The Amish health care system • Hacker News Board

Re: The Amish health care system

#71

Post by paulryanrogers » Thu, Apr 23, 2020, 12:31 AM UTC

SlowRobotAhead wrote: post #58

jay_kyburz wrote: post #44

Earlier quoted context omitted.

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…

Agreed... but you don’t think there is an ugly backend administrator to ? Of course there is. You don’t think the NHS has lawyers and billing professionals, they’re there, just behind the scenes.

Perhaps. Though I'd hope the centralized system is more lean, transparent, and capable than say an opaque market ruled by big players leveraging regulatory capture to fleece patients and providers alike.

Re: The Amish health care system

#72

Post by paulryanrogers » Thu, Apr 23, 2020, 12:33 AM UTC

akiselev wrote: post #43

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 o…

Flint Michigan is an example of how too much trust and not enough verify can go wrong.

Re: The Amish health care system

#73

Post by specialist » Thu, Apr 23, 2020, 12:38 AM UTC

pmiller2 wrote: post #4

_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 inequality is still present, except that now, the system is: * Poor people either get hit with huge bills because they're uninsured, or, if they know how to navigate the system, sometimes get these bills written off through "financial aid." * Middle class people frequently have insurance, but get hammered by deductibles and out of pocket maximums, rarely qualifying for "financial aid." This can be ruinous. * The…

I currently believe rising administrative overhead accounts for most of the cost increase. Single payer is a straightforward proven solution.

Switching from fee-for-service to prevention (capitation) would give us another 25% savings.

But I'm newly interested in notions related to cost disease. Am keen to hear anything anyone has to say about mitigation.

Re: The Amish health care system

#74

Post by specialist » Thu, Apr 23, 2020, 12:43 AM 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?

The bulk of the (public) opposition is from people who like their employer provided insurance. We'll soon learn if the mood changes, due to pandemic induced high unemployment.

Re: The Amish health care system

#75

Post by [deleted] » Thu, Apr 23, 2020, 1:19 AM UTC

kamfc wrote: post #38

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…

is there a list of recommended writings i can study on morals?

[deleted]

Re: The Amish health care system

#76

Post by senectus1 » Thu, Apr 23, 2020, 1:19 AM UTC

testing312 wrote: post #29

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 interaction…

yes there fucking is, and it has ZERO to do with Religion or Secularism.

Treat others how you would like to be treated.

If you wanted to get more complicated its, "consider the well-being".

I'm so outraged by the causal acceptance that religion has ANYTHING to do with a proven successful moral guidance in society. You people need to stop buying the bullshit marketing of religion (and politics).

Re: The Amish health care system

#77

Post by emiliobumachar » Thu, Apr 23, 2020, 1:42 AM 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'…

The Oklahoma Surgery Center isone such place.

https://surgerycenterok.com/about/

Re: The Amish health care system

#78

Post by zajio1am » Thu, Apr 23, 2020, 1:56 AM 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.

Because no such framework exists? If we remove totalitarian pressure to enforce one coherent moral framework (either religious or secular) to all, we end up with pluralistic society in which various persons have fundamentally different moral intuitions, and therefore it needs extensive formal system for cooperation and conflict solving.

Re: The Amish health care system

#79

Post by philwelch » Thu, Apr 23, 2020, 1:59 AM UTC

markdown wrote: post #13

refurb wrote: post #9

Earlier quoted context omitted.

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.

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.

Part of it is because the “Medicare for All” proposal outlaws private insurance.

Re: The Amish health care system

#80

Post by zucker42 » Thu, Apr 23, 2020, 2:04 AM UTC

Is comparing the per capita cost of healthcare to that of U.S. really fair, especially when advocating adopting certain elements of the "Amish system"? The U.S. is pretty the worst example of keeping costs down; other first world healthcare systems cost much less than the U.S.'s with similar or better outcomes. I suppose it's reasonable because the Amish live in the U.S. but I guess the question is do the Amish do particularly well or does the U.S. just generally do particularly poorly?

I do think there are some interesting insights in the article though.

Edit: another observation is that the author is probably not putting enough emphasis on the additional cost of end-of-life care (though he does mention it), especially if he's correct that the Amish tend not to spend as much on prolonging the life of older people.