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 Services Agency's Financial System Council.
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 Services Agency's Financial System Council.
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. From 2017 to 2019, he served as the Dean of the Faculty of Science and Technology and the Chairperson of the Graduate School of Science and Technology. Member of the Science Council of Japan. Appointed as the 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. From 2017 to 2019, he served as the Dean of the Faculty of Science and Technology and the Chairperson of the Graduate School of Science and Technology. Member of the Science Council of Japan. Appointed as the President of Keio University in May 2021. Specializes in solid-state physics, quantum computing, etc.
The Challenge of a Declining Birthrate and Aging Population
Happy New Year. Today, I am joined by Ms. 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 of Keio University, providing tremendous support for the future of Keio University.
Keio University is a Juku that provides a place of learning for many future generations, and is engaged in research and education aimed at becoming a leader of the whole society—that is, 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. As a result, 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 optimism in a good sense appropriate for the New Year, I hope to talk with Ms. Okina about Japan's choices with an eye on the next generation and the future of Keio University.
Thank you for having me. As you said, 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 also went up. Conversely, geopolitical risks have increased, which has difficult aspects, 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 mentioned, 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 serious problem for Keio University as well.
It is inevitable that the population decline will progress to some extent, but within that, it is necessary to create a vibrant society and take long-term initiatives to suppress the rapid decline in the birthrate. I believe this is becoming a very important time for Japan.
Now, many companies are raising the 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 Ceremony Speech 18 Years Ago
Actually, I was first surprised by Ms. Okina, thinking "this person is amazing," at the university's undergraduate graduation ceremony in March 2007. Ms. Okina delivered a congratulatory speech as a representative of the Keio University alumni on stage, and I was listening to it as one person on the floor.
In that talk, you said that 1982, when you graduated, was the last stretch of high growth, just as the bubble was approaching, and that your classmates all joined companies with the feeling of entrusting their entire lives to them, based on the premise of lifetime employment. However, when the bubble burst in the 1990s, some of your peers lost that premise of dedicating their lives to a company.
At that time, it was exactly 25 years since your graduation, but 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 that allows you to be called a professional in at least one thing through your work. 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 now about these three pieces of advice you gave then?
Thank you. If I had the opportunity to speak to young people today, I think I would say the same things. First, I think we are entering an era where professionalism and expertise are increasingly required. In terms of working 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 even in adversity is important in any era. Since there are always difficult situations when you go out into 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 that allows you to be called a professional through your work," you continued by saying, "The era of the so-called 'company man' ended a long time ago." Even if you are fortunately able 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 work. Nowadays, there is the term "job-based," but does having pride in one's own expertise become a mental support and lead to strength as a member of society?
Working 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 an awareness survey by Recruit Management Solutions, people in their 20s and 30s are thinking a lot about their own autonomous and proactive career formation. 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 go to due to transfers, there were times when you couldn't demonstrate your abilities. 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 to provide not only wage increases but also good working environments and opportunities for growth. I think that positive cycle works.
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 transfers.
Even in companies I know, there are increasing cases where the husband quit his job temporarily 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. But 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 feel that way. In particular, not a few women who are active now are playing a pioneering role and face various hardships. I think there are still many who feel anxious 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, "I want you to be persistent and not give up even in adversity," you continued, "When you go out into society, you will face difficulties that cannot be helped by individual power. (...) 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 leeway 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 kinds of support. Mutual aid by various people is important along with public aid. I think it would be good if people can become independent and overcome adversity by successfully layering public and mutual aid in addition to 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 expertise of the work you have worked hard to build." I had the impression that family was 'within,' but the words that 'outside' is everything other than yourself and 'within' is your own expertise had a huge impact.
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 challenged themselves by honing their expertise, were active during times like the financial crisis, and made great strides 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 revitalized various companies. Having gone through such a place, I think I particularly felt the importance of honing expertise and taking on challenges.
Responding to Environmental Changes
2007 was a time when the Internet revolution was happening and the digitalization of transportation cards like Suica was progressing rapidly.
That's right. 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 today's AI revolution, but on the other hand, the world situation was relatively stable at that time.
