2009年 09月 16日 ( 4 )

Hatoyama becomes prime minister

New leader launches tripartite (3党が参加した) Cabinet, vows 'drastic change'

Japan saw the beginning of a new political era Wednesday as Democratic Party of Japan President Yukio Hatoyama became prime minister, putting an end to five decades of almost unbroken rule by the Liberal Democratic Party.

The nation's 93rd prime minister inaugurated (開始する) his Cabinet, kicking off a tripartite coalition with the Social Democratic Party and Kokumin Shinto (People's New Party).

"Today is the beginning of a new turning point in history, a day to start a drastic change in the framework (枠組) of politics and the government," Hatoyama said at a DPJ meeting. "Let's actively work together to make sure that future historians will say that today was a wonderful day."

This could be the start of a two-party political system in Japan after nearly half a century of virtual one-party rule.

Hatoyama said the road from this point forward will not be easy and asked his fellow party members to maintain unity (団結) through the rough times ahead.

"We are about to enter an unknown world, and I think it will be a repeat of the process of trial and error (試行錯誤)," Hatoyama said.

Hatoyama appointed (任命する) former DPJ President Naoto Kan as state strategy minister and vice prime minister, making the veteran lawmaker a cornerstone (礎) of his new government.

Kan will head the National Strategy Bureau, a policymaking organization that will be designed to help the DPJ rein in civil servants (公務員). Kan and Finance Minister Hirohisa Fujii will be the key players in bringing about change in the way policies are implemented and budgets compiled, observers said.

With the launch of the strategy bureau, "the Cabinet will now be able to prioritize policies without having to consider the vested interests (既得権益) of the ministries and its bureaucrats," said Hidekazu Kawai, a professor emeritus of comparative politics at Gakushuin University in Tokyo.

"Power may now return to the hands of politicians from bureaucrats," he said.

Former DPJ Secretary General Katsuya Okada was appointed foreign minister, and Hirofumi Hirano, a close Hatoyama aide (助手), became chief Cabinet secretary (官房長官) — the government's top spokesman and the prime minister's right-hand man.

Akira Nagatsuma, one of the most popular DPJ members, who revealed that the government had lost millions of pension records, was tapped as (~に選ばれる) health minister. Upper House lawmaker and former DPJ member Keiko Chiba got the justice minister's slot.

Kawai pointed out that Hatoyama has drawn on a wide range of members from within the DPJ, including Yoshito Sengoku as government reform minister and Seiji Maehara as infrastructure minister, who have distanced themselves from newly appointed DPJ Secretary General (幹事長) Ichiro Ozawa.

"This isn't a team that will only be known for a single star player, like Ichiro Suzuki," Kawai said. "It's rather a well-balanced team, with all the players asked to play their best."

SDP leader Mizuho Fukushima is now a minister in charge of consumer affairs, the birthrate problem, food safety and gender equality.

The position of defense minister (防衛大臣) went to DPJ Upper House lawmaker Toshimi Kitazawa, who is now tasked to coordinate defense policies the SDP, a pacifist (平和主義の) party.

The SDP is against all overseas dispatch of the Self-Defense Force and Kitazawa and the DPJ will have to find other ways to contribute as a member of the international society.

Kokumin Shinto chief Shizuka Kamei, a former heavyweight (大物政治家) in the LDP, was concurrently (兼任して) appointed to serve as the postal and financial affairs ministers.

Kamei and his small party oppose postal privatization, and he was looking to acquire the internal affairs and communications portfolio so postal services would fall under his jurisdiction (管轄区内の).

Meanwhile, Prime Minister Taro Aso and his Cabinet resigned en masse (総辞職する) in the morning, marking the end of their 358-day rule.

Throughout his term, Aso struggled with a plunging support rate largely triggered by his verbal gaffes (失言) and policy flip-flops (政策のブレ). Under his leadership, the LDP was crushed in the Aug. 30 election to nearly one-third its Lower House strength.

"Nearly a year has passed since the inauguration last September, and I would like to, once again, express my gratitude to the people for their support," Aso said at his final news conference.

"I promised the people that I would create a strong and cheerful Japan. Although one year was a very short period of time, I believe I did my best for Japan."

by yu-fen-sun | 2009-09-16 23:16 | 英語関連
Incoming, outgoing leaders touch on North Korea issues

Two days ahead of the launch of his Cabinet, Yukio Hatoyama met with departing Prime Minister Taro Aso to seek his cooperation to ensure a smooth handover of power, while Aso offered encouragement to the prime minister in waiting.

