The Amish health care system • Hacker News Board

Re: The Amish health care system

#21

Post by GuiA » Wed, Apr 22, 2020, 9:59 PM UTC

daenz wrote: post #14

>How do the Amish keep costs so low? R&D (plus a few other sources) identify some key strategies. >...the Amish are honorable customers. This separates them from insurance companies, who are constantly trying to scam providers however they can. Much of the increase in health care costs is “administrative expenses”, and much of these administrative expenses is hiring an army of lawyers, clerks, and billing professiona…

> Imagine how many social problems would disappear if people had more integrity and stronger morals. Literally every aspect of life would improve.

Granted, everyone in the world is suddenly moral and of utmost integrity and everyone gets used to this new reality. The economic upside in lying/cheating is now so high that a few minutes later the world is back to exactly what it was, except for the first few persons to decide that lying wasn't such a bad idea, who are now a few billion dollars richer.

> Religions, for all their faults, and for all of their misguided morality, at least had morality frameworks that were more or less unified and teachable

This is your daily reminder that the Catholic Church is the organization with the most identified pedophiles in the world. (I'd have written "convicted", but they work really hard - and are really good - at preventing that outcome).

Re: The Amish health care system

#22

Post by a2tech » Wed, Apr 22, 2020, 10:00 PM UTC

floren wrote: post #18

I'm surely hopelessly naive and ill-informed for even asking, but is there a reason a hospital or clinic couldn't operate 100% without dealing with insurance? Do such places exist in the US? We always hear how the hospital sends a bill for $40,000, then the insurance company argues that down to $2000, but woe unto you if you DON'T have insurance because you'll have a hard time getting that same deal yourself. Couldn'…

In practice what you describe in the tail end of your post is how it works. Except the hospital can’t blackball you for emergency care even if you have a history of failure to pay.

The hospital will work with you and put you on a payment plan if you don’t just disappear. If you stop communicating they’ll sell your debt to a debt collector which is a bad deal for both you and the hospital. They’d rather have you paying $20/month for ever then sell your debt.

Re: The Amish health care system

#23

Post by beached_whale » Wed, Apr 22, 2020, 10:01 PM UTC

daenz wrote: post #14

>How do the Amish keep costs so low? R&D (plus a few other sources) identify some key strategies. >...the Amish are honorable customers. This separates them from insurance companies, who are constantly trying to scam providers however they can. Much of the increase in health care costs is “administrative expenses”, and much of these administrative expenses is hiring an army of lawyers, clerks, and billing professiona…

Theory and practice. In practice, this is people, religious or not. However, what is in their place is the arguments you made. We all win, if we are all honest.

Re: The Amish health care system

#24

Post by brians » Wed, Apr 22, 2020, 10:01 PM UTC

floren wrote: post #18

I'm surely hopelessly naive and ill-informed for even asking, but is there a reason a hospital or clinic couldn't operate 100% without dealing with insurance? Do such places exist in the US? We always hear how the hospital sends a bill for $40,000, then the insurance company argues that down to $2000, but woe unto you if you DON'T have insurance because you'll have a hard time getting that same deal yourself. Couldn'…

Sure. And the insurance plans will all tie you up with requirements for their firms to justify it or they won’t pay.

Re: The Amish health care system

#25

Post by lqet » Wed, Apr 22, 2020, 10:02 PM UTC

daenz wrote: post #14

>How do the Amish keep costs so low? R&D (plus a few other sources) identify some key strategies. >...the Amish are honorable customers. This separates them from insurance companies, who are constantly trying to scam providers however they can. Much of the increase in health care costs is “administrative expenses”, and much of these administrative expenses is hiring an army of lawyers, clerks, and billing professiona…

> [Nobel laureate Steven Weinberg] once said, "Religion is an insult to human dignity. With or without it, you’d have good people doing good things and evil people doing bad things, but for good people to do bad things, it takes religion.” To which Freeman Dyson remarked, “Weinberg’s statement is true as far as it goes, but it is not the whole truth. To make it the whole truth, we must add an additional clause: ‘And for bad people to do good things – that takes religion.’"

