How do communities tackle problems arising from medical insurance or lack thereof?

Or in other words, can an intentional community successfully circumvent the medical insurance system? If so, how does the community then provide the various services that medical insurance typically pays for (check-ups, emergency care, medication, etc)? If not, what strategies can a community take to maintain insurance coverage for its members, especially if that community is concerned with maximizing its usage of alternatives to money? Is circumvention advisable in any case, or is it simply inadvisable?

This is a very interesting topic to me, I hope people will respond!

I observe communities successfully circumventing the medical insurance system by not participating... Sure, they might pay the taxes, but that doesn't mean that they use the services. As far as I can tell, "medical insurance" is mostly disconnected from and unrelated to health, and to health-care.

I observe many people practicing alternatives to modern medicine:
Eating healthy foods instead of processed junk.
Not poisoning themselves with deodorants, soaps, ag-chemicals, food-additives, new car smell, fabric dyes, wheat, dairy, processed oils, sugar, etc, etc, etc,
Treating ailments with food and herbs instead of pharmaceuticals.
Recognizing that many ailments cure themselves in a few days or weeks.
Massage.
Inter-personal counseling.
Herbalists, shaman, etc.
Exercise.
Weight management.

It doesn't take a doctor to put in stitches. Anyone can learn to do it well.
Basic veterinary care works as well on humans as it does on animals.

Just cause we have the technology to do open heart surgery, or hip replacement, doesn't mean that they should be done. Just because we have pharmaceuticals to allegedly treat symptoms of thyroid disorders, or diabetes, or high blood pressure, or whatever, doesn't meant that we should be using them. In many cases, the side effects are worse than the symptoms that they claim to be treating.

Joseph Lofthouse wrote:Just because we have pharmaceuticals to allegedly treat symptoms of thyroid disorders, or diabetes, or high blood pressure, or whatever, doesn't meant that we should be using them.

I have family members and self with some of these problems and similar: Sister with intractable serious major depressive disorder (on a crapton of drugs plus electroconvulsive therapy); bro-in-law with Type 2 Diabetes (yeah, it's his fault, but, should he die if he doesn't have the willpower to change his diet?); I have high blood pressure which I've had since my mid-20s when I was underweight and regularly walked ten miles in a day, so not about being fat and lazy (I'm not currently taking medication for it because $$); step-siblings with genetic metabolic disorder which requires medication or they die.

So, I'm wondering, what is the community answer to these problems? Just let us die?

I'm serious.

There is a lot to be said for living in a place with a single payer system as far as the alternative lifestyles, or even the entrepreneur who wants to do a startup but can't afford the benefits either for himself or his employees.

If you live in a place without health care, then you can at least take comfort in the fact that you are one of many without coverage.

My own view about alternatives is that while a lot of that is good, they are mostly evangelized by people who haven't yet got sick. Sooner or later you get sick but for some lucky people it isn't until like my mother in her 90s still going strong. But in my case I had a bypass this year at 56, and while I could have done better by myself, the largest factor is heredity since the patriarch in all prior generations were afflicted also. It isn't lifestyle because our lifestyles are all very different and relatively conservative.

I didn't pay a marginal dime for my angiogram or my bypass. I drove myself to the hospital, but other than the gas for that, every other thing was no cost.

Supposing that doctors and pharmaceuticals were no longer available? Supposing that the only choice was to make healthy choices or to die? Would it be easier to make healthy choices?

My tribe and I use an excellent, money saving, method of controlling high blood pressure that works gloriously for us, but since I'm not a doctor, I'm not going to mention it here. The cure for type 2 diabetes has been generally known for decades. I'm not very sympathetic to doctors that won't insist that their patients do what's necessary to control it without pharmaceuticals. I hold similar views to most food driven mental and physical ailments.

I apologize that in my recent posts about medical topics that I have failed to recognize and articulate the fundamental principle underlying my tribes opinions and practices regarding modern medicine.

So let me give it a try now... We are all about dis-intermediation... We want to experience life directly and locally. We don't want an authority figure in a far off location (legislator, doctor, insurance company) telling us whether or not we can have access to life saving medications or procedures. We want to live or die by our wits. To directly experience life. We want to act on a small scale, and do things which are within our means to do in our own homes, and in our own community.

So when we eat vegetables as an anti-constipation remedy, we are bringing the practice of health and well being into our own homes, and placing it within our own sphere of influence, instead of having to depend on a store to source an anti-constipation remedy from a global chemical company. We can grow and eat vegetables whether or not there is enough money to pay the store.

