Japanese React To The US Healthcare Costs | Street Interview 

Thank you to all our community members and interviewees for participating and helping to bridge cultural gaps. Join asianboss.io if you want to be part of this exclusive community and bring people’s voices together. We are on an important mission, so please watch and share this message video: ru-vid.com/video/%D0%B2%D0%B8%D0%B4%D0%B5%D0%BE-7ukfLMmI8XY.html

Im an American, but im a resident of Japan. I got injured once and needed an MRI, Xray, Medicine, and 2 visits with a specialist. I was deathly scared of the bill. I nearly cried when my total bill was only about $100.

I think those of us in the US all just kind of put up with it, grudgingly. But when you actually try to explain it to someone under a different system, boy does it smack you right in the face just how F'd up it is.

I had appendix in the US. I was carried to a hospital in New York, and to my surprise, they told me that the hospital could not take my insurance. I took a taxi to another hospital, where they also denied my insurance because they "did not work with the insurance company". I booked the next flight to the Netherlands where I am a citizen of, and got my surgery. It costed me 400 EUR (about 500 USD) for the operation and 3 days in the hospital. If I were to get a surgery in the US uninsured, it'll bankrupt me.

Y’all forgot to mention in USA they don’t tell you how much it cost upfront lmao 😂. You get surprised in mail

I came from Switzerland and living in Tokyo. I remember a few years back me and my friends ( a French, an Austrian and a newly arrived American) went for a skiing trip to Nagano. On that trip my american friend had an accident and when I called for an ambulance he was so terrified of the price! Also,he's a type 2 diabetic and he practically wept when he learned how cheap the price of insulin here in Japan compared to the US.

Even with insurance, i had to pay $1,500 out of pocket for an emergency room visit since I didn't hit my deductible limit. Doctor saw me 5 minutes tops, told me everything is ok, and gave me a vitamin drink. What a ripoff!!

I'm moving from the US to Thailand at the end of this month. A major reason is health care costs which will eventually bankrupt me and many Americans over the course of our lives. My neighbor broke her leg. The bill was $60000 before her insurance kicked in but she still had to put out a considerable sum. A doctor friend once explained the US health care system to me as"People here are fine with it until something breaks - they lose their job, lose their coverage, get a chronic condition, then the whole thing spirals out of control."

The national debt, housing costs, record credit card debt, inflation, rising cost of living, etc. Health care costs are just part of the problem. America is lost.

we need to take back the healthcare system from the insurance companies who are practicing medicine without a license.

1 of the interviewees said everyone pitches in to make sure Japanese citizens have healthcare and he seemed glad to do it. Here in 'merica, many believe there are those who don't deserve healthcare (homeless, drug addicts, unemployed, etc) and abhor the idea of "pitching in". Really highlights the community vs individual mindset of Japan vs America.

This is what I was paying in Japan: • Doctor visit: ~$9 • Prescription medicine (for typical colds, other basic ailments): ~$17 • Yearly medical check: Free • Dental cleaning (w/ first time visit fee, left/right/panorama x-rays, cleaning): $30 • Dental filling (one visit, local anesthesia, white composite filling): $17 Of course the USD amount I wrote fluctuates with the exchange rate but it is way more affordable in Japan. In fact, my U.S. dentist even advised me once to get my work done in Japan since it’s cheaper.

Last June, I was crossing the street when I was hit by a car. I recieved minimal care and still suffer from chonic pelvic and head pain, but I now have over 85,000 USD in medical bills. At the heart of this system is profit. It's cruel.

As an American, it's not fair. It's not fair man! For Healthcare alone, I'd move to Japan.

Lmao I love the laughs and the reactions of the Japanese interviewees after hearing US healthcare costs😂 theyre flabbergasted lol

As a U.S. citizen those bills even make you have an heart attack instead of getting treated properly.. how sad😢

As an American, I clicked to see the shock on their innocent faces. Even after learning how high medical treatment can get in the US, and their answers started going higher, I laughed because I knew those numbers were still too low. But I also cried on the inside. The concept of calling an ambulance or going to the hospital unless it's life or death sounds foreign to me. And to that one dude, no we are not rich, $30,000 for a one night hospital stay would financially destroy most of us.

I watched a recent doco about "patient dumping" where they literally dump patients on the street in the middle of the night to make way for new patients. This isn't a flaw. It's just straight up greed..

