The Second World War killed approximately fifty million people, while it led policies and institutions to improve people’s health. This paper will ask why and how these events occur ironically at the same time and rethink the development of health insurance policy. This paper will also examine how war mobilization formed and consolidated the Japanese and American health insurance systems. It is through an examination of the Japanese war experience, the fifteen-year war, that we understand how and why Japan reached a nearly comprehensive national health insurance system with a unique structure. On the other hand, the American war experience, what people call "Big One," largely shaped the subsequent policy path that relied largely on the private health insurance. This paper takes the United Kingdom and Germany as shadow cases to illuminate the Japan-US comparison. Richard Titmuss pointed out a half century ago that total war would lead to the development of social welfare policy. More recently, Jytte Klausen argues that war creates a new notion of what the state can and should do in economic and social policy (see also Kasza, Kryder, Skocpol, and Sparrow). However, historical and comparative political scientists have made only limited efforts to theorize the effect of war experiences on welfare state development. War, like any other single variable, cannot explain such development alone. Nonetheless, war prompts the state to intervene in promoting policies and institutions to improve people’s health. Most simply, state leaders who seek victory at the international level must attempt to improve people’s health to produce good soldiers and good munitions and to control or stabilize social demands. Titmuss saw how the events in the United Kingdom and its war experiences led to the expansion of social policies, including the Beveridge Report released in 1942 and the establishment of the National Health Insurance in 1946. However, his work did not prompt further comparative study as scholars turned their attention to other variables in the discussion of welfare state development, such as industrialization, labor power, culture, and policy and institutional path dependence. When scholars do study the impact of war, they tend to treat it as a simple and identical exogenous shock and do not address how variations in war experiences affect policies and institutions. In contrast, this paper puts forward an argument about how a war’s duration, depth of mobilization, casualties, battle sequence, and war-fighting regime influence health policy development. Thus, this paper seeks to contribute to an understanding of those factors that influence the formation and the consolidation of health insurance systems in various countries by incorporating the Japanese and American cases into comparative study. [ABSTRACT FROM AUTHOR]