I came across this great article on how the Amish culture and their approach towards healthcare in the United States. The Amish - a culture of independance and thrift may be a way to balance community support and individual responsibility. A cost-conscious, community-based take on American healthcare may be able to teach the general population a thing or two about dealing with a broken healthcare system. Health care practices vary considerably across Amish communities and from family to family. Many Amish use modern medical services, but others turn to alternative forms of treatment within their community. The Amish society accepts responsibility for their own actions and chooses not to depend on services offered by the state and Amish communities opt out of the government-funded insurance. Opposed to commercial insurance and they pride themselves on taking care of their own. To assist one another, they willingly offer donations when a member of their community becomes ill. It may not fit in this area, but I thought it was an interesting read a thought I would share.
Excerpt from the article:
Plain communities are highly interested in health education and disease prevention. Coming from an ethic of thriftiness, many Plain people distrust the motives of hospital administrators and even doctors themselves. They believe a profit motive can influence courses of treatment. They are also keenly attuned to unnecessary expenditures within the system.
“In the Amish world, healthcare is seen as a ministry,” says Wengerd, “which is exactly what healthcare in the [non-Plain] world used to be.” Remember apprenticeships and house calls? The doctor used to be viewed like a minister who sacrificed his life for the patient, but there has been a shift. “The patient now sacrifices his livelihood for the doctor’s wellbeing.”
@lasindias has some recent experience of something similar. I will not go into details, if they feel they want to share they will…
@Susa and I had a chat with Glenn from the Woodbine collective in New York about their own approaches towards building autonomous and resilient communities. And they are especially interesting to me because unlike the Amish, they are in the starting phase. As Glenn described it a subgroup in the Occupy movement decided that they would focus their energy on teaching themselves, and others, to become self-reliant communities. They do this through a kind of structured learning program along tracks, when we spoke they were just about to start building the health track. Which reminds me, I need to get back in touch with them!
At the time, I had proposed we roll out a challenge on autonomy and responsibility. Pre-welfare states (19th century), welfare was basically invented by European mutual assistance societies, in turn part of the workers’ movement. I imagine that, in the early days, these societies were small enough that the choice of treating someone would visibily drain the common pool of resources. So, in those days, maybe European factory workers thought a bit more like the Amish. A modern-day version of that, though I only know anecdotes about it, is implemented by @lasindias .
I think autonomy is also an interesting scenario in terms of policy, and fits well into @Lakomaa 's and @Tino_Sanandaji 's institutional economics framework.
My summary from the article:
The Amish refuse to have insurance. "When someone gets sick, the church collects alms to help the patient cover expenses."
This might happen at a time when the community has other objectives as well ("setting up a farm for a young couple"). You can ask of the community to support your treatment, but its costs are not simply discharged into an anonymous "system": they are borne by your own brothers and sisters. As a result, everyone focuses on not spending more money than is necessary, and "[Amish] communities are highly interested in health education and disease prevention".
For this reason, the Amish use genetic screening of children. Prevention is so important that its benefits trump the disadvantages of dealing with the world at large.
They develop their own treatments (one for burns is described in the article). They navigate, with some difficulties, the interface with the mainstream medical world: clinical testing etc. These treatments tend to be very cheap.
Communities negotiate discounts, which hospitals are willing to offer in exchange for payment in full at the time of service. In one example (a child treated with surgery for colon cancer) price was negotiated down to 19,000 USD from 172,000, a 90% discount. "For Americans with health insurance, it may come as a surprise that hospital costs are negotiable".
The Amish don't sue. "When the Amish told [a doctor] they understand doctors are human and make mistakes, he had to pause to let that sink in. To them, he was not simply a member of the medical establishment, but an autonomous individual doing his best, given the choices and information before him."