And there are people in government who genuinely see no problem with this. God Bless America.

I went to the hospital last year with extreme pain in my back and side. My roommate drove me, since I knew it would cost me a huge amount to call an ambulance, but the pain was so intense I felt like I was actually going to die. When I got there, I was taken to a room, had my vital signs measured, and eventually I received an abdominal CT scan and an ultrasound. The CT scan discovered a kidney stone lodged in one of my ureters, but by the time I got in for the ultrasound, it had passed into my bladder and dissolved. I received no treatment, only diagnostics. The bill for my 6-hour stint in the hospital's waiting rooms was over $10,000. Fortunately, my health insurance picked up 90% of that, leaving me with a $1000 bill. I was recently laid off, so now I don't have health insurance. I am desperately afraid of what could happen if I have to go to the hospital before I start a new job.

Man going to the doctor for a sore throat just hits different. For me, salt water mouth rinse, some soup, and just rough it out.

as a Malaysian, as crappy as the waiting times in public hospitals are, i am grateful its immensely affordable... my father regularly needs heart medication and he collects them from the gov hospital dispensary and it only cost him less than 50 cent usd to collect his prescription. i once contracted dengue fever and had to be hospitalised. i was almost there for a week and i paid less than 20 dollars usd for my whole duration at the hospital. i recently did my digital mamogram and breast ultrasound at a private hospital and the whole thing cost me 460 malaysian ringgit (around 100 usd) its insane a simple infection can put you into debt in the US. what is the land of dreams? its sad. a reform is definitely way overdue

As an Argentine living in Australia that had a chance to move temporarily to the US I see myself choosing Australia as a total win.

Average life expectancies, developed nations with universal healthcare (ex-USA): Japan, Hong Kong/Macau, Singapore: 85 (Japanese females: 88; males: 82) South Korea, Italy: 84 [...] USA: 77 (American females: 79; males: 73)

I knew it was high, but I am still surprised by the amounts.. I’m so sorry for those who are too poor to afford health insurance in the US. It’s crazy!

Finding a company with great health coverage is so important (at least for my family and I). I also wanted to add that cost of living in your area can drive cost of medical. For reference, median annual income in my state county is 100k, so cost of living is high along with cost of medical care. 100k might sound like a lot somewhere else, but that’s middle class where I live. 3 nights at a hospital to deliver a baby via cesarean cost me and my baby $100. I delivered at one of the best hospitals for maternity care in my state too. No, I don’t have state assistance. No, I’m not rich. I have an employer that has high coverage.

Our US healthcare system is completely broken on every level. Recently, I was hit by a drunk driver and sustained medical injuries. I have had to pay all co-pays upfront because the car insurance won't pay until all my treatment is complete. I have had to pay hundreds of dollars already and now I need surgery. I don't know what I'm going to do to cover my co-pays for surgery and more physical therapy.

A situation in Serbia. My mother is a retiree, 68 years old, and she spent two weeks in a hospital for covid and heart problems. The ambulance picked her up and took her to the ICU because she had troubles breathing, and the next day they transferred her to the covid section. She was hooked on a NIV for 24 hours. The total cost she had to pay from her pocket - 0$. The only insurance she has is a national insurance as a former employee and now a retiree.

When I was in Japan on vacation I ended up at a Japanese hospital in Kyoto because I came down with a horrible sinus infection and eye infection. After the consultation and medication, it cost me $60 USD total due to no insurance. I was expecting it to be at least a couple hundred dollars.

“Healthcare needs to change badly” - says a New Jersey citizen

In 2023 my friend spent 3 days in the hospital here in Oregon , USA for an infection. Just for crossing the emergency door was $1200. Just for stepping in. When he got his bill. The total bill was $35,000 for 3 days in a hospital.

U should do the other way around …interview ignorant US citizen how much more reasonable healthcare in other part of the world… but their reaction probably be like “what?! There are other country beside US??” Or “but, we can carry gun!!!” 😂😂😂

Maybe if The US starts caring more on their own citizens and focus on internal issues rather than funding weapons to other countries things can actually be better :|

Here in India🇮🇳 we get all these basic health care for FREE. Calling ambulance dial 108 and they are at your doorstep asap for free. 🇮🇳 We are growing and will keep.

