Govt Indecision Draws Criticism of Ishiba; LDP, Komeito Upper House Members Resisted Medical Co-payment Hike

Kota Iga and Koji Sobata / Yomiuri Shimbun Staff Writers

21:00 JST, March 8, 2025

The government and ruling parties have struggled over making adjustments to the high-cost medical expense benefit system, which is designed to limit the monetary burden on patients. The plan to raise the maximum co-payment limit from August this year has now been postponed.

In response to criticism from patients and opposition parties, the government has been indecisive. This, in turn, has brought the leadership of Prime Minister Shigeru Ishiba into question, which may make the management of his administration unstable in the days ahead.

“It has been pointed out that we are not being thorough enough in reviewing the system. As the government, we must take this seriously,” Ishiba said to reporters on Friday evening, following a meeting with senior members of patient groups at the Prime Minister’s Office.

In saying this, Ishiba made clear that the government would put off implementing increases in the maximum co-payment limit, the first stage of which was due in August.

It was members of the Liberal Democratic Party and Komeito in the House of Councillors who worked to have Ishiba postpone the increase.

The plan was first announced by the Health, Labor and Welfare Ministry in December. The government had since already partially backtracked with two modifications to the plan. However, amid persistent criticism, a sense of crisis has been growing within the LDP members in the upper house.

“If this issue becomes a point of contention, we cannot compete for the upper house election this summer,” a senior member said.

At the party headquarters on Friday, Masaji Matsuyama, secretary general of the LDP in the upper house, told the party’s Secretary General Hiroshi Moriyama: “The voice of the people is strong. The consensus of the LDP in the upper house urges you to reconsider the planned hike.”

Komeito also urged Ishiba to reconsider the planned hike, with its leader Tetsuo Saito making an abrupt visit to the Prime Minister’s Office on Wednesday, negotiating directly with Ishiba on the issue.

Likewise, at the meeting of the upper house budget committee on Thursday, Masaaki Taniai, the party’s upper house chairman, said: “This is a matter of life or death [for patients]. I want the decision to be made by listening to the various voices of the people.”

Ishiba, under pressure from inside and outside his own party, resolved to make a third modification to the plan on Thursday evening. The Finance and Health, Labor and Welfare ministries began full-fledged coordination toward postponing the hike the following morning.

Yet, according to an LDP source, the coordination took time because Moriyama showed his reluctance.

The already modified draft budget bill for fiscal 2025, which incorporated the planned hike starting in August, had passed the House of Representatives on Tuesday and was sent to the upper house the same day.

With the postponement, the budget will need to be put to a vote in the lower house once more, making it necessary to obtain approval yet again from the opposition Japan Innovation Party, which had voted earlier in favor of the modified budget.

When a second modification to the co-payment hike was being considered late last month, Moriyama originally proposed to Ishiba that it be postponed. He was also working behind the scenes with the opposition Constitutional Democratic Party of Japan, which was calling for a freeze of the hike.

However, during talks held on Feb. 27, senior officials from the Finance and health ministries proposed that Ishiba implement the hike as planned. He accepted the proposal, thus rejecting Moriyama’s.

Ahead of the meeting with the patient groups, Moriyama continued to coordinate with Ishiba over the phone, and the decision was ultimately made that the planned hike would be put off and the budget proposal would be amended again.

“I am very sorry [to announce this] after the budget proposal has already passed the House of Representatives,” said Ishiba on Friday evening.

Ishiba has vented his anger to those around him, saying that he had been “betrayed” as the responses taken by the health ministry and others had been slow.

Likewise, there are voices critical of Ishiba within the ruling parties. “It was the prime minister who was late in making decisions,” said one member. “He should have made his decision on putting off the planned hike while the budget proposal was still in the lower house for deliberation.”

One veteran member of the LDP said: “The prime minister’s lack of leadership has been brought to the fore. His latest setback could become a flash point of a movement to remove him.”