Geopolitically, there was the collapse of the Soviet Union, 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 starting 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 growing.
The full protection of deposits that had been in place during the financial crisis ended completely in 2005, and companies had become quite lean. China and Asia were gradually emerging there. It was an era when people were starting to call it the era of Asia. But unfortunately, Japan's wages remained low for a long time after that.
From the late 1990s through the 2000s, non-performing loans were disposed of and banks were consolidated to that extent, but what would have happened if that hadn't been done?
At that time, bank consolidation progressed quite drastically; what used to be 11 city banks now feels like 5. With the population decreasing, I think consolidation 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, by taking the time to process it thoroughly, there is an aspect that 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 U.S., but in Japan, it naturally takes a process to change things. In fact, I have been asked if we can really fight with this.
I think the reason they were able to consolidate drastically was that Northern Europe and the U.S. had a foundation where information disclosure was firmly established. 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 called the "convoy system," financial administration was conducted slowly to match the weak points. Because of such things, I think the processing was delayed.
Eighteen years ago, did you feel like you were "in the gap" when working with your peers in their late 40s in the prime of their lives, 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 around the oil shock in 1973, but the economy was still growing in the 80s. When it entered the 90s, the world changed tremendously with the collapse of the bubble. On the other hand, there were many bosses who had successful experiences from 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 I think a gap will open up between companies that can respond and those that cannot.
In the past, under the main bank system, banks had a great influence on corporate management. That gradually changed from around 2000 as overseas shareholders increased, and currently, overseas shareholders are the top in terms of shareholding ratios for companies listed on the Tokyo Stock Exchange. In that way, the environment surrounding companies has changed significantly. While systems such as corporate governance have been considerably refined, I feel that requests for reform from the capital market are also strengthening.
Has the "100 Million Middle Class" Consciousness Transformed?
Next is the part about "I want you to lead 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 results occurred because "the people involved themselves made judgments while keeping their ears closed to the voice in their own hearts somewhere." I think this is exactly the same even now.
Continuing, you asked, "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, "Without forgetting family, friends, hobbies, and various small joys." I also think this is very important now.
Thank you.
In the 1970s, the term "100 million middle class" emerged. It was called the 100 million middle class because more than 70% of people chose "middle" among the choices of upper, middle, and lower in response to the question "What do you think of your standard of living?" I believe this was a very happy thing for Japan.
However, even now, looking at the Cabinet Office's 2023 "Public Opinion Survey on the Life of the People," more than 80% of people choose "middle."
That's right.
But there was also something like this. At a Keio University scholarship award ceremony, a scholarship student representative who grew up in a single-mother household, whose sibling also has a disability, and who has faced great hardships, gave a wonderful speech. What startled me in that was the phrase "In Japan, which is said to be '100 million in poverty'," and the young people in the audience were nodding. Even though it should be the 100 million middle class according to the survey, young people nod at the 100 million in 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 Ms. Okina said in her speech—"living a rich life without forgetting various small joys and so as not to let the water veins 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 at low prices. In that sense, I think there are a fair number of people who think 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. Although 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, as that world is a different world. That area is difficult, but how can each individual feel happiness? Of course, there are problems 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 leeway. However, I think there are problems such as 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. We should reach out not only to those working in companies for reskilling, but also 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 hope to make a leap someday. The term "social bridge" exists in Europe, and I think it is exactly the role of the government, such as the state and local municipalities, to provide support for smooth transitions to the next job.
Despite the principle 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 right. Starting with doctors and nurses, we were truly helped by essential workers during this COVID-19 pandemic.
Firefighters, police officers, and those who clean are also among them.
Since the wage levels for nursery teachers, care workers, and others are low due to public pricing, it is not 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 wonderful.
Furthermore, you mentioned that "in order for companies to operate in the future, it is essential to fulfill social responsibilities such as environmental consideration and support for child-rearing." About 18 years have passed since then; what are your thoughts on these matters now?
I feel that initiatives are finally starting to take shape in earnest. Regarding measures against global warming, European investors in the financial markets began to move significantly around 2015. That international movement has become a groundswell, and companies that cannot respond to environmental issues are now being evaluated as not being sustainable. While the global trend has grown, uncertainty has increased slightly with the possibility of Trump becoming president again.
