엘리트를 보호하는 복지: 전간기 동경제국대학의 학생진료소로 본 능력주의 시대 복지제도의 역설 (Welfare for Elites: The Student Health Center at Tokyo Imperial University and the Paradox of Medicare in Japanese Meritocracy)

서지정보

· 발행기관 : 대한의사학회
· 수록지 정보 : 의사학 / 29권 / 3호 / 1101 ~ 1132페이지
· 저자명 : 최자명

초록

의료복지제도는 일본에서 어떻게 확대되었을까? 역사가들은 지금까지 일본의 사회보험제도가 탄생하는 과정에서 국가관료가 담당한 중추적인 역할을 강조해왔지만, 복지제도의 혜택이 일본사회의 구성원들 중 누구에게 돌아갔으며, 그 혜택의 사회적 의미가 무엇이었는지에 대해서는 주목하지 않았다. 이 연구는 동경제국대학의 학생진료소를 프리즘으로 이 연구사적 공백을 메우고자 한다. 동경제대는 1886년 세워진 일본 최초의 대학으로, 여기에는 의학부의 의료전문가들과 특별한 수입없이 학교를 다니며 값싼 의료서비스를 찾고 있는 학생들이 있었다. 1925년 동경제대 당국은 학생회의 요구에 응해 학생진료소를 설립했고, 동경제대 의학부에 요청해서 동경제대 의학부 출신의 젊은 의사들을 학생진료소의 의사로 고용했다. 곧, 고정적 수입이 없이 일정 기간 교육기관에 적을 두던 동경제대 학생들은 의학부 덕분에 국가가 제공하는 의료복지제도의 수혜자가 되었다. 그런데, 학생진료소의 역할은 다른 복지시설과는 달리 학생들을 가난에서 구제하는 데 그치지 않고, 학생들이 화이트칼라 엘리트로 성장해나가는 핵심적 관문, 즉, 입시, 수학, 그리고 졸업 및 취직과정을 통과하도록 도왔다. 이 시설은 동경제대에서 보호시설인 동시에 특권적 학생문화의 일부라는 이중적 의미를 갖고 있던 바, 필자는 학생진료소를 프리즘으로 복지혜택이 엘리트의 성장을 돕는 역설적인 상황을 해명하고자 한다.

영어초록

How did the Japanese establish a medical welfare system? In answer of this question, historians of modern Japan have accentuated the assertive role of state bureaucrats, especially from those of the Home Ministry. For instance, historian William Johnston, in his pioneering work on tuberculosis in Japan, explored the rise of a hygiene administration on this disease as a state enterprise. However, historians of Japanese medicine have hardly explored how welfare benefits were distributed to members of Japanese society.
This article seeks to fill this historiographical gap by looking at the Student Health Center of Tokyo Imperial University (Tōdai), Japan’s first university established by the state in 1886. This university was a critical locus in the birth of medical welfare in Japan. At this university were the most privileged medical facilities and practitioners who could provide medical services, as well as students without stable incomes of their own, thus in need of welfare supports. The demand of staff of Tōdai’s Student Association to establish a Student Health Center was accepted and realized in 1926. The faculty of Medicine at Tōdai provided its young medical practitioners as doctors at the Student Health Center, who was employed as associate workers (shokutaku) of the Ministry of Education. In this process, Tōdai students became the beneficiaries of state-managed medical support.
The Tōdai Student Health Center was different from other medicare facilities in that its role was not limited to save students from poverty. Student Health Center practitioners helped students check health for university admission, campus life, and job placement to be white-collar elites. Student Health Center practitioners evaluated students’ health when they tried to enter Tōdai and get jobs and inculcated students in how to manage living as mental-worker “gentlemen,” in coping with tuberculosis, venereal diseases, and neurotic breakdown. Also, they produced statistics about the health condition of Tōdai students, which immediately stimulated further investment in facilities of Tōdai authorities for the center. Based on the statistical data, Tōdai authorities developed a hygiene campaign against tuberculosis so that students could take advantage of state-of-the-art treatments cheaply. In this process, Tōdai students became among the biggest beneficiaries of this process.
In other words, the Student Health Center embodied the two difference faces of meritocratic elites at Tōdai. On the one hand, it was a medicare institution supporting students that had to spend many years for schooling without income. But at the same time, the center was part of privileged campus culture. through which students claimed the privileged white-collar positions with their assessed health. Through the lens of this facility, this article seeks to explore the uneven diffusion of medical welfare benefits in Japanese society and the paradox of welfare in meritocracy that contributed elite formation in modern Japan.

참고자료

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