Hatoyama and Aso met in the Diet, along with Chief Cabinet Secretary (官房長官) Takeo Kawamura and his successor, Hirofumi Hirano, ahead of Wednesday's launch of the new administration.

"I would like you to give me guidance and advice as a former prime minister," Hatoyama was quoted by Hirano as asking Aso during the 20-minute meeting.

Hatoyama also asked Aso for advice on diplomacy ahead of his scheduled trip to attend the U.N. General Assembly (国連総会) in New York and the Group of 20 summit in Pittsburgh.

Aso responded, "I hope you will work hard and will not take the wrong direction" in foreign policy, international finance and national security, according to Hirano.

Hatoyama asked about the North Korean nuclear and abduction (拉致) issues. Aso said the Pyongyang Declaration issued by the two countries in 2002 "is still alive and that the incoming government should stick to it."

They did not go into further details about foreign and national security issues, according to Hirano.

The Democratic Party of Japan won 308 seats in the 480-seat Lower House in the Aug. 30 election, ousting the Liberal Democratic Party from power for only the second time in the LDP's 54-year history.

Hatoyama was scheduled to hold talks with DPJ deputy leader Ichiro Ozawa later Monday concerning Cabinet appointments.
by yu-fen-sun | 2009-09-16 03:49 | 英語関連
A 47-year-old man pleaded innocent (無罪を主張する) Monday to charges of arson and murder at a video parlor in Osaka last year that killed 16 people and injured four others.

"I did not commit arson," Kazuhiro Ogawa said in the first session of his Osaka District Court trial over the predawn (夜明け前の) fire at the Shishashitsu Cats Nanba shop in Naniwa Ward last Oct. 1.

Ogawa, who is unemployed and hails from (~の出身である) Higashiosaka, Osaka Prefecture, initially admitted to the allegations, saying he wanted to kill himself because of his hardships, investigative sources said.

The indictment (起訴状) says Ogawa, who was using one of the parlor's private viewing rooms, set fire to tissue paper on a bag containing newspapers and other items, starting a conflagration (火災、火事) that spread through the establishment.

Police sources have said Ogawa gambled away his retirement allowance and was suffering under numerous debts.

He retired from an electric parts factory a few years ago. After gambling away his money, his wife divorced him and his debts snowballed, the sources said.

Ogawa was arrested outside the video parlor after being questioned by a police officer. Most of the fatalities (災害、災難) occurred in the parlor's small private rooms. Such shops are often stocked with porn but are also used by people who need a cheap place to spend the night.
by yu-fen-sun | 2009-09-16 03:43 | 英語関連
My mother wanted to die, but the doctors wouldn't let her. At least that's the way it seemed to me as I stood by her bed in an intensive-care unit at a hospital in Hilton Head, S.C., five years ago. My mother was 79, a longtime smoker who was dying of emphysema (肺気腫). She knew that her quality of life was increasingly tethered (ロープでつなぐ) to an oxygen tank, that she was losing her ability to get about (動き回る、歩き回る), and that she was slowly drowning. The doctors at her bedside were recommending various tests and procedures to keep her alive, but my mother, with a certain firmness I recognized, said no. She seemed puzzled and a bit frustrated that she had to be so insistent on her own demise (死去、死亡).

The hospital at my mother's assisted-living facility was sustained by Medicare, which pays by the procedure. I don't think the doctors were trying to be greedy by pushing more treatments on my mother. That's just the way the system works. The doctors were responding to the expectations of almost all patients. As a doctor friend of mine puts it, "Americans want the best, they want the latest, and they want it now." We expect doctors to make heroic efforts—especially to save our lives and the lives of our loved ones.

The idea that we might ration (分配する、割り当てる) health care to seniors (or anyone else) is political anathema (忌み嫌われる物). Politicians do not dare breathe the R word, lest they be accused—however wrongly—of trying to pull the plug on Grandma. But the need to spend less money on the elderly at the end of life is the elephant in the room (誰もが認識しているが口にしたくない重要な問題) in the health-reform debate. Everyone sees it but no one wants to talk about it. At a more basic level, Americans are afraid not just of dying, but of talking and thinking about death. Until Americans learn to contemplate death as more than a scientific challenge to be overcome, our health-care system will remain unfixable.

