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The story
On November 4, a subcommittee of the Fiscal System Council — an advisory body to the Finance Minister — proposed that medical co-payments should aim for a uniform “30% in principle,” regardless of age. Currently, the standard co-pay is 30% for those under 70, 20% for ages 70-74, and 10% for those 75 and older, with elderly people earning working-age-equivalent incomes already paying 20-30%. Starting in 2029, financial income for those 75 and older will also factor into co-payment assessments, and the council is calling for extending this to those 65 and older as well. On 5ch, voices worried about pensioners’ ability to pay clashed with those pointing out the unfairness toward the working generation, and the debate even spread to how welfare recipients should be treated.
A subcommittee of the Fiscal System Council (an advisory body to the Finance Minister) proposed on the 4th that medical co-payments should “aim for 30% in principle, regardless of age.” Starting in 2029, the financial income of those 75 and older will be factored into co-payment assessments. It also called for expanding the target group to those 65 and older.
The standard medical co-payment rate is 30% for those under 70, 20% for ages 70-74, and 10% for those 75 and older. Those 70 and older with working-age-equivalent income pay 30%, while those 75 and older with a certain income level pay 20%.
Full text at the source November 4, 2026, 17:48
Source: nikkei.com / Original article here
What people said
You guys kept complaining the elderly should pay 30% too, right? Well, good for you — medical costs can be reined in a bit now.
Supporting the vulnerable is the whole point of social security.
Whether you're working-age or a pensioner, getting sick or injured hits you financially, and medical care is the first thing you need when that happens — medical care IS the essence of social security.
Team Mirai's push for a flat 30% medical co-pay and Ishin's push to make OTC-equivalent drugs self-pay would just make life harder for the vulnerable people who actually need care — that's a total denial of social security.
Japan's social security burden is so heavy because a third of the population is of pension age, and only two working people (including the disabled and minors) are supporting one person's pension or welfare.
What Japan needs is to get people who are healthy enough to work, but are instead coasting on pensions or welfare, to become self-sufficient.
Concretely, what should be done is cut pensions and welfare benefits for people under 80.
> get people who are healthy enough to work but are coasting on pensions or welfare to become self-sufficient.
Are you seriously lumping pensioners in with welfare recipients?
Pension recipients are drawing benefits based on premiums they paid in the past — that IS self-sufficiency.
It's a personal property right, which is why raising the pension age sparks protests in Europe.
Pensions are a system that skims disposable income from the working generation and redistributes it to the elderly.
The original intent was to support people who'd grown too old or too sick to work, by cutting into the working generation's disposable income.
Now that healthy life expectancy has risen and people once considered too old to work can actually work,
we should scrap pensions for under-80s, which just skim the working generation's disposable income for nothing,
and instead let the working generation keep more disposable income so they spend it on higher-value-added consumption.
What Japan needs is to get people who are healthy enough to work but are coasting on pensions or welfare to become self-sufficient.
Concretely, what should be done is cut pensions and welfare benefits for people under 80.
They're getting way more than they paid in premiums.
Back in the day it still worked out fine because the population was growing (the bike kept rolling as long as someone kept pedaling) — that's all it was.
If the medical costs are genuinely huge, there's the high-cost medical expense cap system,
and doesn't it automatically get cheaper if your My Number is linked to your health insurance card?
For genuinely expensive treatment, anyway.
That's already the case, though.
There's no way you can afford a 30% co-pay living on a pension.
Give back whatever got skimmed off the top or squandered, will you?
Did they blow it on pointless events, 'culture,' or sports?
Go claw it back from everyone involved.
This is about medical costs.
Can't they just cover that with private insurance?
They won't pay it.
Honestly, ever since they created the late-stage elderly category,
they should have been cutting back on medical care for that group,
but politicians slacked off on it.
That's why Japan ended up with a falling birthrate, an aging population, crushing taxes, and no growth.
Apparently every 5ch user earns over 100 million yen a year AND is an immortal Peter Pan who never ages, so none of this is their problem — none of it.
Are you living in some fantasy land where you think the elderly can pay, out of their pension, for private medical insurance robust enough to cover their actual medical costs?
We're talking national health insurance, long-term care insurance, AND private medical insurance premiums, all together.
In the end it's their working-age sons and daughters who'll have to pay for all of it anyway.
If parents had plenty of time before old age to prepare with private insurance and the like, but neglected to,
isn't it fine to just cut them loose once they hit a certain age?
If it's going to be such a heavy burden, can't you just give up on care and medical treatment?
Give up, and then what, lol?
Just leave your elderly parent suffering at home with no medical care or caregiving at all?
that age threshold's going to drop from 75 to 65 in no time.
And under-65 is coming too.
The government probably wants to tax the people who saved up a ton and FIRE'd (retired early) at 50 as well.
Exactly, which is why it has to happen as soon as possible.
I was in a shared ward and paid around 200,000 yen after hitting the high-cost medical cap,
while an elderly person who had the same surgery got a private room, paid only a few tens of thousands under the high-cost cap, and even with the private room fee added it came out about the same as what I paid — kind of made me envious, and also like something was a little off.
That's infuriating, right?
both the pension system and health insurance will probably have collapsed, making it nearly impossible to ever recoup the premiums they paid,
and the population ratio will likely be even more dire by then.
Since it's a sure thing that it's impossible, the government is frantically pushing 'invest, invest.'
But that alone won't cut it anymore — it's too late. What's waiting is a catastrophic world where even money made from investing turns to worthless paper.
So what you should really be preparing isn't financial engineering, but survival skills.
The government is the one that issues the currency, so if money is needed, the government can just spend it — population ratio has nothing to do with social security.
Background and Key Points of This Topic
Medical co-payments are divided by age: 30% in principle for those under 70, 20% for ages 70-74, and 10% for those 75 and older, rising to 20-30% for those with working-age-equivalent income. This structure has been in place since the late-stage elderly medical care system was introduced, and the thread saw complaints about the system, including questions like “what’s even the point of having a separate late-stage elderly category.” The core of this proposal is how far financial assets and financial income should factor into co-payment assessments — it would first apply to those 75 and older starting in 2029, with expansion to those 65 and older also under consideration. This measure targets elderly people who have assets or financial income even if their pension income is low, meaning early retirees could be affected too. Where opinions split in the thread was over how to judge the elderly’s ability to pay: voices saying “you can’t afford 30% living on a pension” clashed with voices saying “if you have assets, you should pay your fair share.” The question of welfare recipients’ burden also came up, but what’s easy to miss from the replies alone is that this proposal is strictly about revising co-payment categories within the health insurance system, and is a separate matter from the welfare system.
※This article is excerpted and summarized from the 5ch (News Express+) thread “Elderly Co-Payments Should Be ‘30% in Principle,’ Says Fiscal System Council — Also Requests Wider Use of Financial Income“.
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