Most Amish under 30 have secret cell phones. It would only be the oldest generations without them. There are even lots of wink & nod arrangements where they may even have electricity in some outbuilding but they unplug it when elder comes to visit. It also depends on the Order as some are more strict than others. They generally aren't allowed to have electricity in "the house" but batteries and other workarounds exist.
They aren't as isolated these days as they used to be. If you go to Costco, you see them with 3 carts loaded 3 feet high of all the same crap everyone else is buying. A lot of times, they don't even transport it back via buggy but call the "Amish taxi service" which is people who drive them around town in large passenger vans. Even from a work source perspective, a lot have moved on from farm work and work in construction, roofing and other trades. If you go to a gas station in the morning, you'll see work trucks roll up and only Amish rollout to go buy soda and lunches or whatever.
[Source: I live in Lancaster and have for many years.]
There are large populations of Amish who don't use cell phones, landline phones, or anything. The closest they'd get to a phone call is asking a neighbour to call 911 in an emergency (assuming they're even willing to do that).
One group I am aware of will only use a payphone in the nearest town. They actually filed to force AT&T to keep a payphone there because the relevant tariff required AT&T to do so, and were the only people who ever bothered to make AT&T do this. So there is one payphone in that town that they go to and drop their quarters in to make phone calls.
I worked in healthcare start-ups for many years and the main problem is mis-aligned incentives.
The #1 thing we need to do is make it illegal for your healthcare to be tied to your employment. We can still have your employer provide a X% or $Y to an HSA account that the employee can buy health coverage wherever they like. (I'm not optimistic that this will ever happen politically)
The issue today is that NOT healing you makes everyone more money, like a LOT more. There is no incentive for anyone to help people get healthy just to have a different insurance company benefit from the decreased claims.
This is also the only way forward to value based care (for primary) where doctors (providers et al) can take on the risk/reward. They get some amount (say $1K ??) per year and they keep it and submit no claims. However, if there costs go above, they eat it loss. Now the doctor and the insurance company (payer) are all incentivized to get and keep people healthy.
The #1 thing we need to do is make it illegal for your healthcare to be tied to your employment
Yes. Or at the very least, stop making it mandatory. Health insurance should work like literally everything else: your employer pays you money, and you use that money to buy it.
> Health insurance should work like literally everything else
Eh, everything else varies significantly by company. Tradesmen have to buy their own tools. FANG provides free lunches.
I've yet to see an argument for why a singular person is going to be able to do a better job making healthcare more efficient than a company that shells out millions of dollars for that line item. Like why doesn't HR drop the health insurer that just keeps lock-step increasing prices? And why doesn't that reason apply to an individual?
> We can still have your employer provide a X% or $Y to an HSA account that the employee can buy health coverage wherever they like. (I'm not optimistic that this will ever happen politically)
Doesn't this already partly exist? My (US) employer offers an HDHP (high-deductible health plan) that comes with an HSA.
(It's not quite what you described, because you have to use the insurer that the company picked. I think you're describing something more like the Singaporean system with Medisave.)
The main difference there is that with an HDHP your employer is still the one choosing the insurance provider, and the insurance provider views your employer as the customer. There's no risk that you as an individual will switch to another provider as long as the employer remains with this one.
Removing that layer of indirection would make it your own choice to pick a provider, and the provider is then incentivized, at least a little bit, to provide you with a good outcome or else you may freely switch to another provider.
There's also the component that, right now, you lose the discounted group rate insurance premium as soon as you lose or leave a particular job. Putting the purchasing power with the end consumer means that you can keep your provider at the same premiums even if you switch jobs. All that might change is your employer contribution.
I think the mechanic they're trying to speak to is that due to insurance being tied to employer, no insurance plan (besides Medicare/Medicaid) is truly motivated to ensure good health outcomes beyond a ~4 year horizon. You'll switch jobs and get a different plan.
FEHB plans would also have this incentive. I think at least historically Federal employees didn't switch employers as much (though job-hopping between agencies happens), but more importantly if you retire from the Federal government you keep your health insurance.
Yeah, what I'm suggesting is that your premiums are funded through your HSA, not just your deductible and medicines. Obviously, the max HSA funding amounts would have to change.
Why make this so complicated when we can just have medicare for all? You're right that healthcare shouldn't be tied to your employment, but what you're proposing is something that only the rich + affluent can achieve independently.
All you're doing is playing musical chairs with different capitalists, just stop playing the game. A large part of the electorate wants to stop playing the game.
You need to do some actual canvassing and get out of your SV bubble, M4A polls at a consistent 60% support where both independents and democrats are at nearly 80% support.
What you're advocating is more corporate welfare that I don't see happening but it's the only playbook those with money seem to advocate for.
Don't count all those chickens before they hatch. There might be more started but do they all survive? Think back to the dot-com boom/crash for an example of where that initial gold rush didn't just magically ramp forever. There were fits and starts as the usefulness of the technology was figured out.
I design games and have been working on a Red Riichi variant where one of each number is red and this drives scoring instead of all the myriad of Yaku. All the Yaku are hard for beginners to onboard and a lot of hands have to good path to an interesting Yaku and just depend on luck to be able to call Riichi. I'm still testing it but I find it more interesting.
I also have a card game version that implements some of these ideas (although it doesn't have a Furiten concept).
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