I laugh at these answers, but it’s mainly to keep from crying, lol 😭😭

I'd like Asian Boss to do the same street interviews in other countries like Singapore, China, S Korea, Thailand, European nations, India, and even some poorer countries to see how the same treatment differs in an American healthcare system vs those countries above.

I was expecting their system to be more affordable, but those prices and their frequency and reasons for getting care really blew me away. The idea of having a healthcare system that's not as for-profit is just boggling to me

An appendectomy is $33,000 excluding lab fees at Beth Israel on 15th Street in NYC (with traveler's insurance that they won't accept). Healthcare here is simply disgusting.

Great interview. This is what you need to do more of!

Even being a developed country has its own problems. I always advice my friends or colleagues who go to US for study to get yourself checked twice and go there completely healthy and avoid any sort of activities that might land you up in ER. As a doctor myself it was my dream to work in US, but im glad i didnt go and stay in India where i completed my residency and now in Australia doing my fellowship and living a satisfied life

Two of them absolutely nailed it, people just don't call an ambulance or go to the hospital when they absolutely would need it because it's prohibitively expensive out of pocket. Which is a shocking result, and shameful for us as a country really.

I would never live in the US.

In Spain we pay 0€ per doctor's visit, 0€ if you go to the hospital, emergency or not, and 0€ no matter what procedure you get, from a simple cold to a major operation. That includes giving birth and others... And any prescribed medication we pay about 10% of the price. But I won't say it's "free" for us since we have like a "mandatory health care insurance" which we pay from our salaries (company about 25% and worker about 5%, but that includes health care, unemployment assistance and retirement salary among other uses). Kind of the japanese system, but we have 100% covered, not only 70%. Anyway, sounds pretty good to me, and even the japanese system is "rare" from my perspective by making me pay, so not to mention the US one.... Yes it has flaws, we have to wait a few days to get to the doctor, probably some months to get an operation (if critical, is obviously quicker), but we don't have to worry about "getting broke" and such hassels or being scared even to call for an ambulance... And you can always apply for a private one and pay extra for that. So, as someone could say, are "healthy" people paying for the "sick" ones? You could say that, but that is what an insurance is for, and I would be glad to do it anytime, would be for me or any of my close ones, be for whatever stranger, since you never know what could happen.

I was a little worried about my health a few years back and had identical bloodwork and CT scans done in Japan and the US. I did not have insurance in the US at the time, and the price differential was staggering. The blood test in Japan that was about 3200 yen out of pocket was $490 in the US, and the CT scan was 11,000 yen versus $3,400 including the consultation cost. They even charged $80 for the CT results report itself! Total insanity...

It was $4000 for an ambulance drive half mile to Saint Thomas Hospital West in Nashville TN.

I had to get a biopsy for my liver 15+ years ago. All I can say is the medical bills and the charges were just a hair away from 6 digits. Insurance took care of most of it but I will never forget that ever and it was a real eye opener and have tried to live as healthy as I could since that day. The US healthcare system is truly a scary monster

I am paying off a bill that is over $7000 right now. That's AFTER insurance. Before that, it was $14,000. I had to go to the ER in the middle of the night because of severe abdominal pain. They never diagnosed anything after tests and just told me to see my primary and sent me home. I only saw my doctor at discharge and didn't even get anything from him other than paperwork, which I had to go through myself to find out that it might, MIGHT had been an ovarian cyst bursting (though I can't be 100% sure). What a wonderful system we have, where a doctor can't/won't tell you what's wrong with you and still charges a massive fee

I'm an American who grew up here in Japan and I don't know what to do. My Japanese isn't good enough to work in a Japanese company so I might have to move to the U.S. But I'm absolutely terrified of the medical costs and how difficult it is the live in the USA. I don't know what to do...

My case as an example of medical expenses in Japan. In the last month, I visited the hospital three times for a broken toe. X-rays were taken once each time.The total payment was about $30.Public medical insurance is $40 per month. Twenty years ago, I gave birth and the accompanying 5-day hospital stay (in Japan, 5 days for a natural birth and 10 days for a cesarean section is normal), and the bill was $2,500.However, I received $3,500 from the local government because I submitted the birth certificate issued by the hospital to the municipal office.This includes the congratulatory money from the local government for diapers and milk. My 80-year-old mother's case: public medical insurance is also $40.Private insurance is $100 per month. One month hospitalization requiring dialysis: no dialysis fee, hospitalization, treatment, and medication cost about $500.However, she received $800 from private insurance. Charged $150 for cataract surgery on both eyes. However, she received $700 from private insurance.

