36 ms·

Sharing the Load: Amish Healthcare Financing (2016)

60 points by timothyg 4y ago

HillRat 4y ago
For an example of how most of these cost-sharing plans go, see this article on the implosion of a commercial plan that preyed on the Mennonites of southern Ohio: https://www.propublica.org/article/liberty-healthshare-healthcare-sharing-ministries-obamacare https://www.propublica.org/article/liberty-healthshare-healt... Amish economics are weird, because the deep aversion to debt tends to create winner-take-all scenarios: an Amish farmer might become wealthy from mineral and gas rights on his property, for example, and plow those funds into setting up a general store, which creates funds that go into a restaurant — and from there a hotel, a gas station, a gift shop, and pretty soon half the county is working for him. Since no Amish would consider a bank or SBA loan, new business starts are confined to either English outsiders or a small number of very wealthy Amish. (One guy in the cabinet business had a Rolls Royce with solid rubber tires — don’t ask — and an English driver whose name the car was officially in. Technically, not a violation of religious strictures!)
- moomoo11 4y ago
  Would have been impressive if he put the RR in neutral and got it pulled by horses.
- implements 4y ago
  Aside: Hoovies Garage on YouTube taught me that keeping a old Rolls or Bentley in perfect working order costs literally tens of thousands of dollars a year in parts and maintenance - nothing stays ‘fixed’ for very long. Someone should do a kit car with Toyota mechanicals and a Rolls style body!
  - actionfromafar 4y ago
    We call them “Lexus”
    - tiedieconderoga 4y ago
      Rolls is on a whole different level when it comes to fit and finish. The interior and ride quality is why they cost as much as an Italian sports car and weigh as much as an armored vehicle. Adding a bit of leather trim and brushed aluminium buttons doesn't get you into the same league. It is funny that the old ones are so mechanically unreliable though, when you consider that Rolls also has a long history of making aircraft engines.
- DoreenMichele 4y ago
  Your own article indicates it really has nothing to do with the research piece posted: Health care sharing ministries have existed since the early 1900s, primarily among Mennonites and the Amish. The idea was simple: Members chip in what they can to help cover a neighbor’s costs when someone breaks a leg, say, or falls ill. It was the financial equivalent of a potluck dinner, with everyone contributing something to the table and sharing the spread. Few outside those communities knew or cared that health care sharing ministries existed. They were tiny, didn’t advertise for new members and posed no threat to corporate insurance. Most importantly, no one envisioned making money from a ministry.
DoreenMichele 4y ago
I worked in insurance for over five years. This is a very good read. 1. They keep costs down in part by pursuing home remedies for a lot of things instead of seeing a doctor. They have established sources of information and support for this practice. 2. When it comes to medical care, they are not Luddites and are willing to use cutting edge technologies to care for medical issues. 3. I was struck by the repeated mention of genetic disorders. It makes me wonder if this is a big issue in the Amish community. If so, one solution would be to encourage young people to marry outsiders, which is probably not encouraged as it tends to be a threat to the culture of groups like this. By I see it as extremely irresponsible to knowingly pursue practices that increase the odds of children being born with genetic disorders. Neither Amish Hospital Aid nor congregational alms funding cover health care needs that result from prohibited activities within the Amish community. One interviewee mentioned an incident that occurred with a teenage boy in her congregation who was injured in a snowmobiling accident. The use of motor vehicles (e.g., cars, tractors, snow mobiles) is strictly forbidden in Old Order Amish culture. This may sound harsh to some people, but all insurance policies have exemptions which (at least for accident policies) more or less boil down to "if you are behaving irresponsibly and get yourself hurt through taking undue risks, we are not paying for the consequences of your foolish behavior" -- only, you know, in legalese that is defensible in court if necessary. I will note that as someone who processed accident claims, minors who lost limbs driving recreational vehicles like snow mobiles always broke my heart. If you have children and you own anything like a snow mobile, please make sure it is secured and they cannot go for a joy ride on Saturday morning while you sleep in.
- andrewl 4y ago
  I had an anthropology professor in college who did some work on genetic diseases in the Amish. It is a problem. This Wikipedia has a short overview and a lot of references: https://en.wikipedia.org/wiki/Health_among_the_Amish https://en.wikipedia.org/wiki/Health_among_the_Amish
  - wyclif 4y ago
    Anecdotal, but I once had a friend and roommate that came from an ex-Mennonite family of 12 siblings with two sets of twins. He and one of his brothers both developed late-onset Tay-Sachs disease. Although relatively high-functioning and able to do most tasks such as hold down a job and drive a vehicle, there were some unfortunate consequences. For instance, the brothers had lack of coordination, ataxia, and minor speech problems. They were constantly getting pulled over by the local cops for minor violations (like driving too slowly) and nearly every time the cops would insist that they were drunk even though they didn't have a drop of alcohol. To the untrained eye, their affect looked very similar to an intoxicated person: slurred speech, bobbing while standing in place, stumbling when walking or getting out of the car, &c. So yes this is a big problem in these communities.
nonethewiser 4y ago
Its crazy that there are laws against offering health insurance in the open market. There is no reason you couldn't shop around for a plan just like you do for car or home owners insurance.
- boppo1 4y ago
  Is that not what I do when comparing plans on healthcare.gov?
  - mikeyouse 4y ago
    That’s exactly what it is except they have base “minimum essential coverage” laws that these ministries don’t abide by. “HCSMs are not regulated by the ACA. The coverage you get will vary from one HCSM to another, but they are not required to cover pre-existing conditions, cap out-of-pocket costs, or cover essential health benefits. And they can still have annual and lifetime benefit caps.” Since they’re not regulated entities, there’s no enforcement mechanism if you get sick and they decide not to pay out or delay your reimbursement.
  - donatj 4y ago
    I mean kind of. There’s a ton of restrictions on who can have what plan where though, it’s not a very “free” free market.
  - Spooky23 4y ago
    Sort of. ACA set ground rules for one segment of the market and did a good job doing so. There is a real competitive process in most states. Taking about free markets in the context of US health insurance in general is a waste of time.
  - tomohawk 4y ago
    You cannot purchase plans across state lines. You cannot purchase the same plan you would get if you worked at a large company. The law is basically written by the insurers, and favors them. It allows them to segregate people based on who they work for, etc. In an ethical system, there would be just a single, non-segregated pool of people called a 'market', and anyone would be able to purchase any plan they want from that market, regardless of which state they lived in and regardless of who they did or did not work for. Federal employees have such a system, and prior to obamacare, there was actually bipartisan agreement forming around enabling everyone to participate in that system. It's probably why obamacare was rushed through quickly by the insurance companies.
newaccount2021 4y ago
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tomohawk 4y ago
Peter Santenello has a good video series with interviews of Amish. https://www.youtube.com/watch?v=z6SlJZk5guI&list=PLEyPgwIPkHo7lOk-72-tXJ-NjahfkNF_r https://www.youtube.com/watch?v=z6SlJZk5guI&list=PLEyPgwIPkH... One of the more interesting discussions was how they handled covid.
ecommerceguy 4y ago
These plans are not ACA qualified, are underwritten on an annual basis and do not cover pre existing conditions. They are for healthy people to cover something for the duration of the plan, which it sounds like it did. The next year the Agent or Broker (there is a legal difference) should have steered this lady to a Marketplace Plan - Fully Insured plan which covers pre-ex. Problem solved. Who's the agent/broker here? He/she is required to have E&O.
shard_rocker6 4y ago
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slay_hearts7 4y ago
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lion_ankles6 4y ago
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peez_weez9 4y ago
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steel_rebel6 4y ago
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heart_stealer1 4y ago
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shadow_lord3 4y ago
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wolf_gang7 4y ago
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crow_srows9 4y ago
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SasukeUchiha1 4y ago
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60 points by timothyg 4y ago