Re: The Amish health care system

#26

Post by hateMyIdeas » Wed, Apr 22, 2020, 10:02 PM UTC

refurb wrote: post #9

_fq4v wrote: post #2

I thought the most interesting part was the commentary on non-Amish care in the past > I asked my literal grandmother, a 95 year old former nurse, how health care worked in her day. She said it just wasn’t a problem. Hospitals were supported by wealthy philanthropists and religious organizations. Poor people got treated for free. Middle class people paid as much as they could afford, which was often the whole bill, b…

That's what some universal systems already do. I was reading up on Singapore. There is a baseline of insurance for hospital stays, but it's in a ward with 6 other patients in the same room. If you want something better (and there are tiers), you pay more. You can buy insurance policies that pay for the more comfortable stay.

That's not how insurance works, expensive insurance has a lower max out of pocket.

What you are talking about is that rich people don't need insurance at all. They just pay out of pocket.

Re: The Amish health care system

#27

Post by virmundi » Wed, Apr 22, 2020, 10:03 PM UTC

prime_factor wrote: post #15

markdown wrote: post #13

Earlier quoted context omitted.

The same in Fiji. We have universal health care, but anyone is of course free to forego that and pay (or use their private insurance) for a private room rather than a ward, or just go to a private hospital instead. I don't understand the debate about this in the US. It's as if the rich assume that things will change for the worse for them if universal health care is enacted.

What about middle class people who can't afford private care but fear that the socialized healthcare system will be of worse quality than what they currently have?

They have a hard decision. Unlike the US they are allowed to be an adult.

Re: The Amish health care system

#28

Post by lordnacho » Wed, Apr 22, 2020, 10:03 PM UTC

I think what he's getting at is the concept of a "trustful society". Essentially one like the Amish he describes: people act responsibly with the community's money.

You might well think this has broken down in America. There's both a lack of formal restraint in the form of laws holding down the price, like in the Swiss private health system, as well as a lack of informal rules like he's mentioned, preventing people who've hit their deductible from going nuts with their treatment. And the culture of suing doctors has led to even more issues.

The trustful society thing is interesting. A friend of mine lost a grand-uncle in Denmark a couple of years back. Now this guy had grown up before the welfare state, and took pride in not taking handouts that he didn't need. He lived on a family farm on an idyllic island called Bornholm. When he died, the authorities called and asked what to do with nearly 2M DKK of pension money he hadn't collected.

At the other end, you get people growing up having never seen what preceded the welfare state. You often get debates about whether the kids are spending their student allowances wisely, because obviously you see them around town and they are having a good time. This is a cash grant from the government that you don't even need to use for tuition. Are they being profligate with the state's money? It's a debate that keeps going.

Re: The Amish health care system

#29

Post by testing312 » Wed, Apr 22, 2020, 10:05 PM UTC

daenz wrote: post #14

>How do the Amish keep costs so low? R&D (plus a few other sources) identify some key strategies. >...the Amish are honorable customers. This separates them from insurance companies, who are constantly trying to scam providers however they can. Much of the increase in health care costs is “administrative expenses”, and much of these administrative expenses is hiring an army of lawyers, clerks, and billing professiona…

> I'm not a religious person, but the thing that the anti-religion movements have failed spectacularly at is providing a universal, teachable framework for basic morality.

But there is no universal, teachable framework for basic morality. Even the seemingly most basic rule: don't hurt anyone, has so many exceptions.

There is no 'small' set of rules you can use to describe morality. Reality is messy, human interactions even more so. We need to teach people to be empathic, and to be willing to try and understand the others position and view

Re: The Amish health care system

#30

Post by LeoTinnitus » Wed, Apr 22, 2020, 10:05 PM UTC

GuiA wrote: post #21

daenz wrote: post #14

>How do the Amish keep costs so low? R&D (plus a few other sources) identify some key strategies. >...the Amish are honorable customers. This separates them from insurance companies, who are constantly trying to scam providers however they can. Much of the increase in health care costs is “administrative expenses”, and much of these administrative expenses is hiring an army of lawyers, clerks, and billing professiona…

> Imagine how many social problems would disappear if people had more integrity and stronger morals. Literally every aspect of life would improve. Granted, everyone in the world is suddenly moral and of utmost integrity and everyone gets used to this new reality. The economic upside in lying/cheating is now so high that a few minutes later the world is back to exactly what it was, except for the first few persons to…

I think Islam may like a word with you on that one. There it's not just the priests. It's very common for minors to be married off, young boys to be sold as sex slaves (common in the turkic -stans areas although not sure about today), and the "it's only gay if you take it" reasoning I believe in one of the hadith's which condones pedophilia.