Plain People and Healthcare Economics

[RZehr]

This thread is a home for a budding idea that I have rolling around. It is simply this: If health care was free or super cheap, how would that affect our vulnerability towards health scams? And how would it affect our confidence in alternative medicines? What role does personal finance play in our health choices and beliefs? I suspect there is a mix of some law of economics and something else at play here. I suspect that when we pay a high price for something and it doesn't work, we have a higher level of disgust than if we paid a small price for it and it failed.
If I paid $1,000 for a desk stapler, my expectations are that it will be top quality. And I'm disgusted if it breaks the first day under normal use. But if I pay $1 for one and it breaks, I'm really not expecting a high level of performance, and so I'm not disgusted at all.
I think that is why we require results from traditional expensive medicine, while pretty much shrugging off the dubious results from cheap home remedies.

But I wonder if traditional medicine/operations/dental were exceedingly inexpensive, we would probably see our people dispense with many of the strange beliefs we hold on these alternative medicines.

Personally, I think (1) people can rely too much on traditional drugs, and be to quick to use them, and they should dial back on them, and (2) preventative care via alternative medicines are probably under utilized (3) alternative medicine lacks data because of a lack of funding, which would be real fascinating to see (4) traditional medicine is far more proven and studied and regulated than the alternatives are. Studies are good.

So I'm only knocking alternative medicine slightly, not head on. I'm more interested in how pricing and how economics form our behavior and consequently our opinions.

[Josh]

My experience with Canadians, who have “free” medical care and cheap prescriptions, is that they pretty much are the same as plain people in America. Price has little to do with it.

Some people spend huge amounts of money on alternative treatments. An Old Colonist background family in Holmes Co. has gone completely bankrupt with alternative medicine for “chromosome replacement”, down in Mexico. They spent over a million dollars and wiped out their wealth, which used to be $600+. They took out loans on their farm, business etc. and are ruined now.

The fact they are not getting any improvement / results isn’t changing their minds.

[RZehr]

I accept that there will always be people who behave in irrational manners. But at the macro level, surely the law of economic would have some impact. I believe it would. But I don’t know what else would be factors, possibly larger or countering factors.

[Soloist]

My experience with Canadians, who have “free” medical care and cheap prescriptions, is that they pretty much are the same as plain people in America. Price has little to do with it.

Some people spend huge amounts of money on alternative treatments. An Old Colonist background family in Holmes Co. has gone completely bankrupt with alternative medicine for “chromosome replacement”, down in Mexico. They spent over a million dollars and wiped out their wealth, which used to be $600+. They took out loans on their farm, business etc. and are ruined now.

The fact they are not getting any improvement / results isn’t changing their minds.

Well... I approve of the heart to give up earthly wealth at least.

[Wayne in Maine]

I recall a Kenesiologist "weighing the purse" of a plain brother (actually of his church) before offering services.

I think there are far more than economic factors involved in the choices of "quack medicine" among plain churches. Alternative health practitioners seem to have found a niche and a common strategy for infiltrating plain churches, often targeting the well-to-do leadership of a group (ministers, bishops), playing on skepticism and ignorance of science.

I am personally thankful that I have an insurance policy from my employer that is covering the expensive (mind boggling expensive!) cancer treatments I'm receiving. But even without that I would not consider cheap "alternatives" (except I use my own harvested Chaga!)

[steve-in-kville]

Having worked in the EMS industry for many years, plus being uninsured and "self-pay" for periods in my married life, I can attest to the fact that the insurance industry drives the healthcare costs. Hence the reason so many hospitals in areas where there is a large plain community will offer big discounts for cash payments on bills: its worth it them to get guaranteed money at a cut rate rather than deal with the insurance companies.

[Sliceitup]

While health care coverage might make a difference I think there are other factors that would make a bigger difference.

The thing that I think would make the biggest change is if more conservative people were doctors, nurses, or in the scientific fields. Among the car driving anabaptists there are increasing numbers of these people, but more of the nurse, EMT variety and less of the doctor, sciences type. But among the uber conservative Horse and buggy types there is a real scarcity of these vocations. I think this creates a vulnerability to an over dependence on alternative medicines. In my experience I’ve seen people go through health situations where they saw multiple doctors, spent time in the hospital, and still didn’t seem to understand what was happening. They didn’t feel comfortable asking questions, or know what kind of questions were important, or how to process the data they were given. And they didn’t have any relatives or friends with medical knowledge who were able to help them process the information. I ended up going with them to appointments and I was soon able to see why they would be absolutely confused. Multiple times I would ask the medical practitioner to clarify something or explain it, because it contrasted what we had heard from others. There was usually a good explanation, but someone had to be comfortable asking the question.

When you contrast the way most alternative medicine is sold with how traditional medicine is practiced it’s clear how the people in the above situation would be vulnerable. Most alternative medicine has some very nicely packaged explanations that are in simple layman’s terms. Never mind that sometimes it’s overly simplistic and ignores the complexities of the human body, it is easy to understand. Much easier than a fast talking specialist who uses terms you’re barely familiar with.

