of medicine.
However, for example, if there is a patient with stomach cancer who also has a heart condition, a cardiac surgeon will join the stomach cancer surgery, but in that case, only the points for the stomach cancer surgery can actually be charged. We assemble the strongest team, but because it is insurance-covered treatment, the medical fees we receive do not change. In short, the more complex the treatment, the more it results in a deficit. But such advanced medical care is precisely the mission of Keio Hospital.
The current situation is that cutting-edge hospitals cannot survive unless the reality of advanced medical care is understood.
There is a system for combined use of insurance-covered and non-covered medical care, and I think it is necessary to combine such things effectively. Keio is also strong in regenerative medicine, but since there are few clinical trials in these fields, I think we should consider utilizing the system for combined use of insurance-covered and non-covered medical care effectively.
In a sense, various hospitals are fighting for survival. For example, a certain private university hospital is trying to scale up and secure profits by increasing the number of beds. I think that's a good thing, but if Keio Hospital were to do the same, there would be an oversupply of beds, which would not be good for Japan as a whole.
Actually, in the Tokyo metropolitan area, the number of hospital beds is sufficient, so insurance-covered treatment can be received without waiting. In the UK, because there are not enough beds, it is common to wait six months for advanced treatment under insurance, so many patients pay high medical fees for private treatment to receive priority. Japan is wonderful, but on the other hand, Japan is the only developed country where the income of specialists such as those in surgery is lower than that of so-called practitioners. This leads to a decrease in people aiming to become specialists.
I think the issue of setting official prices called medical fees is also significant. Ultimately, we want it to be pay-for-performance, don't we?
That's right. There's no need to make a profit, but at the very least, we need enough to make it sustainable.
Also, whether it's drugs, treatments, or medical devices, I want innovation to be more highly evaluated. I think it's important to make drug prices more well-modulated as a whole.
As a patient, one would especially think so.
Regarding drug discovery, a major policy to create innovation in drug discovery was established during the Kishida administration, so things are moving in a good direction. Also, the medical and healthcare industries have been positioned as very important.
However, digitalization and data linkage in medical care in general are not progressing well, so I think we must break through in those areas.
The Philosophy of Education Supporting the Middle Class
In a situation where the declining birthrate is accelerating further, the number of top-tier students will also gradually decrease, but if we do not firmly provide education to the middle class, which we call the volume zone, national strength will decline.
As seen in Yukichi Fukuzawa's Gakumon no susume (An Encouragement of Learning), Keio University has traditionally placed great importance on nurturing "middle-class" people. Yukichi Fukuzawa said that the role of the state is to guarantee the freedom of the people and to restrain wrongdoers. Through learning by the middle class within freedom, various innovations emerge. Since that is the volume zone, we will create a place for learning where that layer can be active.
Recently, because the deviation scores for Keio University's entrance exams are high, it has become difficult for the middle class to enter. I feel that we must proceed with educational reforms with this in mind, together with people from other universities who share the same aspirations of supporting the volume zone.
There is a tendency in every era for children of elites to have an advantage, which determines their later life. How can we create a world where the middle class can live happily, enjoy hobbies, earn a living through various jobs, be respected, support each other as couples or partners, and live brightly? I believe it is the mission of us educational institutions to lead the realization of such a society. What do you think, Ms. Oki?
People who received an education at Keio University have gone out into society, become middle management, become top leaders, and are still very active in Japan today. I believe that such people can make society as a whole sustainable and rich by doing work and management with an eye on the next generation, or by practicing management with an awareness of sustainability and creating new innovations.
Toward a Society Where Diverse People Can Live Happily
Aiming to be leaders of the whole society means exactly that. By the way, did you watch the NHK morning drama "The Tiger and Her Wings" (Tora ni Tsubasa) broadcast in the first half of 2024?
I watched it every day.
In that show, there was a message from the protagonist, an elite judge couple, to their children saying that it's okay to make free choices.
That was a good message.
Respecting the child's will and hoping they find happiness within it. I thought that kind of messaging was amazing.
I think "The Tiger and Her Wings" was wonderful in every way. I feel the same about the part you pointed out.
While worrying that it might not be the way of life their parents wanted, they gradually find happiness, and eventually everyone realizes that it is okay. As a parent, I am always worried, but there was a lot to learn.
It really shows that every individual is diverse. There was also a full-time housewife named Hanae, and I think there was a message that all people can find happiness in their own way of life.
But from a woman's perspective, there were many parts where I felt things really haven't changed even now. For example, a stubborn-looking scholar appeared during the section on the revision of the Civil Code, and I thought, "There are still people like this today" (laughs).
I felt that times have changed when such a message appears in an NHK morning drama.
Yes, I think it's wonderful. It even delved into issues like LGBT rights. Sairi Ito's great performance also helped, and I'm glad I watched it. I watched it with great empathy.
I wonder what the reaction of young people was.
It seems young people were also watching with interest. I think people in their 20s and 30s also empathized with it. The idea that women can also demonstrate their abilities and that diversity is fine.
I hope the government will review various systems, such as the social security system, to make them suitable for the Reiwa era, where lifestyles are becoming more diverse. I also want today's top executives and middle managers in their 50s and 60s to lead management while keeping their antennas high for environmental changes. I believe that making Japan grow and making it sustainable depends on each and every one of our generation. I think it is important to think about various issues for the future.
It has been exactly 30 years since I started working at Keio University as a faculty member, so it exactly overlaps with the "lost 30 years." In the beginning, I focused only on research and left things to others, which is my biggest regret. I feel that from a younger age, we should have raised our voices more while thinking about the future together.
It was exactly 10 years after I became a faculty member that I heard Ms. Okina's congratulatory speech at the entrance ceremony, and I still remember how I felt then very well. I want to work on various things as Keio University now, with the hope that faculty and staff in their 20s and 30s will not have the same kind of regrets in the future. I look forward to your continued support.
The pleasure is mine. I look forward to working with you.
*Affiliations and titles are as of the time this magazine was published.