The implementation of Japan's Long-Term Care Insurance Scheme in April 2000 was the culmination of some 30 years of policy deliberation on aged care. Understanding the policy debate surrounding the Long-Term Care Insurance scheme and its financing arrangements requires an appreciation of rapid demographic and social change, especially in family structures and attitudes to caring for aged parents; but the pressures that population aging and economic downturn are placing on Japan's pension and health insurance systems also must be recognized. Even more generally, the delicate balance of political interests in Japan's central governing body, the Diet, has shaped the implementation of Long-Term Care Insurance as a forerunner to other reforms in social security and health insurance.