Amish people don’t have health insurance, and pay much less than you do for health care. But their health is fine. What can we learn?
He explores various hypotheses, but he does not address my main hypothesis.
In 2006 when I wrote Crisis of Abundance, I asked why health care cost more in 2006 than in 1970. I determined that much of the answer was what I called “premium medicine,” which uses expensive equipment and medical specialists. You can think of getting an MRI when you hurt your back or getting a routine coloscopy screening as recommended at age 65.
Premium medicine contributes a lot to health care spending but relatively little to aggregate health outcomes. Those outcomes are affected more by lifestyle considerations. If in a society you increase substance abuse at the same time as you increase overall use of premium medicine, the net impact on longevity will not be particularly positive.
The Amish philosophy on technology in general is to be late adopters. That is, they do adopt new inventions, but the process is very gradual. My guess is that they are a lot less inclined to use premium medicine.
In my book, I pointed out that in 2006 we could easily afford health insurance that covered only those procedures that were prevalent in 1970. Perhaps the Amish are following that approach.
One big difference seems to be that the Amish have an actual community. Since they have an actual community, they can pool risk at the community level rather than having to pool risk through a giant faceless bureaucracy. This leads to a lot of efficiencies.
Do you think the Amish relief from being forced into the more general community (having to pay Social Security, Medicare, etc) can continue forever. Their exceptions have been remarkably robust over the long run, but it’s not like the Amish have any way to defend it other than cultural deference to their way of life.
> they can pool risk at the community level rather than having to pool risk through a giant faceless bureaucracy
How does this make any difference financially, apart from stripping out profit margin of insurers, which as Scott points out is in single figure percentages?
As he points out, it means that there is transparency and everyone is accountable to one another. You don’t use medicine you don’t need because it would be embarrassing to do so. Your community does play weird insurance gotcha games on care you do need. There aren’t several different payers leading to weird incentives. And your lifestyle is under scrutiny if it leads to higher spending.
So much of what goes on in healthcare at every level would be embarrassing to explain to someone if you ever had to. In an Amish community you do.
The bare bones Brazilian system sounds like Amish system. The constitutionally mandated spending on health is incredibly efficient: https://agenciabrasil.ebc.com.br/en/saude/noticia/2018-11/brazil-spends-daily-092-person-health-care yet provides adequate care for most and those who want more can pay for it privately. And the Brazilian life expectancy of about 75.5 is similarly less than the USA average of about 78.5. But interpersonal violence is the 4th leading cause of death in Brazil (which is not in the top ten USA causes) so they are doing pretty well. Scrapping all the federal health programs and replacing with a SUS-style direct delivery system would likely increase access to basic essential health services, eliminate the crisis of abundance (people would need to get used to waiting), and perhaps reflecting the new economic reality, save money.
Nicely said, Arnold.
If any community was to avoid drug addiction and violence, and have good communal pre-natal care, and not carry insurance for transplant and end-stage cancer treatments, that community would have lower health costs.
Although I liked a lot about the Affordable Care Act, one provision I disliked was requiring all insurance policies to have unlimited dollar maximums. I say, if care cannot be done for $100,000, then there is price gouging or just too much focus on one individual, or both.