¹ For a recent, concise statement of the JMA's position on health insurance and a variety of related issues, see: Tarō, Takemi, The Medical Practitioner of Japan (Tokyo: Japan Medical Association, 1970)Google Scholar.

² Cf., Eckstein, Harry, Pressure Group Politics: The Case of the British Medical Association (London: Allen & Unwin Ltd., 1960)Google Scholar; and Blishen, Bernard R., Doctors and Doctrines: The Ideology of Medical Care in Canada (Toronto: University of Toronto Press, 1969)CrossRefGoogle Scholar. Of the extensive literature dealing with the American Medical Association, see especially: Garceau, Oliver, The Political Life of the American Medical Association (Cambridge: Harvard University Press, 1941)Google Scholar; Rose, Arnold M., The Power Structure: Political Process in American Society (New York: Oxford University Press, 1967), pp. 400–55Google Scholar; and Key, V. O., Politics, Parties, and Pressure Groups (New York: Thomas Y. Crowell, 1958), pp. 135–41Google Scholar.

³ MacIver, R. M. and Page, Charles H., Society: An Introductory Analysis (New York: Rinehart and Company, Inc., 1959), pp. 437–52Google Scholar.

⁴ For a biography, see: Mikinosuke, Miyajima (ed.), Kitazato Shibasaburō den (Tokyo: Kitazato Kenkyujo, 1932)Google Scholar. In English, see: Mikinosuke, Miyajima, Robert Koch and Shibasaburō Kitazato (Geneva: Printing “Sonor,” 1931)Google Scholar.

⁵ The major sources which are available and which have been used here include the following: Imukyoku, Kōseishō, Isei hachi jū nen shi [An Eighty Year History of the Medical System], (Tokyo: ūkurashō Insatsukyoku, 1955)Google Scholar; Takeshi, Kawakami, Nihon no isha: gendai iryō kōzō no bunseki [Japanese Doctors: An Analysis of the Structure of Modern Medical Care], (Tokyo: Keisō Shōbō, 1961)Google Scholar; Saguchi Takashi, “Kaigyō-i seido no seiritsu to iryō no shakaika” [The Formation of the Private Practitioner System and the Socialization of Medical Care], Waseda Shogaku (September 1958), pp. 123–56; and Junshirō, ūmura, “Iryō seido to Ishikai” [The Medical Care System and the Medical Association], in Shakai hoshō III: Nihon ni okeru shakai hoshō seido no rekishi [Social Security III: History of the Social Security System in Japan] (Tokyo: Shiseidō, 1959), pp. 147–64Google Scholar. Unlike many other important associations in Japan, the Japan Medical Association has not yet published a comprehensive history of its activities and development However, for a collection of documents and editorial commentary related to post-World War II issues, See: “Kenkō hōken shinryō hōshū tanka no rekishi” [A History of the Medical Fee Unit], Nihon Ishikai Zasshi, 49, 9 (November 1, 1962), pp. 691–912Google Scholar. For a recent history of medical education in English, see: Bowers, John Z., Medical Education in Japan: From Chinese Medicine to Western Medicine (New York: Harper & Row, 1965)Google Scholar.

⁶ MacIver and Page, op. cit., p. 437.

⁷ Key, op. cit., p. 143. Bernard Berelson and Gary A. Steiner cite as one of their “scientific findings” the following: “Organizations tend to call forth organizations; if people organize on one side of an issue, their opponents will organize on the other side.” Human Behavior: An Inventory of Scientific Findings (New York: Harcourt, Brace and World, Inc., 1964), p. 366Google Scholar.

⁸ Koseisho Imukyoku, op. cit., p. 805.

⁹ Ōmura, op. cit., pp. 148–52.

¹⁰ Kōseishō Imukyoku, op. cit., pp. 243–46.

¹¹ Ibid., p. 236.

¹² Ōraura, op. cit., p. 150.

¹³ Kawakami, op. cit., p. 133.

¹⁴ Kōseishō Imukyoku, op. cit., p. 237.

¹⁵ For the text see: Ibid., pp. 521–32.

¹⁶ Ōmura, op. cit., p. 153.

¹⁷ Kōscishō Imukyoku, op cit., p. 239.

¹⁸ Ibid., p. 240.

¹⁹ Takeshi, Ishida, Gendta soshiki ron [Modern Organization Theory] (Toyko: Iwanami Shoten, 1961), pp. 65–102Google Scholar.