We pay 30 baht (100yen) for public hospitals in Thailand. No matter kind of sicknesses.

Very interresting interviews! In Sweden we have the same system as Japan. Everything is "free" (paid by taxes), everyone gets the same healthcare, you dont need to be a millionaire to be sick. My youngest daughter has Diabetes Type1, i would have to sell my car and my house to be able to help her in the USA. Amazing USA....😂😂😂😂

I hate our healthcare system, Baltimore Maryland

Im from Indonesia, for us to have medical checkup on local regional clinic, it cost around $1-$1,5 (med included) If you got to medium hospital, without insurance, you spent around $5 (without med) and for specialist doctor around $10-$30 for one consultation with kight checkup. The insurance cost is free for poor citizen, and around $2 - $10 monthly for working class citizen. But dont expect a high tech medical treatment like on the US!

Expensive healthcare is one brick in the wall of pain for the American consumer. Talk about the growing cost of rent, of home ownership, and how much we pay for bad food...

When my daughter got sick (really bad cough) in Japan while traveling, I called a pediatrician in the area and they were able to see her on the same day, and it was 6300 yen (about 45 dollars) with no insurance. Sadly, with my high deductible plan in the US, an office visit with a PCP would cost me about 100 dollars with insurance and that's if they don't order labs or other extra stuff.

Essentially why I left corporate America. Crazy country, guns, and healthcare.

genuinely curious how america's population still growing when even giving birth is expensive af . 18000 usd would discourage me to even dream about having kids

I love when we get to see one country's thoughts about another - very authentic perspective - trying to get to this level with my videos!

1500 dollars for calling the ambulance is already a very cheap price. My friend who got involved in a terrible motorcycle accident was charged around 3000 dollars.

It would be interesting to see what Japan and the rest of Asia think of Australia

Man i knew it was bad in the us but $1200 for an ambulance? 18k for giving birth? that is completely insane (here all care for mothers and kids is free and i think an ambulance might cost $20, but that fee can be waived as well)

Love your videos ❤

I am in japan without any insurance, had to do a full medical check up. From blood tests, xray, urine, MRI, and so many others. It took me one full day for the whole test. The bill was around $ 500. And my friends told me that's expensive.

In America, we are fooled into believing we are saving money excluding the needy from healthcare when we pay twice as much for it. By charging exorbitant prices, our doctors are seduced into thinking they should be rich and have opposed healthcare for all. We pay insurance companies when we are healthiest and have our lowest medical bills. When we are too ill to work or take care of ourself, we need to depend on our life savings and government aid. The government pays for 2/3 of all healthcare, but we have 30 million with no coverage at all and about 80 million who cannot afford healthcare because they have bad healthcare insurance with high deductibles and other out of pocket expenses. A sane system would have us chipping in when we are healthiest and working to cover us when we can’t care for ourselves any longer, we pay insurance companies instead. If we become disabled to an accident like a car accident, we lose our jobs and healthcare insurance, and will need to depend on government aid and our life savings. We also need to spend all our money until we are impoverished to qualify for government longterm care that requires hundreds of thousand of dollars a year. Medicare is underfunded and does not cover long term care.

There is a youtuber that had to be flown out of a forest with a helicopter because of health problems... she got a bill of $65 k 😂... but luckily, she had insurance... I live in Germany and I never have to pay for the doctor... we are a family of four and we pay $250 per month for all of us... Some Americans criticize that we have to wait way longer for an appointment, which is possible, though I personally never had a problem with that, but we can also pay cash like in the US and have an appointment in 1 or 2 weeks... So we can go for free and wait, or pay... or we can go to the ER for free, but we obviously can't go there because we coughed twice the day before

Overnight stay after birth at Hoag Hospital in Newport Beach CA 20 years ago cost $20000 with insurance.

Health insurance companies should never be publicly traded.

What this vlog doesn't review is how much a month is health insurance in the US ? Sure without health insurance most will get a huge bill they can never repay, but also even with health insurance it costs around $800usd/month for good basic coverage so if you have a family of 3 that would be $2400usd every month !

this is why american GDP is the highest. not because the people are rich. but because everything are super expensive.