For an example of how most of these cost-sharing plans go, see this article on the implosion of a commercial plan that preyed on the Mennonites of southern Ohio: https://www.propublica.org/article/liberty-healthshare-healthcare-sharing-ministries-obamacare https://www.propublica.org/article/liberty-healthshare-healt... Amish economics are weird, because the deep aversion to debt tends to create winner-take-all scenarios: an Amish farmer might become wealthy from mineral and gas rights on his property, for example, and plow those funds into setting up a general store, which creates funds that go into a restaurant — and from there a hotel, a gas station, a gift shop, and pretty soon half the county is working for him. Since no Amish would consider a bank or SBA loan, new business starts are confined to either English outsiders or a small number of very wealthy Amish. (One guy in the cabinet business had a Rolls Royce with solid rubber tires — don’t ask — and an English driver whose name the car was officially in. Technically, not a violation of religious strictures!)

moomoo11 4y ago
Would have been impressive if he put the RR in neutral and got it pulled by horses.
implements 4y ago
Aside: Hoovies Garage on YouTube taught me that keeping a old Rolls or Bentley in perfect working order costs literally tens of thousands of dollars a year in parts and maintenance - nothing stays ‘fixed’ for very long. Someone should do a kit car with Toyota mechanicals and a Rolls style body!
- actionfromafar 4y ago
  We call them “Lexus”
  - tiedieconderoga 4y ago
    Rolls is on a whole different level when it comes to fit and finish. The interior and ride quality is why they cost as much as an Italian sports car and weigh as much as an armored vehicle. Adding a bit of leather trim and brushed aluminium buttons doesn't get you into the same league. It is funny that the old ones are so mechanically unreliable though, when you consider that Rolls also has a long history of making aircraft engines.
DoreenMichele 4y ago
Your own article indicates it really has nothing to do with the research piece posted: Health care sharing ministries have existed since the early 1900s, primarily among Mennonites and the Amish. The idea was simple: Members chip in what they can to help cover a neighbor’s costs when someone breaks a leg, say, or falls ill. It was the financial equivalent of a potluck dinner, with everyone contributing something to the table and sharing the spread. Few outside those communities knew or cared that health care sharing ministries existed. They were tiny, didn’t advertise for new members and posed no threat to corporate insurance. Most importantly, no one envisioned making money from a ministry.

