The Amish health care system • Hacker News Board

Re: The Amish health care system

#81

Post by karmicthreat » Thu, Apr 23, 2020, 2:10 AM UTC

robocat wrote: post #64

hateMyIdeas wrote: post #26

Earlier quoted context omitted.

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.

That is how health insurance works in New Zealand. If you want private health insurance for say $50 a month[1], then insurance gives access to procedures more quickly and the rooms are much nicer than the public health care system. It may give access to rare but expensive procedures. If you don’t want insurance, then the default is the public healthcare system, which is paid for by taxes. You will usually be in a war…

That system looks terrible for handling cancer and pre-existing conditions.

Re: The Amish health care system

#82

Post by kyuudou » Thu, Apr 23, 2020, 2:14 AM UTC

jpab wrote: post #54

bluejekyll wrote: post #12

“ The Amish have had a life expectancy in the low 70s since colonial times, when the rest of us were dying at 40 or 50. Since then, Amish life expectancy has stayed the same, and English life expectancy has improved to the high 70s.”

I found that curious. Why were the Amish living so much longer than others in colonial times?

They lead non-sedentary lives involving manual labor, keeping their bodies in good health. They also don't have frankenfood and tend to have actual food instead. I'm surprised people don't understand just how important these 2 factors are towards longevity.

Re: The Amish health care system

#83

Post by gen220 » Thu, Apr 23, 2020, 2:20 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'…

It's a good question.

There are some hospitals that proudly make a point of not accepting insurance. They avoid the administrative overhead of negotiating insurance contracts and pricing procedures, and accordingly have a smaller salary footprint.

As a byproduct of not working with insurance, they're allowed to advertise standard prices per procedure, because there actually is a standard price instead of 3-5 different "negotiated" prices. This price transparency is a competitive advantage, and it means they can attract price-sensitive patients for elective procedures.

The competitive advantage of price transparency is just enough to make them competitive with insurance-taking clinics.

The difference is that, in these setups, your clinic lives and dies by its reputation. Being in a big insurance carrier's network will effectively guarantee you a baseline patient volume. Going it "on your own" means you get no such guarantees. It's a riskier proposition.

I work in health insurance tech, but if you're curious to hear it from the horse's mouth, Keith Smith is the head person of an insurance-refusing operation in Oklahoma: https://www.econtalk.org/keith-smith-on-free-market-health-c...

Re: The Amish health care system

#84

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

kyuudou wrote: post #82

jpab wrote: post #54

Earlier quoted context omitted.

I found that curious. Why were the Amish living so much longer than others in colonial times?

They lead non-sedentary lives involving manual labor, keeping their bodies in good health. They also don't have frankenfood and tend to have actual food instead. I'm surprised people don't understand just how important these 2 factors are towards longevity.

This doesn't answer parent's question. In "colonial times", most people did physical labor and ate real food.

Re: The Amish health care system

#85

Post by op00to » Thu, Apr 23, 2020, 2:23 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?

It’s not that their care will get worse, it’s because their care gets worse due to “those people” getting better care. Source: my in-laws.

Re: The Amish health care system

#86

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

_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…

The past is not a useful guide, because until recently, there was relatively little that could be done medically, and costs were commensurably low. The elephant in the room is that medical technology has advanced to the point where any person's needs can potentially greatly exceed their lifetime's ability to produce. When there are relatively few who find themselves in this state, insurance (and what is described in both Alexander's article and tathougies' post are informal forms of it) works, but not when it is a majority.

Re: The Amish health care system

#87

Post by kevin_thibedeau » Thu, Apr 23, 2020, 2:24 AM UTC

karmicthreat wrote: post #81

robocat wrote: post #64

Earlier quoted context omitted.

That is how health insurance works in New Zealand. If you want private health insurance for say $50 a month[1], then insurance gives access to procedures more quickly and the rooms are much nicer than the public health care system. It may give access to rare but expensive procedures. If you don’t want insurance, then the default is the public healthcare system, which is paid for by taxes. You will usually be in a war…

That system looks terrible for handling cancer and pre-existing conditions.

As opposed to one where everyone avoids medical care at all costs to avoid extortionate bills?

Re: The Amish health care system

#88

Post by duckMuppet » Thu, Apr 23, 2020, 2:28 AM UTC

bmelton wrote: post #33

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.

> It's as if the rich assume that things will change for the worse for them if universal health care is enacted. Well, it depends on the implementation, but Bernie Sanders has been on record numerous times as stating that his Medicare-for-All proposal would absolutely ban private insurance. Elizabeth Warren is another Democratic front-runner who indicated that she's on board with that, though her proposals didn't nec…

For what purpose would they not ban it?

Re: The Amish health care system

#89

Post by jessaustin » Thu, Apr 23, 2020, 2:29 AM UTC

lqet wrote: post #25

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…

How do we know whether a person is good or bad, other than by seeing what the person does? In truth, the idea of a good or bad person is a trope of fiction intended for children. In real life everyone does good and bad things.

Re: The Amish health care system

#90

Post by ineedasername » Thu, Apr 23, 2020, 2:32 AM UTC

specialist wrote: post #73

pmiller2 wrote: post #4

Earlier quoted context omitted.

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.

The biggest administrative costs in health care are the insurance companies' costs. [0] To the tune of more than $200 billion dollars/year.

[0] https://time.com/5759972/health-care-administrative-costs/