I need reminders like this every so often just how insane the US system is. I remember when I finally got my kokumin hoken my first month in Japan and just how much of a relief it was. It's impossible to describe the overwhelming sense that if you're in an accident in the US, it's better to die than be in debt.

In China, an ambulance call is about $80- $100, a hospital registration fee is about $3, and if it's just a cold or stomach ache, the total cost is about $20. Last year, I had a rectal polyp removal operation in the hospital, and the total cost of the operation, including hospitalization expenses, was about 1,500 US dollars. Because my company pays the mandatory employee medical insurance, I only paid about 600 US dollars, which is about half of my monthly salary after tax.

Hi, I’m from America. My liver and kidney transplant is a little over 1m alone.

Unless you start by giving any overview of how taxes affect healthcare costs and take home pay, this conversation seems misleading to me. For example: A family with a take home pay of $100k in the U.S. would pay ~$23k in income tax (even less if claiming dependents) whereas in Japan they would pay ~$36k in income taxes. Your take home pay in Japan is $13k less. Most health insurance annually is less than $13k, so most of the time you end up saving more money annually in the U.S. due to lower taxes at that income level (which you can save up for a emergency if needed, though insurance should cover a large portion of healthcare costs). Private healthcare in Japan can still cost $330 - $370 per month. In addition to the higher taxes you pay. There of course is a break even at some point where a lower income compared between US and Japan does not see tax savings that offset the higher healthcare costs in America, but even at $40k a year, you save $4k in taxes compared to Japan that could go towards better health insurance and provide better coverage to reduce any potential healthcare costs. Plus, with decent health insurance, you can go get surgery basically whenever you want in the U.S., whereas many countries with more universal healthcare have a long queue if the surgery is not deemed urgent (this is coming from someone whose in-laws live in Australia and who has coworkers in the UK that often complain about the healthcare for specialists). It’s mainly those that do not have health insurance that get screwed by the U.S. system (although if you picked them up and placed them in Japan, they’d earn less money and likely deal with a higher cost of living over there.. except healthcare). Not saying which way is right or wrong. But both systems have clear benefits for different groups of people.

It costs nothing if I am using public healthcare system and around $15 - $50 for consultation in private hospital (even with specialist doctors). I found our system is really good now after I heard US healthcare system are so so so expensive like that.

Americans aren’t rich, we either go into debt for healthcare or go bankrupt or, sometimes, die. I believe the main reason we think national healthcare will have worse service is because the state healthcare provided for low income people is pretty awful. The fees are covered by the state but the waits are long and often doctors don’t seem at all concerned with finding what is wrong. We just assume that other countries experience the same or worse, since their system serves more people.

Flfc!!! Love ur channel keep going ❤

here on germany it's the same as in japan - we pay for healthcare through taxes and have to pay a similar amount for the things mentioned on the video as in japan. i was shocked when I heard about the prices in the US for the first time. they really need change their healthcare system, people going broke bc they are sick is crazy

nice this have a community forum!

This is the reason health insurance has to be a thing. Honestly I saw my bill once and it was insane but for one medication it was over $600 US and yeah it’s insane to me. Some hospitals actually post a $30 US fee for a tissue. We do have some ways of cost reduction like doing a billing item inventory as some services which weren’t done should not be on the list and would be taken off. You may also have charges that are too high for some reason so an item check could reduce the cost. Always ask for an itemized check when you get the bill as sometimes the hospital accidentally overcharges because they haven’t switched to the computer system yet or the software might be outdated. Fortunately I have insurance and it helps a lot.

Do this in every country you have teams able to do them in. The only way we gain better perspectives here is to see other places in the world with similar living standards, but who aren't being gouged for life's maintenance.

And yet, when I have lived in other countries they are always asking me 'why don't you want to live in the US anymore?' Then I tell them about the laundry list of problems just being a citizen both domestically and abroad. While the country seems like a fun and wild place, it is also very poorly organized for their people. That is why I live in the Nordics now and plan on gaining citizenship elsewhere if the offer presents itself.

4:35 perfect choice of words there

If you catch a cold in the US you don't have to see a doctor though. You can just get some medicine from the store on your own.

