Japanese American Seniors and the US Healthcare Crisis

By David Monkawa. Posted on March 5, 2021.

There is a crisis in the Japanese American communities. It impacts all Asians, all elderly really. We have the most numbers of seniors over 65 in the nation, about 19%. More than any other race. On average, nursing homes start at $5,000 a month. Bilingual bicultural care is a lifeline for non-English speaking people but is considered an “amenity” in some private healthcare facilities for those who can afford it.

Medicare only partially covers nursing homes up to 100 days. If your income is $1,200 or less per month as a single, you can get Medi-Cal to cover long term care (LTC) but the reimbursement that the government sends to LTC facilities is only $200 per head per day. Medicare reimburses $600. There’s a built-in monetary incentive to admit patients with the highest reimbursement rates. There are 2 million beds in the US but in another 30 years, 27 million more beds will be needed for the elderly.

The tragedy of the Keiro Nursing homes in LA is a good example of the failure of the US healthcare industry. Its goal is to make money from illness, not to prevent it.  As more corporations take over non-profit nursing homes and hospitals like Keiro, working class and low-income folks are phased out along with bilingual bicultural services.

How did the Japanese community get to this point and what can we do? In countries like Denmark, long term care is free. It’s a part of their overall universal health system similar to “Medicare-for-All” with nursing home coverage included. Why can’t we have that in the US?

What was healthcare like for Japanese in America?

Hawai’i circa 1900. Portuguese “Luna” overseer with whip looks over Japanese sugar worker.

At the turn of the century, Japanese immigrants like others had no healthcare insurance. They paid the local doctor cash, if they even served Japanese. No need for “nursing homes” since the average lifespan was about 50 years, even for white males. The earliest demands for rudimentary “healthcare” were packaged inside collective demands when Japanese sugarcane workers wanted potable water, toilets, and first aid as part of broader labor actions for better pay and conditions. The 1903 Oxnard Sugar Beet strikes led by the Japanese-Mexican Labor Association and struggles of Japanese and Chinese sugar cane cutters in Hawai’i are good examples.

In the cities, prefectural associations called “Kenjin-Kais”, trade groups, doctors, business people, temples and churches would pool together funds called “tanomoshi” to build Japanese run clinics. Hundreds of certified Japanese midwives immigrated to the US before 1924 when Asian immigration was halted. The “sanba”, midwife in Japanese, birthed a majority of the Nisei born between 1910 and 1940.


Japanese midwives from Kyoto training in Chicago, early 1900’s.

Midwifery was more than just birthing babies for Japanese and other women of color because hospitals would not serve non-whites. Safe birth was a life and death matter that often came with political and legal risks. The Japanese midwives were not only nurses but served as gynecologists,  counselors, social workers and translators for Issei mom’s, many who were picture brides. The basic team of Japanese male doctor and midwife was a pillar of healthcare for the Issei.

A Pandemic stirred with racism

The Flu Pandemic of 1918 hit California at a time when anti-Japanese racism was at a high point. Anti-Japanese Leagues were being publicly organized on the west coast from 1916 onwards.

Japan shockingly beat Russia in 1905. This was the first time an Asian nation defeated a European power which rattled US elites. On the west coast hostility against Japanese grew as they began to “compete” with whites for jobs. Japanese farms and orchards became more valuable than their white competitors. School and housing segregation ran rampant, alien land laws and statutes were passed, and anti-miscegenation laws were enforced harshly. Rumors were spread that the Japanese or other immigrants brought the virus. Hospitals and white doctors refused to treat Japanese. Non-masked people were jailed, classes and meetings were held outside, social distancing and sterilization was required.

1918- Los Angeles, “Wear a mask or go to jail”

1918 – Japan. Schoolgirls masked up

Few records remain of how many Japanese died but judging by the outpouring of donations by Japanese communities from Washington to San Diego to quickly build hospitals, the toll must have been significant. In L.A., the earliest Japanese hospitals were built in Little Tokyo and Boyle Heights. Because it was one of the only areas without racial covenants in home deeds that forbid the owner to sell to non-whites. These hospitals were the precursors to the Keiro Japanese nursing homes now owned by Pacifica-Kei-Ai.

Japanese Hospital in Boyle Heights, 1929

A pandemic in a racist environment spurred the creation of Japanese hospitals. One hundred years later another pandemic in a racist environment may contribute to the end of the last Japanese nursing home formerly called Keiro. This is due to developers like Pacifica Co. seeking to kick-out seniors to build apartments.

The “New Deal” and some old raw deals

Corporate profits and inequality reached historic levels and led to the Great Depression. FDR considered a “Medicare-for-All” type of national healthcare, but massive unemployment and homelessness was a bigger priority. His platform was jobs and union rights for workers. But not for brown farmworkers, as a favor to California’s Big Ag. Unemployment insurance, relief for farmers, social security and housing – these were demands raised by the social movements of leftists, progressives, unions, people of color and women.

FDR told Wall St. to pony up 75% in corporate taxes to create the “New Deal” or prepare to fend off the angry unemployed and evicted at the gates. In 1933, he stated, “No question in my mind that it is time for the country to become fairly radical for at least one generation. History shows that where this occurs occasionally, nations are saved from revolution.”

The New Deal created a great boost to the economy and millions of jobs for all people including many people of color outside the South. It proved that getting money into the hands of people on Main Street was the path out of the Depression, not austerity. But many were also shortchanged when the “deal” was dealt. Anyone not a citizen, including all Issei and most immigrants were out. Nisei were young and many received WPA jobs. But whatever Japanese gained from the New Deal evaporated when we were thrown into US concentration camps in 1942.