Compared with other Western countries, the United States has more health care—but, generally speaking, not better health care. There is no way we can get control of costs, which have grown by nearly 50 percent in the past decade, without finding a way to stop overtreating patients. In his address to Congress, President Obama spoke airily (軽快に、軽やかに) about reducing inefficiency (非能率), but he slid past (前方を横切る) the hard choices that will have to be made to stop health care from devouring ever-larger slices of the economy and tax dollar. A significant portion of the savings will have to come from the money we spend on seniors at the end of life because, as Willie Sutton explained about why he robbed banks, that's where the money is.

As President Obama said, most of the uncontrolled growth in federal spending and the deficit (赤字) comes from Medicare; nothing else comes close. Almost a third of the money spent by Medicare—about $66.8 billion a year—goes to chronically ill patients in the last two years of life. This might seem obvious—of course the costs come at the end, when patients are the sickest. But that can't explain what researchers at Dartmouth have discovered: Medicare spends twice as much on similar patients in some parts of the country as in others. The average cost of a Medicare patient in Miami is $16,351; the average in Honolulu is $5,311. In the Bronx, N.Y., it's $12,543. In Fargo, N.D., $5,738. The average Medicare patient undergoing end-of-life treatment spends 21.9 days in a Manhattan hospital. In Mason City, Iowa, he or she spends only 6.1 days.

Maybe it's unsurprising that treatment in rural towns costs less than in big cities, with all their high prices, varied populations, and urban woes (都市部の問題). But there are also significant disparities (不均衡) in towns that are otherwise very similar. How do you explain the fact, for instance, that in Boulder, Colo., the average cost of Medicare treatment is $9,103, whereas an hour away in Fort Collins, Colo., the cost is $6,448?

The answer, the Dartmouth researchers found, is that in some places doctors are just more likely to order more tests and procedures. More specialists are involved. There is very little reason for them not to order more tests and treatments. By training and inclination, doctors want to do all they can to cure ailments (病気、疾患). And since Medicare pays by procedure, test, and hospital stay—though less and less each year as the cost squeeze tightens—there is an incentive to do more and more. To make a good living, doctors must see more patients, and order more tests.

All this treatment does not necessarily buy better care. In fact, the Dartmouth studies have found worse outcomes in many states and cities where there is more health care. Why? Because just going into the hospital has risks—of infection, or error, or other unforeseen complications. Some studies estimate that Americans are overtreated by roughly 30 percent. "It's not about rationing care—that's always the bogeyman (ブギーマン、子取り鬼) people use to block reform," says Dr. Elliott Fisher, a professor at Dartmouth Medical School. "The real problem is unnecessary and unwanted care."

But how do you decide which treatments to cut out? How do you choose between the necessary and the unnecessary? There has been talk among experts and lawmakers of giving more power to a panel of government experts to decide—Britain has one, called the National Institute for Health and Clinical Excellence (known by the somewhat ironic acronym (略語) NICE). But no one wants the horror stories of denied care and long waits that are said to plague (苦しめる、悩ます) state-run national health-care systems. (The criticism is unfair: patients wait longer to see primary-care physicians in the United States than in Britain.) After the summer of angry town halls, no politician is going to get anywhere near something that could be called a "death panel."

There's no question that reining in (制御する) the lawyers would help cut costs. Fearing medical-malpractice suits, doctors engage in defensive medicine, ordering procedures that may not be strictly necessary—but why take the risk? According to various studies, defensive medicine adds perhaps 2 percent to the overall bill—a not-insignificant number when more than $2 trillion is at stake (賭けられて、危機に瀕して). A number of states have managed to institute some kind of so-called tort reform, limiting the size of damage awards by juries (陪審員) in medical-malpractice cases. But the trial lawyers—big donors to the Democratic Party—have stopped Congress from even considering reforms. That's why it was significant that President Obama even raised the subject in his speech last week, even if he was vague about just what he'd do. (Best idea: create medical courts run by experts to rule on malpractice claims, with no punitive damages.)