²⁰ This description of the reorganization of the Japan Medical Association is based on the secondary sources already cited as well as on the two basic documents published by the JMA, i.e., “Ishikai kaiso no keika hōkoku” [A Report on the Progress of the Medical Association Reorganization], Nihon Ishikai Zasshi, 21, 1 (January 1947), pp. 55–57Google Scholar; and, “Ishikai kaiso no keika” [Progress of the Medical Association Reorganization], Nihon lshikai Zasshi, 21, 3 (February 1947), pp. 26–27Google Scholar.

²¹ The procedures for the incorporation of juridicial persons” are provided for in Chapter II of the Civil Code of Japan. According to Article 34, “An association or foundation related to worship, religion, charity, science, art or otherwise related to public interest and not having for its object the acquisition of gain may be made a juristic person subject to the permission of the competent authorities.” This is defined as a “public interest juridicial person.” For an English translation, see: The Civil Code of Japan (as of 1960): EHS haw Bulletin Series, Vol. II, No. 2100 (Tokyo: Eibun Horeisha, 1960)Google Scholar.

²² Igaku nenkan [Medical Yearbook] (Tokyo: Ishiyaku Shuppan Kabushikigaisha, 1963), pp. 8–10Google Scholar.

²³ For a documentary history of the Federation of Health Insurance Societies, see: Kenkō Hoken Kumiai Rengōkai (ed.), Kenkō Hoken Kumiai Rengōkai sōritsu jū-go-shōnen kinen shi [In Commcmoration of the Fifteenth Anniversary of the Establishment of the Federation of Health Insurance Societies] (Tokyo: Kenkō Hoken Kumiai Rengōkai, 1960). For a JMA documentary history with commentary, see Nihon Ishikai Zasshi (November 1, 1962), pp. 571–938. The Welfare Ministry side of contemporary disputes is presented annually in Kōsei hakusho [Welfare White Paper] (Tokyo: Ōkurashō Insatsuryoku, annual).

²⁴ Cf., the account of these disputes and alliances in Taguchi Fukuji and Toshinai Yoshinori, “Atsuryoku dantai to shite no Ishikai” [The Medical Association as a Pressure Group], Chūō Kōron (April 1959), pp. 257–62; Junshirō, Ōmura, “Iryō seido to Ishikai,” loc. cit.; and Shōei, Ōuchi (ed.), Sengo ni okeru shaken hoshō no tenkai [The Postwar Evolution of Social Security] (Tokyo: Shiseido, 1961)Google Scholar.

²⁵ For example, see the series of articles which appeared in the Asahi Shimbun republished as “Atsuryoku dantai to seiji,” [Pressure Groups and Politics,] in Usui Yoshimi (ed.), Kanryō, seitō, atsuryoku dantai [Bureaucracy, Parties, and Pressure Groups], Vol. 21 of Gendai kyōyō zenshū [Modern Culture Collection] (Tokyo: Chikusa Shobō, 1960), pp. 219–37; and the collection of articles and commentary in Chūō Kōron (May 1958).

²⁶ The JMA's 1960–61 campaign is described in detail in my, Doctors in Politics: The Political Life of the Japan Medical Association (New York: Praeger, Forthcoming).

²⁷ The Japan Medical Association, 1971 (Tokyo: Nihon Ishikai, 1971), p. 7Google Scholar.

²⁸ Interview with Dr. Takemi Tarō, July 25, 1966.

²⁹ Officials of the JMA point out, however, that such authority is rarely exercised except in the case of narcotics addiction. For the most part, members are simply encouraged to conform to the rules and ethics of the medical profession but the singling out of individual members for violations of the code is considered a very serious and delicate matter and therefore avoided as much as possible, Cf., “Professional Controls,” in Howard M. Vollmer and Donald L. Mills, Projessionalization (Englewood Cliffs: Prentice-Hall, 1966), pp. 110–52.

³⁰ Taguchi and Toshinai, op. cit., p. 250.

³¹ Figures are based on, The Japan Medical Association, 1971, pp. 8, 22, and 48.

³² Interview with Dr. Takemi Tarō, December 27, 1962.

³³ While emphasizing the voluntary basis of JMA membership, Dr. Takemi also expressed his aversion to Japanese Communists during an interview of December 27, 1962, as he has in print on innumerable occasions. Interviews with other national officials invariably produced strong anti-communist expressions.