Having a health crisis in US would be the end. Id just stop living rather than be in that enormous debt

Everyone talks about health care costs, nobody talks about the wretched quality. US doctors require US doctor licenses, and those require "knowledge" made with horrible methodology. US medical care will give you a pill instead of a good diet plan, it will give you medical treatment instead of prescribe physical exercise, it's designed to sell you drugs. You can get top notch care if you are rich, but the best doctors don't take medicare and probably won't take your standard insurance either, not the best ones at least, unless you got cadillac insurance (very expensive but high quality). But wait, it gets worse. People who are not professionals often are legally banned from giving you advice to help you avoid needing medical care. Sure the health care is expensive, but the worst part is how they railroad you into it. It's not good healthcare. They even fired the healthcare workers that didn't get untested experimental vaccines. The entire industry is messed up, and you might get better care from illegal drug smugglers, er I mean undocumented pharmacists.

My current prescription cost for a single medicine is $147 per month. That is with insurance. It is insane and unacceptable. This is for a medicine I need to be able to function and live

At one point I didn't have any health insurance and I had to go to the hospital for 4 days and got an MRI and steroids via IV every 4 hours. I told them I didn't have any insurance and they just said "don't worry, we'll work it out". I didn't have to pay anything. Now I'm lucky to have Medicaid insurance. I don't pay anything for doctor or hospital visits or prescriptions. Regular dental visits are free and I get a big discount on other dental work. Eye doctor visits are free and one pair of glasses per year but right now I can't find anyone who accepts the insurance for glasses.

American healthcare is insanely expensive but still the best quality in the world. We do the best medical research and have the most unique and rare surgeries and treatments, along with the best facilities. But it's all so unbelievably expensive it will put you into debt unless you have good healthcare. Big pharma companies here are to blame. If they could be taken down and free competition could occur again, the prices of medicine would significantly drop. Also, healthcare and the right to life should be a basic human right anyways and the government should guarantee at least basic free healthcare.

its a good thing i live in canada

Wow that's really interesting I didn't know

in Indonesia there is an insurance program from the government called BPJS, and the cost is only Rp. 150,000 or less than $10 USD, and the insurance covers almost all illnesses, even giving birth is free in Indonesia if registered with BPJS, my father has a health check every month at the hospital, and doesn't pay for anything including medicine and insulin for 1 month's supply, in fact hospitalization is also free. Indonesia, which is not a developed country, can be cheap, why is it only America that is expensive?

god I hate it here in the US

If you are low income, health insurance is free in the states. Medicare and medicaid covers it. If you are middle income, you better find a good company that give good and low health insurance coverage. If you get fired or out of job, go apply for free health insurance.

In Canada you get full free coverage, but the wait times are ass.

Should have told them the price of 1 Tylenol in the hospital. Cost me $24 USD. Its insane

this survey is a little misleading since all the prices are for paying out of pocket without considering the services the government does provide. first most people in the US has insurance, which for the most part cuts down on these costs. second those who do not have access to insurance either due to poverty or being unemployed can apply for government subsidized healthcare programs such as federally funded medicaid, or various state funded programs like medi-cal. these programs offers low cost to free health insurance. the biggest problem with the US healthcare system is that the middle class has the worst deal. those who are in poverty can take advantage of government subsidized healthcare, and those with good jobs or are financially stable have employer sponsored healthcare. its the middle class working not-so-great jobs that gets screwed due to the employers only offering terrible insurance programs in order to save money. but at the same time making too much money to qualify for government subsidies. there are tons of real problems with US healthcare, but this video is making the wrong points, as nobody really pays those prices.

wait, seriously, "the average Japanese person goes to the doctor 13-14 times a year"??????? WHAT? WHY? That's overuse. Maybe twice a year... or maybe this is "average" as the very young and very old go A LOT MORE than average. That seems insane to me (US).

Health insurance taxes in Japan are 5% of annual income. Even if you lose your job, you must pay insurance taxes based on your annual income from the previous year. If you don’t pay, your property will be seized and you will have to pay all medical expenses yourself.

Their reactions are amazing, I think, that's how most people react to US healthcare prices. Great video Asian Boss!

It's so easy for people from much smaller countries to act like we should do what they do. Right now the Canadian health care system is doing their best to assist people offing themselves. The British system is broken and you can hardly get in to see someone. The US health care system was broken by the interference of government and the collusion of the government with insurance.