Why the Medical Association Holds Strong Influence Over the LDPWhenever Japanese healthcare is discussed, one name always appears: the Japan Medical Association (JMA). This organization has quietly but steadily extended its reach into how the country's annual medical spending of roughly 48 trillion yen (about 300 billion dollars) is used, and into how the "price of medicine" we pay at the counter gets set. Why has a single professional body stayed so deeply tied to the ruling Liberal Democratic Party (LDP) for so long? Tracing it back, you find two easy-to-grasp engines, votes and money, alongside a distinctive machinery that has rooted itself in the gaps of the system. Looking at both the good and the bad, let me unpack that structure.Two Engines: Votes and MoneyThe source of the Medical Association's political power, when you boil it down, comes to two things: votes at the ballot box, and political donations. Here it's worth noting that the public-facing "Japan Medical Association" and the "Japan Medical League (Nichii-ren)," which handles political activity, are set up as separate organizations. The JMA wears the face of a public-interest body and is formally structured to keep its distance from politics. Yet the head of the League is concurrently held by the JMA president, and the two are, in practice, two sides of the same coin.The flow of money is concrete. In 2022 the League took in 951.1 million yen (about 5.9 million dollars) in donations from prefectural medical leagues, with the underlying source being the dues that doctors pay. In Tokyo's branches, for example, members pay roughly 36,000 yen (about 230 dollars) a year. The money collected then flows toward the political world. According to the 2024 disclosures, the League provided a total of about 390 million yen (about 2.4 million dollars) to roughly 160 members of the Diet, centered on the LDP. Spreading it broadly and thinly is seen as a way, in the "numbers are power" world of Nagatacho, to win over even one more lawmaker sympathetic to the JMA.On the vote side, the Association fields "organizational candidates" in the proportional-representation bloc of the Upper House, and rallies members nationwide to bring in votes. The medical world's network, spread across the whole country, becomes an election machine in itself. Keeping pipelines to lawmakers open with money, and sending its own spokespeople into the Diet with votes: this two-track approach has been the foundation of its long-running influence.How the "Price of Medicine" Called Reimbursement Is DecidedThe Association has good reason to care so much. It is the existence of "medical reimbursement," the official set price attached to each and every medical act. Initial consultation fees, tests, surgeries, drug management, and more, all have prices set by the state, and those prices directly shape the income of hospitals and clinics. The price is revised roughly once every two years, debated in a body within the Ministry of Health, Labour and Welfare (MHLW) called the Central Social Insurance Medical Council (Chuikyo).The Council brings together those who provide medical care (the Medical Association among them), those who pay the premiums (health insurance unions, labor unions, and so on), and neutral members. In theory, prices are supposed to be set rationally on the basis of evidence and cost. In reality, however, room remains for political factors to creep in, such as strong requests from medical groups, or lawmakers leaning on the MHLW. A slight shift in the revision rate changes the income of medical institutions nationwide enormously. That is precisely why the Association refuses to let go of its position to influence that decision.This is where waste in medical spending has been said to arise. In Japan, for instance, people visit clinics and hospitals more often than in other countries, and long-term prescriptions and refill prescriptions (a system that lets the same prescription be reused) have been slow to spread. Under a pricing system where each individual visit or prescription translates into income, reforms aimed at cutting the number of visits are hard for the provider side to welcome. The very design philosophy of the reimbursement system is tightly bound up with self-interest.Why the MHLW Cannot Stand Up to the AssociationIt is often said that the MHLW is weak against the interest group representing private-practice physicians. Behind this lies a dynamic at work among the bureaucracy, politics, and the industry. Revising reimbursement or reworking the healthcare system requires the cooperation of a medical world that moves the front lines. No matter how splendidly the system is designed, healthcare cannot run if doctors refuse to go along with it.On top of that, there is the political route. Lawmakers backed by the Association, the so-called "health-and-welfare tribe" politicians, put the brakes on reform or relay the industry's wishes to the bureaucracy. For the ministry, the intentions of politicians who hold the keys to budget-making cannot be ignored. The League is said to have channeled funds to LDP health-and-welfare tribe members centered on successive health ministers, as well as to former finance ministers. Once a structure forms in which politicians tied together by money and votes apply pressure over the heads of the ministry, bureaucrats with no front line of their own are at a disadvantage.The COVID-19 pandemic became an occasion for public attention to turn to this relationship. As infections spread, clinic after clinic turned away patients with fevers, and a distrust grew: how can a body that does not move when it matters most wield such strong influence in normal times? The official posture of an organization protecting healthcare, and the reality of an interest group protecting members' livelihoods. The gap between those two faces became plainly visible in that moment.The Hidden Circuit: How Dues Turn Into Political FundsThe heart of the matter lies in the details of the machinery, the parts that are hard to see from the outside. The League's office is deliberately placed in a room of a roughly 50-year-old apartment building outside the Japan Medical Association building. It is a formal