But the biggest cost booster is the way doctors are paid under most insurance systems, including Medicare. It's called fee-for-service, and it means just that. So why not just put doctors on salary? Some medical groups that do, like the Mayo Clinic, have reduced costs while producing better results. Unfortunately, putting doctors on salary requires that they work for someone, and most American physicians are self-employed or work in small group practices. The alternative—paying them a flat rate (均一料金) for each patient they care for—turned out to be at least a partial bust (失敗). HMOs that paid doctors a flat fee in the 1990s faced a backlash (反発、反動) as patients bridled at long waits and denied service.

Ever-rising health-care spending now consumes about 17 percent of the economy (versus about 10 percent in Europe). At the current rate of increase, it will devour a fifth of GDP by 2018. We cannot afford to sustain (維持する) a productive economy with so much money going to health care. Over time, economic reality may force us to adopt a national health-care system like Britain's or Canada's. But before that day arrives, there are steps we can take to reduce costs without totally turning the system inside out.

One place to start is to consider the psychological aspect of health care. Most people are at least minor hypochondriacs (心気症患者) (I know I am). They use doctors to make themselves feel better, even if the doctor is not doing much to physically heal what ails (苦しめる、悩ます) them. (In ancient times, doctors often made people sicker with quack (いかさまの) cures like bleeding.) The desire to see a physician (内科医) is often pronounced in assisted-living facilities. Old people, far from their families in our mobile, atomized (細分化された) society, depend on their doctors for care and reassurance (安心). I noticed that in my mother's retirement home, the talk in the dining room was often about illness; people built their day around doctor's visits, partly, it seemed to me, to combat loneliness.

Physicians at Massachusetts General Hospital are experimenting with innovative approaches to care for their most ill patients without necessarily sending them to the doctor. Three years ago, Massachusetts enacted (制定する) universal care—just as Congress and the Obama administration are attempting to do now. The state quickly found it could not afford to meet everyone's health-care demands, so it's scrambling for (~に奔走する) solutions. The Mass General program assigned nurses to the hospital's 2,600 sickest—and costliest—Medicare patients. These nurses provide basic care, making sure the patients take their medications and so forth, and act as gatekeepers (門番)—they decide if a visit to the doctor is really necessary. It's not a perfect system—people will still demand to see their doctors when it's unnecessary—but the Mass General program cut costs by 5 percent while providing the elderly what they want and need most: caring human contact.

Other initiatives ensure that the elderly get counseling about end-of-life issues. Although demagogued as a "death panel," a program in Wisconsin to get patients to talk to their doctors about how they want to deal with death was actually a resounding success (大成功). A study by the Archives of Internal Medicine shows that such conversations between doctors and patients can decrease costs by about 35 percent—while improving the quality of life at the end. Patients should be encouraged to draft living wills to make their end-of-life desires known. Unfortunately, such paper can be useless if there is a family member at the bedside demanding heroic measures. "A lot of the time guilt is playing a role," says Dr. David Torchiana, a surgeon and CEO of the Massachusetts General Physicians Organization. Doctors can feel guilty, too—about overtreating patients. Torchiana recalls his unease over operating to treat a severe heart infection in a woman with two forms of metastatic cancer (転位癌) who was already comatose (昏睡状態の). The family insisted.

Studies show that about 70 percent of people want to die at home—but that about half die in hospitals. There has been an important increase in hospice or palliative (一時凌ぎの) care—keeping patients with incurable diseases as comfortable as possible while they live out the remainder of their lives. Hospice services are generally intended for the terminally ill in the last six months of life, but as a practical matter, many people receive hospice care for only a few weeks.

Our medical system does everything it can to encourage hope. And American health care has been near miraculous—the envy of the world—in its capacity to develop new lifesaving and life-enhancing treatments. But death can be delayed only so long, and sometimes the wait is grim (残酷な) and degrading (品位を落とす). The hospice ideal recognized that for many people, quiet and dignity—and loving care and good painkillers—are really what's called for.

That's what my mother wanted. After convincing the doctors that she meant it—that she really was ready to die—she was transferred from the ICU to a hospice, where, five days later, she passed away. In the ICU, as they removed all the monitors and pulled out all the tubes and wires, she made a fluttery (ひらひらした) motion with her hands. She seemed to be signaling (合図を送る) goodbye to all that—I'm free to go in peace.

end-of-life issueについてでした。
by yu-fen-sun | 2009-09-16 00:11 | 英語関連