Political and Cultural Foundations of Long-term Care Reform; Comment on “Financing Long-term Care: Lessons From Japan”

This paper comments on Naoki Ikegami’s editorial entitled “Financing long-term care: lessons from Japan.” Adding to the editorial, this paper focuses on analyzing the political and cultural foundations of long-term care (LTC) reform. Intergenerational solidarity and inclusive, prudential public deliberation are needed for the establishment or reform of LTC systems. Among various lines of ethical reasoning related to LTC, Confucian ethics and other familist ethics are specifically important in the societies that share these values. The core issue in the debates around LTC reform is how to (re-)define the scope of social entitlements and accordingly to allocate the responsibility for care between states and families, between social groups, and between generations with limited resources.