³⁴ See, Nakane, Chie, Japanese Society (Berkeley: University of California Press, 1970)Google Scholar, especially pp. 104–40. For a critical discussion of traditional group theory which also argues that professional associations and other large economic lobbies like farm organizations and labor unions obtain support because they perform functions other than lobbying, see Olson, Mancur Jr., The Logic of Collective Action: Public Goods and the Theory of Groups (New York: Schocken, 1968), pp. 132–67Google Scholar.

³⁵ A similar conclusion is expressed in Keizō, Funamoto, “Seiji to Ishikai” [Politics and the Medical Association], Shakai Hoshō Gekkan, XVII (March, 1963), pp. 32–35Google Scholar; and in, “Nihon Ishikai o kaibō suru” [Dissecting the Japan Medical Association], Asahi Jānuru, III (January 29, 1961), pp. 8–15Google Scholar.

³⁶ For a discussion of the political effectiveness of JMA organization and the problem of strategic position and “access” in the political process, see my, “The Japan Medical Association and the Liberal Democratic Party,” in Sakai, Robert K. (ed.), Studies on Asia, 1965 (Lincoln: University of Nebraska Press, 1965), pp. 143–61Google Scholar.

³⁷ For one appraisal, see Nitto Shūichi, “Itansha: Takemi Tarō ron“[A Heretic: Comments on Takemi Tarō], Chūō Kōron (July 1964), pp. 246–58.

³⁸ For example, in introducing the JMA's basic policy draft for 1962 to the members of the House of Delegates, he commented:

For the past five years, we of the Japan Medical Association have struggled with various problems related to the so-called “Health Insurance for the Whole Nation” system—one which is unique in the world. As of the present, we need not feel ashamed of the actions of the Japan Medical Association and its role in world history. Congratulations are in order. Now, Th e American Medical Association is beginning to study our activities. Also, the British Medical Association is carefully studying our problems. Moreover, it is said that even the very small medical association of Switzerland—the so-called “Mecca of social security”—is beginning to study the JMA. It is through the World Medical Association that the problems of the JMA under the “Health Insurance for th e Whole Nation“system have been brought to the attention of the world.

During this time, I have been keenly impressed by the fact that, under the social security systems of all nations, the welfare of the people cannot be really improved unless doctors make an effort to increase their authority. We should allow no one, including the government, to decrease the authority of doctors.

Takemi Tarō, Shōwa san jū shichi nendo Nihon Ishikai jigyō keikakuritsuan no kihon hōshin ni tsuite [The Basic Policy of the Japan Medical Association's 1962 Business Plan] (Tokyo: Nihon Ishikai, 1962, mimeo), pp. 1–2. In an interview of December 27, 1962, Dr. Takemi talke d at some length of the development of the JMA and the system of medical care in Japan, concluding with the observation that the proper role to be played by the JMA was dependent upon historical circumstances. If the JMA appeared to be deeply involved in political struggles, he felt that this was dictated by the nature of the times. It was only through political action that the Association could contribute to the development of a system of social security and medical care which would not be under complete bureaucratic control while at the same time maintaining its own self-respect an d autonomy as a voluntary association of the medical profession. Since Japanese political parties and parliamentary system are still “immature,” it is necessary for groups like the JMA to help check the expansion of bureaucratic power. If the political parties improve, then the bureaucracy will also improve. Therefore, it is necessary to contribute to the improvement of the party system. Only after the parties and the parliamentary system have come of age, he argued, will it be possible for the JMA to retreat from the political arena. In presenting this justification for the deep political involvement of the JMA, Dr. Takemi also emphasized his hope that other nations would learn from Japan's experiences with an “authoritarian bureaucracy“and avoid the hardships of “excessive state control” over social, economic, and intellectual life.

³⁹ Berclson and Steiner, op. cit., p. 365.

⁴⁰ Berelson and Steiner write: “The broad effects of voluntary associations within the society are usually considered to be these: (a) to promote participation in the social life, by providing frequent and attractive opportunities for personal contacts; (b) to increase personal freedom, by increasing the choice of appropriate modes of behavior; (c) to promote social change, by increasing pressures from particular organized segments of the society; (d) both to sharpen and to soften class distinctions, depending on the extent to which the associations are limited to ‘one's own kind’ as against bringing diverse groups together in a common cause—i.e., the extent to which people's memberships are homogeneous or heterogeneous in character.” Ibid., p. 380. Also, see the discussion of voluntary associations in Rose, op. cit., pp. 213–52; and of professional associations in Vollmer and Mills, op. cit., pp. 153–96 and 295–326.