I am a member of the government's Council for New Form of Capitalism Realization, and its philosophy is to view solving social issues as an opportunity to improve long-term corporate value. In other words, it is the idea of increasing corporate value alongside solving social issues through a growth strategy. This began to be discussed in the United States around the 2010s by people like BlackRock CEO Larry Fink and at the Business Roundtable, and Japan is also moving in that direction. 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 a very important thing.
In your congratulatory speech, you also said, "Leading a life with a good work-life balance requires effort." You concluded by saying, "I want you to walk a good life while making an effort 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 peace of mind and was just doing my best 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. Then I became able to pursue hobbies other than my work. It feels like things get much easier after about 10 years, so I hope that those who are currently struggling to balance everything can successfully overcome the difficult times and spend their lives richly over the long term.
In Ms. Oki's generation, and also in the generations slightly after, almost all married women who are active in their careers undoubtedly have the support of their partners.
That is very important. I think balancing family and work becomes easier if you can help each other. 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 declining birthrate is more advanced in such countries. Therefore, now that we are changing 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 you 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 deeply I have understood and worked on this until now, but without a doubt, young couples today are trying to work in that way, so it's important that adults of the parent and grandparent generations do not get in their way.
Exactly. There is a Cabinet Office questionnaire survey that looks at opinions by age group on the so-called division of roles between men and women—where the man works outside and the woman supports him. Over 40% of those in their 70s and older are positive about this, and over 30% of those in their 60s, but for those in their 20s, it is less than 20%. I believe that the management generation changing 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 shifting it to 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 working generation currently sends about 70,000 yen per person per year to those aged 75 and older, which is like sending an allowance.
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 or so particularly difficult.
If the population continues to decline along with aging, the problem arises that the ratio of elderly people will remain 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 indeed important.
In that context, the percentage of voters aged 18 to 30 has currently dropped to about 15%.
That is what is called silver democracy. This is a major problem, 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 drive innovation. There is also the aspect that it takes time for elderly people to get used to new technologies.
While digitalization is not progressing easily, reforms are moving forward, such as using health insurance cards integrated with My Number Cards to keep records of vaccinations, making everything viewable portably instead of using Maternal and Child Health Handbooks, and integrating medication notebooks.
However, in places like the United States, management is done via Social Security Numbers, and from the time you pay into the pension through a part-time job, everything is totaled throughout your life, and you are contacted via a push-type notification saying that as a result, you have the right to receive this much pension no matter 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, money is automatically received according to income rather than having to apply.
I truly think so. If data linkage reveals that a person is in trouble, local governments and others can respond immediately. I think we need to make the convenience of such digital infrastructure even higher.
Instead of doing things like distributing 40,000 yen to all citizens, I believe that if the government takes responsibility for managing and making visible who needs what, the necessary support can be obtained.
I have also made various statements regarding the future of higher education. If a student from a family without money wants to go to university, I hope for a system where they are notified via a push-type message saying, "No matter which university you go to, you can receive this much support every year," and support can be obtained whether it is a public or private university.
I agree. In a digital age where everyone has a smartphone, I think push-type support is very important. The key is data linkage.
In Japan, when trying to grasp the disposable income of each individual, the governing agencies for taxes, insurance premiums, and allowances are all separate. When combined, the burden rate for young people with low incomes is heavy. In particular, social insurance premiums have become high, and the burden rate for young people with incomes just 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 allowances to the elderly.
I think more consideration should be given.
Various reasons for why things cannot be done come up, such as not being able to do this because of personal information protection.
Even with the My Number Card, if there is a small mistake, the media makes a fuss. However, as a major trend, health insurance is also moving forward with the My Number Card. I think this is an important thing.
Ultimately, we want to ensure that people in need can receive help through push-type support. For those with money, we ask them to accept that their financial 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 trouble can receive such support.
Wise Spending is Necessary
Regarding the country's 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 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, since we are 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 must 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 think issuing government bonds is also necessary if it provides a large social return.
You mean if it is an investment for the future.
That's right. Regarding fiscal expenditure itself, I would like to see "wise spending" that provides a large social return.