measure to keep distance from the public-interest JMA, yet its secretariat itself sits on the third floor of that very building, making them one and the same in practice. It is a symbolic arrangement, a deft separation of appearance from reality.And the most vivid part is how donations are decided. Who gets how much is ultimately said to be decided by the committee chair, that is, the JMA president, who allocates funds by weighing a lawmaker's influence, contribution to the JMA, whether they are a physician, future potential, and so on. The dues paid by each individual member become tied, at the discretion of the top, to an evaluation of politicians. The deeper inside the organization one is, the more keenly one feels this dynamic.In recent years, the flow of money has grown even harder to see. Because party tickets do not require listing the purchaser's name in reports if each purchase is 200,000 yen or under, they are increasingly used as effectively concealed de facto donations. The League's total income in 2023 was about 2.1 billion yen (about 13 million dollars), most of it dues paid by doctors across the country. Given the nature of dues, members rarely raise their voices to question where the money goes in detail, and it quietly circulates back into the political world. It should also not be overlooked that some doctors belong to the Association but not to the League, so there are differences of temperature even within.Seen Positively: The Face That Has Sustained Universal CoverageSo far the critical view has been at the center, but it would be unfair to dismiss the Association's role entirely. From the standpoint of those who defend it, a different scene comes into view.Japan built universal health insurance, where anyone can receive care with a single insurance card, and has achieved one of the world's highest life expectancies. Sustaining that has been impossible without private-practice physicians who maintain clinics across every corner of the country. There is a view that the Association has functioned as a "brake," preventing front lines from being worn down by excessive cost-cutting and preventing medical institutions from vanishing from local communities. If reimbursement is cut unilaterally, unprofitable rural care, pediatrics, and obstetrics can no longer survive. The logic is that protecting them through political power ultimately serves the public interest as well.In fact, it has been the network of doctors that has supported the front lines of public health, from vaccinations and screenings to providing care in disasters. Should engagement in politics be dismissed as mere defense of vested interests, or evaluated as legitimate activity to protect the sustainability of healthcare? Evaluations diverge greatly depending on one's standpoint, and this is not an issue where one side can be declared absolutely right.Going Back Through History, and Thinking About the Shape of Things to ComeThe figure who symbolizes the Association's political power is its 11th president, Taro Takemi. Known by the nickname "Fighting Taro," he served as president for 25 years across 13 terms, clashing thoroughly with the Ministry of Health and Welfare without flinching even at nationwide simultaneous clinic closures, extending his influence not only over the Medical Association but also the dental and pharmacist associations, to the point of being called "Emperor Takemi." His wife was a granddaughter of former Lord Keeper of the Privy Seal Nobuaki Makino, and he served as personal physician to former Prime Minister Shigeru Yoshida, giving him a thick pipeline to the political world that translated into strong political power. Family networks and backbone supported the enormous influence of that era.Yet that power now shows signs of decline. There was a time, back in 1977, when an organizational candidate gathered 1.27 million votes, but in 2010, when the Association shifted from supporting the LDP to supporting the Democratic Party, the organization split and all three candidates lost, a failure it also experienced. And most recently, the power of votes has shrunk dramatically. In the 2025 Upper House election, organizational candidate Satoshi Kamayachi won his first seat, but his vote total came to only about 174,400, and Keizo Takemi, the son of "Fighting Taro" and a former health minister himself, lost his seat. Notably, Keizo Takemi himself is not a physician but a man who studied political science at university, a politician who had been supported by his pedigree as a thoroughbred of the medical world.The world of doctors, too, is not monolithic. Discontent over a structure in which clinic directors earn more on average than overworked hospital physicians, generational gaps in attitude, and competition for votes with other medical groups: these internal creaks are weakening the unity of old. Even so, as long as the self-interest surrounding reimbursement, the "price of medicine," does not disappear, the bond between the Medical Association and politics will never vanish completely. The focus from here is how to make that influence transparent, and how to reconcile it with rationality in medical spending. Precisely because it connects directly to how our premiums and taxes are used, there is meaning in keeping our attention on it.ReferencesThe True Nature of the Japan Medical Association: Why Medical Cost Waste Is Not Reduced (a work by a Tokyo Shimbun editorial committee member, examining medical costs, reimbursement, and the Association's political power) Tokyo Shimbun Digital, the "Price of Medicine" series (investigative reporting on votes and money and on the reimbursement decision process) Gendai Business and Diamond Online (reporting on the Japan Medical League's political donations and party tickets) Records concerning Taro Takemi (biographical dictionaries on Kotobank, the Japan Medical Association's "50-Year Postwar History," Wikipedia, and others) Jiji Press, Nikkei Medical, and m3.com (results of the 27th Upper House election and analysis of medical-sector organizational votes) Ministry of Health, Labour and Welfare, materials on the composition of the Central Social Insurance Medical Council (Chuikyo) and on reimbursement revisions