When we eat fruits, grown in our backyard, instead of refined sugar and insulin, we are again bringing the practice of health and well-being into our own homes, rather than outsourcing it to corn growers in Iowa, mega-chemical plants, a doctor and his staff, and a global pharmaceutical company. Fruits grown at home without external inputs are free.

When we devote hours/days/weeks/months/years to understanding the mental illnesses suffered by members of our group, and learning techniques to ameliorate and/or cope with them, we are getting immersed in some of the worst things that humanity has to offer. Rather than put our mental health into the hands of a distant therapist, we are placing it directly into the hands of our loved ones. I'm using an expanded definition of loved ones here, not limiting it to family or household. Again, it doesn't cost money to depend on friends and family for counseling. And it's an activity that is well within the ability of most normally functional humans.

When we practice massage, or touch therapy, or acupressure, or foot-zoning, or other healing modalities on each other, there is no cost, and the results are usually better than those provided by chiropractors, physical therapists, etc. And we have done the healing locally. In our own homes, and without cost. Sure, it takes effort to learn muscle groups, and anatomy, and bone structure, and processes. But the learning is straight forward. Some people take to it better than others. But we are devoted to each other. We are committed to practicing the healing arts, both in our own lives, and in sharing them with the community. To those of you that live nearby. I'd love to swap food, drink, medicinal herbs, and healing touch with you. Want someone to be a guinea pig for you latest recipe, concoction, or massage technique. I'm usually a willing volunteer.

When we use food as medicine, or fasting, or cleanses, we are taking our health and well being into our own hands, rather than putting it into the hands of a distant doctor. By taking care of our own physical and emotional well being, we are closing the loop. We are preventing our resources from leaking away and being consumed by others. We are living in the home economy instead of a global economy. We are providing bottum-up solutions to humanities problems instead of being directed by a hierarchy.

So those sorts of considerations are the foundation for all of my recent writings about medical care...

Oh my heck! And I thought that I wasn't a permaculturist. It's like I've just channeled David Holmgren.

Joseph Lofthouse wrote:
Supposing that doctors and pharmaceuticals were no longer available? Supposing that the only choice was to make healthy choices or to die? Would it be easier to make healthy choices?

My tribe and I use an excellent, money saving, method of controlling high blood pressure that works gloriously for us, but since I'm not a doctor, I'm not going to mention it here. The cure for type 2 diabetes has been generally known for decades. I'm not very sympathetic to doctors that won't insist that their patients do what's necessary to control it without pharmaceuticals. I hold similar views to most food driven mental and physical ailments.

Do you have a cure for glaucoma? Many in my family have it. I'm going through the whole eye drop routine because I don't want to go blind....might be more natural to just let the disease take it's course and I know others would help me out but since I have a choice I'm following the pharmaceuticals. And in spite of wishful thinking by some, smoking pot doesn't work to lower eye pressure except for the moment you are smoking it.

Joseph Lofthouse wrote:
Supposing that doctors and pharmaceuticals were no longer available? Supposing that the only choice was to make healthy choices or to die? Would it be easier to make healthy choices?

Unhealthy choices such as processed foods would no longer be available, so some conditions such as Type 2 Diabetes would be much more difficult to acquire. Some conditions which exist due to genetics might still arise, but not be treatable, so the sufferer would simply suffer, and possibly die. I imagine without treatment my sister would eventually starve to death once she became unable to function. If I'm not able to control my blood pressure with diet, I might end up having a stroke and then die of pneumonia due to reduced mobility.

Regarding high blood pressure, check out: http://100777.com/node/1319

We incorporate a week to ten day long fast per year into our healthy living routine, sometimes twice a year if deemed useful. It seems much more effective than drugs. We can do it at home, and it saves us a ton of money. I generally choose the time between Christmas and New Year.

Our non-medical approach to glaucoma is the same as for other food related diseases: Reduce insulin levels though fasting, not eating grains, sugars, or high starch foods, and eating a low-inflammatory diet. We use long term fasting to reduce pressure in the body, both blood pressure and eye pressure.

So I keep coming back to the same place... My first rule of healthy living is don't poison myself. In my world view, grains, refined sugars, and common industrial cooking oils are poisons that should be avoided by anyone that wants to live a healthy life.

Joseph Lofthouse wrote:Regarding high blood pressure, check out: http://100777.com/node/1319

Thank you.

Joseph Lofthouse wrote:Our non-medical approach to glaucoma is the same as for other food related diseases: Reduce insulin levels though fasting, not eating grains, sugars, or high starch foods, and eating a low-inflammatory diet. We use long term fasting to reduce pressure in the body, both blood pressure and eye pressure.