There were benefits during the COVID-19 pandemic, 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 think wise spending is important. For gasoline, there is also consistency with policies to reduce CO2 in the future. In such areas, I wonder if we can use money in a way that is more beneficial for the future.
I agree. But as I mentioned earlier, reflecting the voices of future generations is difficult because they represent a small percentage of voters, and young people from overseas also do not have the right to vote.
In the field of economics, there is a discussion about whether to introduce 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. It is crucial 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. In particular, 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 is a problem if it hinders innovation. Digitalization is important for medical care, and I believe we can improve efficiency by promoting it to check for excessive medical treatment and duplicate prescriptions. At the same time, I think we must also review the medical delivery system.
For example, Keio University Hospital takes pride in being the last resort for patients with intractable diseases and is opening up the frontiers of medical care.
However, for example, if there is a patient with stomach cancer who also has a heart condition, a heart doctor also participates in the stomach cancer surgery, but in reality, only the points for stomach cancer can 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-insurance-covered medical services, and I think it is necessary to combine such things effectively. Keio is also strong in regenerative medicine, but since the number of clinical trials in these fields is small, I think we should consider utilizing the system for combined use of insurance-covered and non-insurance-covered medical services 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, the number of beds would become oversupplied, 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 to receive 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, among developed countries, Japan is the only place where the income of specialists such as surgeons is lower than that of so-called practitioners. This will lead to a decrease in the number of people aiming to become specialists.
I think the problem of setting official prices for medical fees is also significant. You want it to be pay-for-performance, don't you?
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 the patient side, I especially think so.
Regarding drug discovery, a major policy was established during the Kishida administration to create innovation in drug discovery, so things are moving in a good direction. Also, the medical and healthcare industries are positioned as being very important.
However, digitalization and data linkage in medical care as a whole are not progressing easily, so 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 gradually decrease, but if we do not firmly provide education for 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 always placed great importance on raising "middle-class" people. Yukichi Fukuzawa said that the role of the state is to guarantee the freedom of the people and to restrain wrongdoers. Various innovations emerge from the middle class learning within freedom. Since that is the volume zone, we will create a place for learning where that layer can be active.
Recently, because the deviation values 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 to support the volume zone.
There is a tendency in every era that if parents are elite, their children also have an advantage, which determines their subsequent lives. 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 our educational institutions to lead the realization of such a society. Ms. Oki, what are your thoughts?
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. Such people will engage in work and management with an eye toward the next generation. Or, by practicing management with an awareness of sustainability and creating new innovations, they should be able to make society as a whole sustainable and prosperous.
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 drama, there was a message from the protagonist, an elite judge couple, to their children saying that they are free to make their own choices.
That was a good message.
It said that they should respect the child's will and find happiness within that. I thought that kind of messaging was amazing.
I think "The Tiger and Her Wings" was wonderful in every way. I agree with the point you mentioned.
While worrying that it might not be the way of life the parents wanted, everyone gradually finds happiness, thinking that this is fine. As a parent, I am always worried, but there was a lot to learn.
It really shows that every single person is diverse. There was also a character named Hanae who was a full-time housewife, and I think there was a message that everyone 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 scholar appeared during the scene about the revision of the Civil Code, and I thought, "There are still people like this today" (laughs).
I felt that times have changed seeing that kind of message appearing 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 make it very good. I watched it with a lot of empathy.
I wonder what the reaction of young people was.
It seems young people were also watching with interest. I think it resonated with people in their 20s and 30s—the idea that women can demonstrate their abilities and that diversity is a good thing.
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 current top executives and middle managers in their 50s and 60s to keep their antennas high regarding environmental changes and lead management. I believe that making Japan grow and making it sustainable depends on each and every one of us in 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 as a faculty member at Keio University, so it overlaps exactly with the "lost 30 years." In the beginning, I focused only on my research and left other things to others, which is my biggest regret. I feel that from a younger age, we all should have thought about the future together and spoken up more.
It was exactly 10 years after I became a faculty member that I heard Ms. Oki'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 because I don't want faculty and staff in their 20s and 30s to 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 as well.
*Affiliations and titles are those at the time of publication.