African Americans suffered in the Jim Crow South. Native American Indians were confined to “reservations.” Mexicans, many of whom were US citizens, had been rounded up in Boyle Heights and across the nation and deported by the millions during the Depression. All of these folks and residents of the 16 territorial “possessions” of the US, did not get the full benefits of the New Deal.

The New Deal was the right fix for the country. But FDR’s racism yielded to the demands of California’s politicians who represented the interests of Big Agriculture, bankers and local white supremacists. This alliance finally found in WW2 the perfect excuse and scapegoats to demand that Roosevelt imprison 120,000 Japanese Americans to increase their own economic and political fortunes.

“Free” government healthcare behind barbed wire

The “medical system” inside the concentration camps was set-up and maintained by volunteer inmates but overseen by white doctors of the US Public Health Service. Courageous JA doctors and nurses did their best despite a severe lack of supplies and medicines and kept the death count to 1,862. Not counting those killed by guards and the disappeared. JAs had “free government healthcare” for the first and only time behind barbed wire, like Native Americans on reservations who had the Indian Health Service. 11% died of tuberculosis as disease spread fast in close quarters. Nutrition was a challenge; the food budget was 38 cents per person per day. On the plus side, many JAs, saw a dentist for the first time in their lives.

Heart Mountain Hospital

During the war Roosevelt brokered a truce between unions and corporations so war production would not be disrupted in order to fight a more immediate common enemy – German, Japanese and Italian fascism. CEOs pledged, no lock-outs and union-busting while unions agreed to no strikes or slowdowns.

FDR also wanted to reduce competition among corporations to recruit workers. He froze wages and benefits so no company had an advantage over another. Only “insurance and pension benefits” could be given to workers. Employers could deduct employee benefits from profits and workers didn’t have to pay taxes on health premiums paid by employers. Providing health insurance became the way to recruit and retain workers and it spread quickly. About half of the US workforce has employer based healthcare.

Sort of a Post War “Boom” for JAs

After the war millions of GIs returned looking for jobs. White GI’s, African Americans and Latinx participated in the largest organizing drives for unionization in US history and won good paying jobs and healthcare benefits.

Japanese Americans released from the camps as well as JA veterans were excluded from good paying union jobs, and settled for agricultural related jobs like gardening, produce, the flower market, and various small businesses in Little Tokyo, J-Flats and the westside in L.A. A minority went to college on the GI Bill and went on to become doctors, lawyers and real estate agents who helped desegregate housing for JAs in L.A.

Isamu “Sam” Hirahara, Japanese American gardener

US unions fought for healthcare one workplace at a time. However, in Europe, post war social democratic political parties fought for healthcare for the entire country. ln Britain the National Health Service was established to provide free public healthcare. Unlike the US where not a single bomb fell, Europe and Japan were devastated and healthcare was a desperate need for millions surviving in bombed out rubble.

In 1956, the newly formed Southern CA Gardener’s Association offered a Blue Cross healthcare plan for its members. In March 1965, the Japanese American Citizens League with a more white collar leadership offered their Blue Shield plan. By the 1960’s the majority of JA families had a self-employed gardener as the main breadwinner. They helped to rebuild the economic base of the post-war JA community.

The Russians are coming. F_ _ _k healthcare let’s build missiles!

Universal health coverage still enjoyed high public support but became completely eclipsed by “national security” when Russia sent the “Sputnik” satellite into space during the Cold War. This was also the “communist witch hunt” period. The US rulers freaked out and shifted priorities to fund the military and nuclear arsenal. In 1961, an actor, Ronald Reagan, who worked for  war contractor G.E., went on national radio and said “universal healthcare” was socialism” imported by the Russians. Support fell for universal healthcare again.

1961-Ronald Reagan speaks out against “Socialized Medicine”

By 1965, the Gardener’s Federation enrollment into its Blue Cross plan exceeded 6,000. After 1965, many Koreans, Chinese and other Asians immigrated to the US. They worked in jobs that didn’t offer healthcare like restaurants and small shops, and the underground economy was restricted by language and cultural barriers.

The movements for civil rights, Black power, opposition to US imperialism, and women’s equality created the political space where the Voting Rights Act and some healthcare, at least for the elderly and poor, were won. Medicare and Medicaid were passed in 1965.

Japanese Americans and all people will benefit from Medicare-for-All

Today JAs have healthcare coverage a little higher than the national average, but not so for 1 out of 4 Koreans and 1 out of 5 Vietnamese people. Pacific Islander communities have even less health coverage, but this is hidden by statistics that roll all Asian Pacific Islanders in overly broad groups.

If Medicare-for-All were passed, such as AB 1400 sponsored by Assemblyman Miguel Santiago and Ash Kalra, there would be no deductibles, no copayments, no fees, everybody in and nobody out. Vision, dental, mental, hearing, medicine, equipment, hospice, homecare and nursing homes will all be covered for free. Rep. Pramila Jayapal has sponsored a national version of a Medicare-for-All bill HR. 1384.

The average US family makes $60,000 a year and spends $12,000 for healthcare. This cost would drop to about $1,200 per year, saving $10,800. Your taxes will go up a little bit but this is far exceeded by the savings. Communities may request to strengthen the bills’ bilingual bicultural component as an important lifeline.  Democratic community input into healthcare delivery is needed since it will become a public service.

Today about 30 million Americans still have no health insurance and tens of millions more have inadequate coverage. Nearly 3.5 people die each hour (30,000 year), and they are disproportionately people of color. Medical debt is the top reason for personal bankruptcy for Americans including Asians. The US ranks 37th out of 190 countries in the quality of healthcare. We’re better than #38 Slovenia but lag behind #36 Costa Rica. In the meantime, the healthcare industry made a record $100 billion in profits in 2018.

We, the people of all races and classes, can do better than this.

Author’s bio: David Monkawa is an artist and member of the Progressive Asian Network for Action. 

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