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How do the Amish pay for medical care?

There is an interesting article a few weeks back in the Wall Street Journal (“Opting Out“) which describes the plight of Amish and Old Order Mennonites who refuse to buy health insurance. Further, since these groups also refuse to participate in Medicaid government assistance will not bail them out either.

Nevertheless, these societies do have one form of insurance: mutual aid. When one member of the community becomes ill, the rest will pitch in to help finance the cost of the needed medical care. “Thousands of Amish families rely on the age-old system of churches paying bills members can’t afford, through voluntary donations.”

Because they are very closed societies, however, many Amish and Old Order Mennonite individuals marry distant cousins which can lead to a handful of genetic diseases. With such a high rate of expensive-to-treat diseases, this mutual aid system is faltering.

Further, since the Amish and Mennonite are uninsured, they actually pay more for medical care than would someone with private or public health insurance. This phenomenon was documented in my “Uncompensated Care” post.

What is the solution?

The Amish hope to persuade their local hospital to lower medical costs, but it is unlikely that a hospital will negotiate a lower rate for uninsured Amish compared to the uninsured non-Amish. The local Lancaster General hospital “…has increased its discount for uninsured patients to 25% from 15%…uninsured patients now receive the same discount that commercial insurers do, though not as much as the government does.”

The moral of the story is that it is very difficult to receive medical care in America today without health insurance.

A Side note: If everyone receives at least a 25% discount, isn’t that just the regular price?


  1. Interesting. I could have sworn a few years ago the same WSJ posted an article about how the Amish WERE ‘saving’ on health care as much as if they had insurance by using two factors in their negotiations with providers:

    1) They could guarantee a fairly large volume AND they were paying in cash

    2) They were using the cheap cost of care in Mexico for various procedures as a leverage in negotiation (they are the original medical tourists for sure)

  2. Hmmmm.

    What’s the difference between “Mutual Aid” and “Mutual Insurance”? The only thing I can come up with is the presence or absence of an enforcable contract…

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