Sharing the Load: Amish Healthcare Financing (2016)
ncbi.nlm.nih.gov
ncbi.nlm.nih.gov
Amish economics are weird, because the deep aversion to debt tends to create winner-take-all scenarios: an Amish farmer might become wealthy from mineral and gas rights on his property, for example, and plow those funds into setting up a general store, which creates funds that go into a restaurant — and from there a hotel, a gas station, a gift shop, and pretty soon half the county is working for him. Since no Amish would consider a bank or SBA loan, new business starts are confined to either English outsiders or a small number of very wealthy Amish. (One guy in the cabinet business had a Rolls Royce with solid rubber tires — don’t ask — and an English driver whose name the car was officially in. Technically, not a violation of religious strictures!)
Someone should do a kit car with Toyota mechanicals and a Rolls style body!
It is funny that the old ones are so mechanically unreliable though, when you consider that Rolls also has a long history of making aircraft engines.
Health care sharing ministries have existed since the early 1900s, primarily among Mennonites and the Amish. The idea was simple: Members chip in what they can to help cover a neighbor’s costs when someone breaks a leg, say, or falls ill. It was the financial equivalent of a potluck dinner, with everyone contributing something to the table and sharing the spread.
Few outside those communities knew or cared that health care sharing ministries existed. They were tiny, didn’t advertise for new members and posed no threat to corporate insurance. Most importantly, no one envisioned making money from a ministry.
1. They keep costs down in part by pursuing home remedies for a lot of things instead of seeing a doctor. They have established sources of information and support for this practice.
2. When it comes to medical care, they are not Luddites and are willing to use cutting edge technologies to care for medical issues.
3. I was struck by the repeated mention of genetic disorders. It makes me wonder if this is a big issue in the Amish community. If so, one solution would be to encourage young people to marry outsiders, which is probably not encouraged as it tends to be a threat to the culture of groups like this. By I see it as extremely irresponsible to knowingly pursue practices that increase the odds of children being born with genetic disorders.
Neither Amish Hospital Aid nor congregational alms funding cover health care needs that result from prohibited activities within the Amish community. One interviewee mentioned an incident that occurred with a teenage boy in her congregation who was injured in a snowmobiling accident. The use of motor vehicles (e.g., cars, tractors, snow mobiles) is strictly forbidden in Old Order Amish culture.
This may sound harsh to some people, but all insurance policies have exemptions which (at least for accident policies) more or less boil down to "if you are behaving irresponsibly and get yourself hurt through taking undue risks, we are not paying for the consequences of your foolish behavior" -- only, you know, in legalese that is defensible in court if necessary.
I will note that as someone who processed accident claims, minors who lost limbs driving recreational vehicles like snow mobiles always broke my heart. If you have children and you own anything like a snow mobile, please make sure it is secured and they cannot go for a joy ride on Saturday morning while you sleep in.
Two other factors for low cost would be their healthy lifestyle and end of life care choices. The Amish get about 20k steps in per day - double the recommended 10k steps that most English fail to meet. Rates of many chronic diseases are lower. When they do get old, they don't drag things out and they generally don't go into longterm care facilities. Most English tend to want the doctor to "do everything you can".
> Amish mortality patterns were not systematically higher or lower than those of the non-Amish, but differed by age, sex, and cause. Amish males had slightly higher all-cause MRs as children and significantly lower MRs over the age of 40, due primarily to lower rates of cancer (MR = 0.44, age 40-69), and cardiovascular diseases (MR = 0.65, age 40-69). Amish females MRs for all causes of death were lower from age 10-39, not different from 40-69, and higher over age 69. https://pubmed.ncbi.nlm.nih.gov/7315833/
Basically, Amish boys are more likely to die young. There are no long term lifestyle benefits for Amish women.
And "English" by which I assume you mean Americans don't have infinite funds.
Rates of many chronic diseases are lower.
Amish males had ...significantly lower MRs over the age of 40, due primarily to lower rates of cancer (MR = 0.44, age 40-69), and cardiovascular diseases (MR = 0.65, age 40-69).
Also, mortality rates and costs are not synonyms.
The men over 40 subset of population has slightly lower mortality and no one else. The numbers even out.
That is not consistent with "healthier lifestyle overall" as if they generally got benefits.
Also you: Amish females MRs for all causes of death were lower from age 10-39, not different from 40-69, and higher over age 69.
Women only "got more issues as their aged" after age 69. Before that, they were either better off or about the same. This also agrees with the point the parent comment was making that they generally have healthy lifestyles and don't go into long-term care facilities in old age. Instead, they accept death when the time comes.
