Wednesday, October 3, 2018

The Church, The Amish, and Health Care Provision

And all of a sudden, just like that, my family was vulnerable.

The income that was the supermajority of our household revenue was gone, as my wife stepped out of an unsatisfying, overstressful position and started up her own business.  The transition time wasn't what concerned me, because we're fiscally prudent and deeply conservative financially.

We never spend above our means, and keep a healthy reserve of savings for emergencies or job transitions.

We had plenty of reserves to carry us until her new business found its legs.

But what we couldn't handle, should it happen, would be any significant medical emergency.  One major injury, one unexpected and unwelcome diagnosis, and even the nearly two years of reserve we keep on hand wouldn't be enough.  A lifetime of prudence and caution with money would mean nothing when that first hospital bill came in.

Well, maybe the first.  But not the second, and then the fifth, and then the eighth, all utterly indecipherable, all for the same procedure.

One twist of ill fortune, and it would be hard not to avoid bankruptcy, because that's America right now.

I'd stepped out of my denomination's health and pension plan a couple of years back, because the burden on the congregation just seemed too great.  As costs for health insurance expanded and expanded, they were biting into our mission, and as my wife had coverage, I figured, why not?  I blanched at the idea the church should pour resources into a benefit I neither needed nor used.

That was true up until our coverage vanished.

I approached the lay leaders of my little church, because, well, my wife and I were a little freaked out.  And they, well, it was humbling how willing folks were to step in and commit the resources to help my family.

So we're going to be fine, but the thought lingers in my mind:  why is this the responsibility of the church?  Why should they be responsible for providing health insurance?

The argument could be made that it is a Christian responsibility, that a community should care for individuals who have committed their lives to serving Jesus.  Feed the oxen as they tread out the grain, as ol' Uncle Paul would put it, and be sure they've got access to a bovine dental plan, too.

While there's some truth in that, there's also the truth that we don't extend similar care to all members of a church.  Which Christian among us *shouldn't* receive health care?  Is a pastor more worthy of that care than any other member?

I'm not.  No member of my church is unworthy of medical care.  No member should fear for their children's well being, or their own.

And therein lies a conundrum.

Providing health insurance to employees could be seen as extrinsic to the core mission of congregations.  It's the church compensating for a societal failing, one that is immaterial to our core mission.   It's the same burden that falls on every business in America, as employers large and small are forced by ideologues to absorb a cost that is unrelated to the product or service they provide.  It's the burden that sits heavy on countless entrepreneurs, who have a great idea for a new business but are forced to remain in less satisfying work because individual insurance is too expensive.

The analogy, as I see it, has nothing to do with compensation practices.  It's about the provision of a basic need.  No enterprise that involves humans can operate effectively if said humans are rendered incapable of participation.  It's why you need a viable network of roads for commerce.  It's why you need power, water, and communications infrastructures.  Some of that can be provided by utilities, of course.  But utilities are...ideally, at least...regulated by government.

Why, again, are congregations and employers responsible?  Because of a governmental failure, one that shifts the costs of care into the least efficient...and thus most profit-heavy...model of service provision.

Given that the most efficient approach to care involves the largest possible pools of individuals, single-payer is just inherently superior.

But as much as I wrestle with the idea that my sweet little church should have to absorb my health care costs, that principle got me to thinking. 

If "the larger the pool, the more efficient the system," why *wouldn't* churches offer health care?  I mean, not just to employees, we Jesus-gigolos who get paid to do the church thing, but to every single member?

As much as I think...from both the research and personal experience in the worry free environment of countries that have nationalized health care...that it's the best way?  Healing the sick and care for the ill among us is very much a Christian thing.

Jesus, as I recall, did it all the time.

In researching the dynamics of the Amish for my recent novel WHEN THE ENGLISH FALL, Amish health care provision was an interesting subnarrative.  The Amish do not participate in any "English" health care plans, because of course they don't.  They also don't participate in social security, or stand for the National Anthem, because they're Amish.

If you're Amish and mildly ill, you either rely on home remedies or pay for doctor's care out of pocket.  If that cost becomes burdensome, the community or settlement pitches in.  When they require hospitalization or find themselves seriously ill, the Amish fall back on a more formal system of mutual support: the Amish Hospital Aid plan.

Operated entirely by the Amish, the AHA is crisis insurance that covers 80% of all medical expenses,with the remaining 20% picked up either by the family out of pocket or by medical support reserves sustained by the congregation.  Cost are staggeringly low.  For individuals, it's $125 a month.  For families?  Total cost is $250 monthly.

There are reasons for this.

First, it's just crisis coverage.  Hence the "hospital" part of the plan.

Second, the AHA has a large pool of participants, and actively negotiates price discounts with hospitals and care providers.   With large families, many are young, and all engage in a lifestyle that is physically active.

Because the Amish are Amish, that negotiating stance also includes a 100% guarantee that there will never be any accusations of malpractice, or malpractice lawsuits.  No lawyers, ever, period.  As far as the Amish are concerned, doctors are flawed human beings trying their best, and if a mistake is made, so be it.  For a hospital administrator, that's pretty much your ideal patient.

Third, the AHA has extremely low overhead costs.  By "extremely low" I mean zero.  None.  It's run by a board (all men, because, you know) and hundreds of local administrators.  They are paid nothing.  All of them are volunteers.  Their participation is viewed as a religious obligation and fundamental duty to their Ordnung.  Bureaucracy is kept to a minimum, and only the barest and most essential processes are implemented.  All it has to do is work, and that's fine.

As a Presbyterian, that's almost unfathomable.  A complex system that operates without bureaucracy?  What strange witchery is this?

More details and interesting nuances can be found in this recent study by the National Institutes of Health, which I wish had been around when I was working on my manuscript.

There are other denominations and orders that do similar things, of course, and those models of mutual aid are equally fascinating.

In the context of a national debate that is locked down by blind ideology and a health care "system" that is perversely oriented towards both inefficiency and profit maximization, it's a countercultural model worth reflecting upon.