DoreenMichele 4y ago

I worked in insurance for over five years. This is a very good read. 1. They keep costs down in part by pursuing home remedies for a lot of things instead of seeing a doctor. They have established sources of information and support for this practice. 2. When it comes to medical care, they are not Luddites and are willing to use cutting edge technologies to care for medical issues. 3. I was struck by the repeated mention of genetic disorders. It makes me wonder if this is a big issue in the Amish community. If so, one solution would be to encourage young people to marry outsiders, which is probably not encouraged as it tends to be a threat to the culture of groups like this. By I see it as extremely irresponsible to knowingly pursue practices that increase the odds of children being born with genetic disorders. Neither Amish Hospital Aid nor congregational alms funding cover health care needs that result from prohibited activities within the Amish community. One interviewee mentioned an incident that occurred with a teenage boy in her congregation who was injured in a snowmobiling accident. The use of motor vehicles (e.g., cars, tractors, snow mobiles) is strictly forbidden in Old Order Amish culture. This may sound harsh to some people, but all insurance policies have exemptions which (at least for accident policies) more or less boil down to "if you are behaving irresponsibly and get yourself hurt through taking undue risks, we are not paying for the consequences of your foolish behavior" -- only, you know, in legalese that is defensible in court if necessary. I will note that as someone who processed accident claims, minors who lost limbs driving recreational vehicles like snow mobiles always broke my heart. If you have children and you own anything like a snow mobile, please make sure it is secured and they cannot go for a joy ride on Saturday morning while you sleep in.

andrewl 4y ago
I had an anthropology professor in college who did some work on genetic diseases in the Amish. It is a problem. This Wikipedia has a short overview and a lot of references: https://en.wikipedia.org/wiki/Health_among_the_Amish https://en.wikipedia.org/wiki/Health_among_the_Amish
- wyclif 4y ago
  Anecdotal, but I once had a friend and roommate that came from an ex-Mennonite family of 12 siblings with two sets of twins. He and one of his brothers both developed late-onset Tay-Sachs disease. Although relatively high-functioning and able to do most tasks such as hold down a job and drive a vehicle, there were some unfortunate consequences. For instance, the brothers had lack of coordination, ataxia, and minor speech problems. They were constantly getting pulled over by the local cops for minor violations (like driving too slowly) and nearly every time the cops would insist that they were drunk even though they didn't have a drop of alcohol. To the untrained eye, their affect looked very similar to an intoxicated person: slurred speech, bobbing while standing in place, stumbling when walking or getting out of the car, &c. So yes this is a big problem in these communities.

nonethewiser 4y ago

Its crazy that there are laws against offering health insurance in the open market. There is no reason you couldn't shop around for a plan just like you do for car or home owners insurance.

boppo1 4y ago
Is that not what I do when comparing plans on healthcare.gov?
- mikeyouse 4y ago
  That’s exactly what it is except they have base “minimum essential coverage” laws that these ministries don’t abide by. “HCSMs are not regulated by the ACA. The coverage you get will vary from one HCSM to another, but they are not required to cover pre-existing conditions, cap out-of-pocket costs, or cover essential health benefits. And they can still have annual and lifetime benefit caps.” Since they’re not regulated entities, there’s no enforcement mechanism if you get sick and they decide not to pay out or delay your reimbursement.
- donatj 4y ago
  I mean kind of. There’s a ton of restrictions on who can have what plan where though, it’s not a very “free” free market.
- Spooky23 4y ago
  Sort of. ACA set ground rules for one segment of the market and did a good job doing so. There is a real competitive process in most states. Taking about free markets in the context of US health insurance in general is a waste of time.
- tomohawk 4y ago
  You cannot purchase plans across state lines. You cannot purchase the same plan you would get if you worked at a large company. The law is basically written by the insurers, and favors them. It allows them to segregate people based on who they work for, etc. In an ethical system, there would be just a single, non-segregated pool of people called a 'market', and anyone would be able to purchase any plan they want from that market, regardless of which state they lived in and regardless of who they did or did not work for. Federal employees have such a system, and prior to obamacare, there was actually bipartisan agreement forming around enabling everyone to participate in that system. It's probably why obamacare was rushed through quickly by the insurance companies.

newaccount2021 4y ago

[dead]

tomohawk 4y ago

Peter Santenello has a good video series with interviews of Amish. https://www.youtube.com/watch?v=z6SlJZk5guI&list=PLEyPgwIPkHo7lOk-72-tXJ-NjahfkNF_r https://www.youtube.com/watch?v=z6SlJZk5guI&list=PLEyPgwIPkH... One of the more interesting discussions was how they handled covid.

ecommerceguy 4y ago

These plans are not ACA qualified, are underwritten on an annual basis and do not cover pre existing conditions. They are for healthy people to cover something for the duration of the plan, which it sounds like it did. The next year the Agent or Broker (there is a legal difference) should have steered this lady to a Marketplace Plan - Fully Insured plan which covers pre-ex. Problem solved. Who's the agent/broker here? He/she is required to have E&O.

shard_rocker6 4y ago

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slay_hearts7 4y ago

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lion_ankles6 4y ago

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peez_weez9 4y ago

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steel_rebel6 4y ago

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heart_stealer1 4y ago

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