The Amish have no health insurance. Exempt from Medicare and Medicaid. And they manage.
System
Minor issues: herbs, home remedies (see Health section). Medium: local doctor (pay cash — many doctors give Amish 30-50% discount). Serious: hospital (surgery, fractures, complicated births).
Payment
Community. Each has an 'aid fund.' Everyone contributes. When someone needs a $50,000 surgery — the fund covers it. If insufficient — additional collection (benefit auction). Never refused.
Why Cheaper
No middleman (insurance takes 20-30% for administration). Cash = discount (hospitals save on billing). Preventive medicine: physical labor, fresh food, no stress, no alcoholism, no drugs. Amish live on average 3-5 years longer than Americans.
Problems
Genetic diseases (small gene pool — 200 founders). Cartilage-hair hypoplasia, Ellis-van Creveld syndrome. Vaccination refusal (not all communities, but many). Delayed medical visits (until serious).