Having someone who is even minimally informed about medical terms and practices can make a big difference in conversations about medical issues. Frequently you will have a group of Old Order people discussing a medical issue and there’s no one there to pump the brakes when an absurd idea is brought up. Sometimes all that is needed is a simple comment to explain why or how this seemingly absurd thing isn’t what it appears to be on the surface. Sometimes it’s something as basic as explaining why the statistic they think is so damning, doesn’t mean exactly what they thought it does.

I don’t think these people are ignorant fools, they just don’t have much, if any, generational knowledge about these fields. Give me a group of Old Order Amish grandmothers and they will be a fountain of wisdom on certain topics. Competent medical advice is not usually one of those topics.

[ohio jones]

Having worked in the EMS industry for many years, plus being uninsured and "self-pay" for periods in my married life, I can attest to the fact that the insurance industry drives the healthcare costs. Hence the reason so many hospitals in areas where there is a large plain community will offer big discounts for cash payments on bills: its worth it them to get guaranteed money at a cut rate rather than deal with the insurance companies.

Our church-based plan encourages people to negotiate with providers, and applies savings to the deductible. One member needing surgery was told "Self-pay? Yes, we offer a 50% discount for that." She went on to explain in more detail how the system worked, and that once the price was agreed on the full payment would be issued within a day or two. "We aren't Amish, but our plan works the same way." The response was "Oh! In that case we can give you 80% off." Of course Medicare probably gets 85% off, but at least it sounds good.

[Ken]

Having worked in the EMS industry for many years, plus being uninsured and "self-pay" for periods in my married life, I can attest to the fact that the insurance industry drives the healthcare costs. Hence the reason so many hospitals in areas where there is a large plain community will offer big discounts for cash payments on bills: its worth it them to get guaranteed money at a cut rate rather than deal with the insurance companies.

Our church-based plan encourages people to negotiate with providers, and applies savings to the deductible. One member needing surgery was told "Self-pay? Yes, we offer a 50% discount for that." She went on to explain in more detail how the system worked, and that once the price was agreed on the full payment would be issued within a day or two. "We aren't Amish, but our plan works the same way." The response was "Oh! In that case we can give you 80% off." Of course Medicare probably gets 85% off, but at least it sounds good.

I suspect hospital pricing for the uninsured has a lot to do with the tax code and write-offs.

Say, for example, a hospital has 100 indigent patients who have no ability to pay. They could bill them out at the Medicaid rates and the cumulated unpaid bills might amount to say $100,000. Or they can bill them out at some inflated 'retail' price that no one actually pays and the resulting unpaid bills might amount to $2 million.

If the hospital doesn't expect to get paid either way, which will their accountants prefer when it comes to tax time? A write-off off $100,000 or a write-off of $2 million. I'm guessing the latter. Which is why I suspect a lot of hospital pricing really has to do with inflating their write-offs rather than extracting blood from a turnip.

[RZehr]

While health care coverage might make a difference I think there are other factors that would make a bigger difference.

The thing that I think would make the biggest change is if more conservative people were doctors, nurses, or in the scientific fields. Among the car driving anabaptists there are increasing numbers of these people, but more of the nurse, EMT variety and less of the doctor, sciences type. But among the uber conservative Horse and buggy types there is a real scarcity of these vocations. I think this creates a vulnerability to an over dependence on alternative medicines. In my experience I’ve seen people go through health situations where they saw multiple doctors, spent time in the hospital, and still didn’t seem to understand what was happening. They didn’t feel comfortable asking questions, or know what kind of questions were important, or how to process the data they were given. And they didn’t have any relatives or friends with medical knowledge who were able to help them process the information. I ended up going with them to appointments and I was soon able to see why they would be absolutely confused. Multiple times I would ask the medical practitioner to clarify something or explain it, because it contrasted what we had heard from others. There was usually a good explanation, but someone had to be comfortable asking the question.

When you contrast the way most alternative medicine is sold with how traditional medicine is practiced it’s clear how the people in the above situation would be vulnerable. Most alternative medicine has some very nicely packaged explanations that are in simple layman’s terms. Never mind that sometimes it’s overly simplistic and ignores the complexities of the human body, it is easy to understand. Much easier than a fast talking specialist who uses terms you’re barely familiar with.

Having someone who is even minimally informed about medical terms and practices can make a big difference in conversations about medical issues. Frequently you will have a group of Old Order people discussing a medical issue and there’s no one there to pump the brakes when an absurd idea is brought up. Sometimes all that is needed is a simple comment to explain why or how this seemingly absurd thing isn’t what it appears to be on the surface. Sometimes it’s something as basic as explaining why the statistic they think is so damning, doesn’t mean exactly what they thought it does.

I don’t think these people are ignorant fools, they just don’t have much, if any, generational knowledge about these fields. Give me a group of Old Order Amish grandmothers and they will be a fountain of wisdom on certain topics. Competent medical advice is not usually one of those topics.

This makes a ton of sense to me.