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The Amish health care system

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Re: The Amish health care system

#41

Post by bpfrh »

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?

You can look at austria to see that that doesn't happen.

An MRI cost me about 0€.

A 4000€ test which tests for nearly any rheutmatic diseases markers and the visit to the hospital for that test cost me 0€, both things got done within two weeks.

Even if you are poor and want to go to a private doctor it will cost you not nearly as much as in the usa. For me it was about 100€, for one visit and that was on the higher end.

Socialized healthcare is always cheaper.

Re: The Amish health care system

#42

Post by pdonis »

lordnacho wrote: post #28

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 w…

> The trustful society thing is interesting.

Yes, it is, but it doesn't scale. It only works for communities that are small enough that everyone can keep track of the trust relationships and how well everyone is honoring them. The problem we moderns have is that many of us either don't want to live in such a community (even Scott notices this when he says there is something to be said for not having your neighbors judging your lifestyle all the time) or don't have access to one. So we have a different set of priorities, and we therefore have to make different choices and tradeoffs.

Re: The Amish health care system

#43

Post by akiselev »

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. But instead, we have to bulletproof everything (largely without success) from people who scheme and scam their way through life. We sink enormous costs into this, and it slows the progress and complicates life for everyone else.

What bulletproofing? Humanity has operated on an extremely high trust basis since the beginning of civilization - it's the only reason we've been able to grow so fast and reshape the planet. It's why McDonald's employee don't check someone's ID at the pick up window and why social engineering works so well. It's the reason why we even have power grids, indoor plumbing, and modern medicine - all of those systems require extreme levels of trust.

That's not hyperbole: A decent sized power plant joining the grid out of phase can crash the entire system, destroying - aka exploding - other power plants and distribution infrastructure. Our water supply systems and reservoirs are almost completely unprotected and vulnerable to malicious actors. A significant fraction of our health and safety regulations operate on scout's honor and personal liability: the FDA approved the diagnostic tests at the clinical labs I've worked at because they trust some certified lab managers (that we hired) to review our procedures and quality control - for life or death clinical testing - without a regulator ever stepping foot in the lab. Our species has even scraped our noses against nuclear war several times, ending in some low level officer deciding "nah... not today."

As a species we are weak: we can't run fast or climb very well, our stomachs and immune systems aren't worth squat in the wild, and it takes us longer to raise our young than most animals' life expectancies. It is only through intelligence and trust have we been able to overcome those limitations to build the world we have today.

The problem isn't individual morality, it's the systemic incentives built up over millennia of societal debt, tribalism, and a dash of corruption. Trying to moralize at an individual level is a big reason why so many people are anti-religious to begin with.

Re: The Amish health care system

#44

Post by jay_kyburz »

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…

No, what we should do is build our systems so that human nature is taken into consideration. There will always be good and bad people.

Medical pricing should be simple, upfront and direct. It should not require lots of clerks and "billing professionals"

It shouldn't required armies of expensive lawyers to settle disputes. Whether the bill was not paid by the customer, or the doctor failed to deliver what the customer paid for.

Re: The Amish health care system

#45

Post by carapace »

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. But instead, we have to bulletproof everything (largely without success) from people who scheme and scam their way through life. We sink enormous costs into this, and it slows the progress and complicates life for everyone else.

That the central problem of human life. "Hell is other people."

Arguably, cities are a bad idea. There's no a priori reason to expect our so-called civilization to work. In evolutionary time-frame it has only just appeared and it shows every evidence of being an ephemeral flash-in-the-pan. I mean, not only are we about to roast ourselves in our own waste heat, but a single virus has deranged our whole global economic structure.

It may well turn out that coming down out of the trees and inventing digital watches was wrong, and the Orangutans and Dolphins have got it right all along.

Government (kings and whatnot) is a kind of machine to manage human wickedness.

> ...a universal, teachable framework for basic morality. ... What do we have now in their place?

The simple answer is e.g. the Universal Declaration of Human Rights:

https://en.wikipedia.org/wiki/Universal_Declaration_of_Human...

Re: The Amish health care system

#46

Post by oconnor663 »

> For the [non-Amish], the “other people” are faceless insurance companies, and we treat people who don’t extract as much money as possible from them as insufficiently savvy.

This is just a side comment in the post, but I think it's an important observation. People really, really don't like feeling (or looking) like suckers. When we see other people breaking the rules, we're much more likely to break the rules. Some of this is that we're seeing evidence that breaking the rules won't be punished, sure. But I think the larger effect is that now we feel like suckers for following the rules.

Re: The Amish health care system

#47

Post by chkaloon »

This model already exists in other forms in the US. One of them is called a healthshare. Usually a religion-based scheme where you pay in a certain amount a month, and then you negotiate with the doctor yourself, pay the bill yourself, and then get reimbursed by the healthshare if there is enough pooled money.

This does a number of things:

1) It puts patient skin-in-the-game in that they have the direct incentive to shop around and/or negotiate lower bills since they have to front the cost.

2) it removes the costly middle-men referenced in this article and all the administrative cost that goes with that.

3) It puts much more of the administrative burden on the patient because they have to negotiate and pay, keep track of things, then get reimbursed.

These three things result in reduced monetary costs, but add other costs like the patient's time and stress level.

Healthshares previously could only exist if they had been grandfathered in via a special provision in the ACA. Since then enough of the ACA has been eaten away that new healthshares are taking advantage of the resulting loopholes.

Re: The Amish health care system

#48

Post by seph-reed »

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…

> 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

Within my personal morality framework, it is completely ethical to lean into rage if you can hold your logic, and those few persons have just sacrificed themselves to becoming a lesson.

There's a great saying which is "if you're incapable of violence, you're never peaceful, merely harmless." It's time we start talking about was is and is not okay within the context of intentional harm and suffering. What are the pros and cons of punishment? When should it be applied? How?

I'd say a week of waterboarding could be enough to get someone very adamantly expressing "it wasn't worth it." Those words would never go unsaid by these culprits. "It wasn't worth it" should be the slogan of every evil deed.

Re: The Amish health care system

#49

Post by notyourday »

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…

> ...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 professionals to thwart insurance companies’ attempts to cheat their way out of paying. If you are an honorable Amish person and the hospital knows you will pay your bill on time with zero fuss, they can waive all this.

My wife came from a splinter of that group.

I skimmed the article. It is missing the most important cultural part -- Amish even when sick will continue to work and eventually simply die. Culturally they do not try to extend life at any cost.

Re: The Amish health care system

#50

Post by selimthegrim »

a2tech wrote: post #19

Yeah...just no. The Amish are not a group you should be modeling yourself after. I grew up surrounded by the Amish and the clean living salt of the earth myth is simply that—a myth.

Did you have to pick up their beer cans from their circling their wagons on your field during their rumspringa? I sure did.
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