Friday, August 17, 2012

Summer on the Amish farm

Over the past 11 months, I have interviewed dozens of people and had rewarding opportunities to speak with community audiences about healthcare.  As I have spoken with groups about this issue, I have been amazed that when we connect as citizens the media noise and the political rhetoric disintegrates.  Healthcare is an issue we all care about and we all want clear answers.  Therefore, for the next few weeks I will be doing a series called “Concerns from the Community”.  These are questions and concerns raised to me by people I have met through speaking engagements, e-mails, phone calls and my Facebook page. 

This week's concern came from a woman from Pennsylvania's Amish community.

Artwork by Merrill Coffin

The humidity of a summer’s afternoon gave way to the relief of a westward moving storm that rolled over the fields of the Pennsylvania country side as I sipped mint tea on Charlotte’s front porch.  As two women from two very different cultures, we came together to discuss something that we all share as common concern-the health and wellbeing of our families and community.

Pennsylvania is blessed with a rich culture that is deeply routed in tradition, our Amish neighbors are a testament to this.  With a lifestyle that has remained unaltered for generations behind the backdrop of a rapidly changing world around them, it goes without saying that a national dialogue on healthcare is a concern to this community and the impact it will have on their way of life.

In our discussion, I alleviated her concerns that under the PPACA, the Amish religion is exempt from the individual responsibility clause (AKA: The Mandate) for the same reason they are exempt from paying and receiving Social Security.  As a self-sustaining culture, a major factor in their religious belief is to depend primarily on their tightly knit community.  Their religious belief calls them to take care of their community and I soon found that the one really learning about healthcare on this day was me.

Charlotte, an Amish woman with a chronic health condition that utilizes modern medical equipment and treatment, explained that as a culture they do not “reject” modern technology and innovation, as many wrongly believe, but embrace it selectively as it becomes life dependent.  Like the cistern that provides them indoor plumbing and the water wheel in the creek that delivers them hydro-power, their healthcare insurance system is self-sustaining and powered from within the Amish community.  Essentially, they “self insure” their community.

She explains that at the age of 18 each Amish adult pays $125 a month (premium) to their district health fund.  They receive treatment from modern physicians and hospitals as needed and are individually responsible for the first $2000 in bills (deductible).  They do have negotiated contract prices with area physicians and hospitals because the providers know that they will receive payment immediately and in cash, whereas with insurance companies they have to wait and may not get reimbursed.  When an individual meets their $2000 or has a serious medical need, they turn to the district health fund.  If the condition calls for care beyond the allowance of the district health fund, they turn to “free will” (charity from the community and neighboring districts).  Above all, their system is non-profit.  Funds are not lost to administrative costs and profit margins.  Furthermore, because the system of this community covers their medical expenses, they therefore do not contribute to the “uncompensated care” that has burdened our healthcare system for decades and increased the cost of care for everyone.   

As I came to understand their system, I also saw that the exemption for this religious group goes beyond religion.  This community is already taking responsibility for its citizens and is not a burden on the system.  Within this small, homogeneous microcosm-it works.  

The late day storm began to subside and carried with it the suffocating heat of the July day.  While the winds began to settle, so did a sense of peace within me.  Like the relief provided by the storm, I too felt refreshed by an open and civil dialogue about healthcare and relished in the opportunity to escape the hostility that surrounds this topic in our national news outlets.  If only our national landscape could be more like 2 women sipping mint tea on the porch of a Pennsylvania farm house.  


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