69 years old women are not in the long term facilities for that matter eitminor Nor are men. In UK, 66 years old is retirement age. This is age when strength and health declines, but nowhere near the level necessary to be in some kind of facility. These are self sufficient people, able to care about themselves, able to care about relatives or animals.
None of that are numbers that overall superior healthier lifestyle. Just a minor shifts around.
Part of the confusion is that you are conflating mortality with health.
If two people live to the same age, but one requires many surgeries, drugs, and treatments, I dont think you would say they are equally healthy.
"significantly lower MRs over the age of 40, due primarily to lower rates of cancer (MR = 0.44, age 40-69), and cardiovascular diseases (MR = 0.65, age 40-69)"
As they said, cause differs. When looking at costs, causes are very important. Things like cancer and cardiovascular diseases tend to cost a lot of money to treat as they drag on. If you die young in an accident, it's likely to cost less.
In order for lifestyle to be healthier, I would want to see more benefits then just some middle aged men mortality shifted onto young ones.
Some of these disorders are quite rare, or unique, and are serious enough to increase the mortality rate among Amish children.
I criticized the practice of inbreeding in my first comment.
This is why I have a hard time taking cost comparisons seriously between the US and Europe - European healthcare systems will pull the plug a lot earlier, saving the money (and the indignity) involved in dying as slowly as possible.
Ironically, doctors in the US have some of the lowest end-of-life care costs, because they know their actual chances and don't seem to be so afraid of dying.
For instance, the brothers had lack of coordination, ataxia, and minor speech problems. They were constantly getting pulled over by the local cops for minor violations (like driving too slowly) and nearly every time the cops would insist that they were drunk even though they didn't have a drop of alcohol. To the untrained eye, their affect looked very similar to an intoxicated person: slurred speech, bobbing while standing in place, stumbling when walking or getting out of the car, &c. So yes this is a big problem in these communities.
They do sometimes adopt children from outside their population. I don't know how common that is and whether it makes a difference.
Some accident policies may have those features, but zero health insurance ones do.
1. What you pay out of pocket before insurance coverage kicks in.
2. No coverage for out-of-network providers.
3. Caps on how much they will cover.
Insurance is a numbers game. Rest assured, all insurance policies and all insurance providers find ways to limit how much they pay out.
You may find some means to limit payments more distasteful than others, but they all do this. It's the only way they can possibly stay in business.
One of the necessary casualties of that is restrictions on who is able to offer what and when. It's a good trade.
What I mean by that is if I work for a large company, I can get access to health insurance that I cannot buy on the market myself. If that company changes insurers to a crappy one, my only choice is to change employers to one that provides access to a better insurer. If I self employ, I cannot get access to those plans.
Insurers should be forced to sell in a single market all the plans they offer. Insurer like to talk about "economy of scale" with large employers, but that is an artificial limit. Why should insurance pools be limited to who works at a company?
Very true. There should be one insurance pool. Either state or nationwide.
There should be one pool where everybody can get insurance regardless of agr, employment status or preconditions. Insurers should compete for that pool.
If your complaint is that employers have access to better insurance plans on private offer, well that's true. Walmart also has self-insured property/auto coverage not available to smaller companies. But COBRA let's you stay on your employers plan if you leave for up to a year (at a pretty high cost) so that's a thing.
The law is basically written by the insurers, and favors them. It allows them to segregate people based on who they work for, etc.
In an ethical system, there would be just a single, non-segregated pool of people called a 'market', and anyone would be able to purchase any plan they want from that market, regardless of which state they lived in and regardless of who they did or did not work for.
Federal employees have such a system, and prior to obamacare, there was actually bipartisan agreement forming around enabling everyone to participate in that system. It's probably why obamacare was rushed through quickly by the insurance companies.
It should be quite evident that everything about this system is broken, but this is part of how broken systems get entrenched.
“HCSMs are not regulated by the ACA. The coverage you get will vary from one HCSM to another, but they are not required to cover pre-existing conditions, cap out-of-pocket costs, or cover essential health benefits. And they can still have annual and lifetime benefit caps.”
Since they’re not regulated entities, there’s no enforcement mechanism if you get sick and they decide not to pay out or delay your reimbursement.
Taking about free markets in the context of US health insurance in general is a waste of time.
https://www.youtube.com/watch?v=z6SlJZk5guI&list=PLEyPgwIPkH...
One of the more interesting discussions was how they handled covid.
Who's the agent/broker here? He/she is required to have E&O.