[DoreenMichele]

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.

[giantg2]

"They keep costs down in part by pursuing home remedies for a lot of things instead of seeing a doctor."

Two other factors for low cost would be their healthy lifestyle and end of life care choices. The Amish get about 20k steps in per day - double the recommended 10k steps that most English fail to meet. Rates of many chronic diseases are lower. When they do get old, they don't drag things out and they generally don't go into longterm care facilities. Most English tend to want the doctor to "do everything you can".

[watwut]

Not really

> Amish mortality patterns were not systematically higher or lower than those of the non-Amish, but differed by age, sex, and cause. Amish males had slightly higher all-cause MRs as children and significantly lower MRs over the age of 40, due primarily to lower rates of cancer (MR = 0.44, age 40-69), and cardiovascular diseases (MR = 0.65, age 40-69). Amish females MRs for all causes of death were lower from age 10-39, not different from 40-69, and higher over age 69. https://pubmed.ncbi.nlm.nih.gov/7315833/

Basically, Amish boys are more likely to die young. There are no long term lifestyle benefits for Amish women.

And "English" by which I assume you mean Americans don't have infinite funds.

[DoreenMichele]

Your quote agrees with the thing you are rebutting:

Rates of many chronic diseases are lower.

Amish males had ...significantly lower MRs over the age of 40, due primarily to lower rates of cancer (MR = 0.44, age 40-69), and cardiovascular diseases (MR = 0.65, age 40-69).

Also, mortality rates and costs are not synonyms.

[watwut]

Women had no such benefit. Women got more issues as their aged. Health of children mattter too and costs too. Young males dying more often is not healthy for them.

The men over 40 subset of population has slightly lower mortality and no one else. The numbers even out.

That is not consistent with "healthier lifestyle overall" as if they generally got benefits.

[DoreenMichele]

You: Women had no such benefit. Women got more issues as their aged.

Also you: Amish females MRs for all causes of death were lower from age 10-39, not different from 40-69, and higher over age 69.

Women only "got more issues as their aged" after age 69. Before that, they were either better off or about the same. This also agrees with the point the parent comment was making that they generally have healthy lifestyles and don't go into long-term care facilities in old age. Instead, they accept death when the time comes.

[watwut]

Women got no benefit after 40. Healthier lifestyle as cause would had them having this benefit at that age range too. It is exactly that age when men started to have benefits. In case of women you have slight benefit at the age range when men are dying more.

69 years old women are not in the long term facilities for that matter eitminor Nor are men. In UK, 66 years old is retirement age. This is age when strength and health declines, but nowhere near the level necessary to be in some kind of facility. These are self sufficient people, able to care about themselves, able to care about relatives or animals.

None of that are numbers that overall superior healthier lifestyle. Just a minor shifts around.

[s1artibartfast]

I see that as direct evidence contrary to your point. Achieving comparable mortality with less Healthcare and Associated cost would imply that they are in fact healthier.

Part of the confusion is that you are conflating mortality with health.

If two people live to the same age, but one requires many surgeries, drugs, and treatments, I dont think you would say they are equally healthy.

[giantg2]

What do you mean "not really"? It seem you just posted what I was saying for lower rates of many chronic diseases.

"significantly lower MRs over the age of 40, due primarily to lower rates of cancer (MR = 0.44, age 40-69), and cardiovascular diseases (MR = 0.65, age 40-69)"

As they said, cause differs. When looking at costs, causes are very important. Things like cancer and cardiovascular diseases tend to cost a lot of money to treat as they drag on. If you die young in an accident, it's likely to cost less.

[watwut]

Women had literally zero benefits. And young boys die more. There is only one segment of population that is getting some benefit and that benefit is small.

In order for lifestyle to be healthier, I would want to see more benefits then just some middle aged men mortality shifted onto young ones.

[DoreenMichele]

The Amish suffer from genetic disorders due to inbreeding. From the Wikipedia article someone linked to:

Some of these disorders are quite rare, or unique, and are serious enough to increase the mortality rate among Amish children.

I criticized the practice of inbreeding in my first comment.

[giantg2]

We're talking about costs, not mortality. You also can't equate mortality with healthy or unhealthy lifestyle. Many of the things in the lifestyle are healthy, the two biggest being more physical activity and less processed foods. You can "live" in a nursing home for a long time. But quality of life is an important factor not captured in your mortality figures, including things like some of the lowest obesity rates (and chronic illnesses that go with that).

[pclmulqdq]

Americans' insistence on living to their last possible machine-assisted breath makes healthcare very, very expensive. Something like a third to half of the healthcare costs of an individual are incurred in their last year. Americans are terrified of dying.

This is why I have a hard time taking cost comparisons seriously between the US and Europe - European healthcare systems will pull the plug a lot earlier, saving the money (and the indignity) involved in dying as slowly as possible.

Ironically, doctors in the US have some of the lowest end-of-life care costs, because they know their actual chances and don't seem to be so afraid of dying.

[HWR_14]

Highly physical work can easily cause damage. Sure, it's bad to sit behind a computer for 8-10 hours a day. But it's also bad to be constructing barns 8 hours a day. You want a happy amount of physical activity. It's easy to look up to the people on the far side of goal as being healthier, but US tradespeople in their 40s and 50s tend to be pretty messed up in the knees/back.

[andrewl]

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

[wyclif]

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.

[praptak]

The Amish are aware of their small population problem. I believe their population bottleneck was a few hundred people.

They do sometimes adopt children from outside their population. I don't know how common that is and whether it makes a difference.

[mikeyouse]

> 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.

Some accident policies may have those features, but zero health insurance ones do.

[DoreenMichele]

All insurance policies have limits on what they will pay. Those limits come in various forms, such as:

1. What you pay out of pocket before insurance coverage kicks in.

2. No coverage for out-of-network providers.

3. Caps on how much they will cover.

Insurance is a numbers game. Rest assured, all insurance policies and all insurance providers find ways to limit how much they pay out.

You may find some means to limit payments more distasteful than others, but they all do this. It's the only way they can possibly stay in business.

[watwut]

Which are all an entirely different thing.