So I keep coming back to the same place... The first rule of healthy living is don't poison yourself. In my world view, grains, refined sugars, and common industrial cooking oils are poisons that should be avoided by anyone that wants to live a healthy life.

There are some natural supplements that can dramatically help reverse past damage, but it is not fast or easy or cheap. Turmeric is the common one, but there are others I can't remember off hand.

So after invoking David Holmgren the other day, I thought that I'd visit his web site and grab a quote: "By adopting the ethics and applying these principles in our daily life we can make the transition from being dependent consumers to becoming responsible producers."

So what would that look like in the context of medical care? Perhaps something like this, "By adopting the ethics and applying these principles in our daily life we can make the transition from being dependent consumers of medical insurance to becoming responsible healers in our own lives, in our families, and in our communities."

So how about it permies? Are you producers of health care or consumers? I fall cleanly on the side of producing health and well being in my community. And I'm getting better at it all the time. I grow more medicinal herbs every year. My collaboration with the local herbalists, shamans, and healers gives purpose and meaning to my life.

I'd love to be a producer, and am giving it a try, but I may totally crap out and have to go back to being a consumer (of pharmaceuticals).

@Joe L.: "....the transition from being dependent consumers to becoming responsible producers."

I'll take it one step further and say that I join many others in not just being a consumer, but being an addict....cuz that's what dependency is. My diet, my choice of work (to a certain extent), and what I choose to do with my free time all have elements of addiction to them. Just like any drug, they have elements of moderate benefit, with major life-draining drawbacks.

My tribe and I have been producing our own music and dance... We use gourd rattles, drums, bells, voices, guitars, harmonicas. Whatever is available. Sometimes it might have a recognizable melody, other times there is none... It's all part of re-localizing our lives. Local music. Local herbs. Local healers. Local food production. Local energy.

I love it Joseph.

Nathan Schwarz wrote:Or in other words, can an intentional community successfully circumvent the medical insurance system?

I live among an Old Order Amish community and have seen how they do circumvent the medical insurance system. (Please note that there are various sects in the Amish community and their "rules" differ greatly.)

Nathan Schwarz wrote:If so, how does the community then provide the various services that medical insurance typically pays for (check-ups, emergency care, medication, etc)?

Individual families pay out of pocket for their own expenses (with few exceptions, any type of insurance is not allowed as part of their religion, and they are therefore exempt from "Obamacare"), and when tragedies happen there is a "general fund" that helps out. I have been told that when necessary, the fund is replenished with a "tax" (my word, not theirs) where each family contributes based on their net worth.

I don't know if this information is helpful at all, but I have been fascinated by learning from my Amish friends since we moved to the area. note: this is not an endorsement, I'm just trying to share.

How do the Amish do it?

My understanding is they:

Work with the hospital to lower the bill because of no insurance overhead to deal with (30-50% of the medical cost is dealing with insurance companies and/or Medicare)

The local community helps when the family is struggling. Could be money, could be help doing fieldwork or fixing the house or...

Word is sent to other communities and a free will offering is taken at church and sent to help.

The person is still ultimately responsible for the bill, all help is voluntary.

I think in many cases, of communities which do not accept modern medicine, the person simply dies and that is considered acceptable. I would want to know how a community which does not accept modern medicine would treat my dad's Necrotising Fasciitis (aka Flesh Eating Bacteria). This used to be guaranteed 100% fatal. Without modern medicine, my wonderful dad would be dead now. Very painfully dead.

Having rotted to death.

Re: Necrotising Fasciitis (aka Flesh Eating Bacteria).

I'd hope that my friends and family would say to me all the things that they would regret not saying while there was still time.

It's another one of those conditions that seems to be most common in people that have been poisoning themselves for a long time, such as those with diabetes, cancer, alcoholism, drug abuse, smoking, etc. And, it's increasingly a disease associated with anti-biotic resistant bacteria that are bred by the medical and mega-ag systems. My philosophy is to stay away from doctors and hospitals in order to stay away from the most dangerous pathogens.

Intellectually, I 100% agree with you, Joseph. I will carry out that philosophy with my flock, because why would you want to keep those bad genetics around? The phrase "survival of the fittest" didn't come from no where... I admire your ability to stay strong in the face of some of the scenarios presented above, but I know I could not. I was visiting a dear friend at the hospital yesterday whose labor started too early, and I can not imagine telling her that she shouldn't do everything she can to let her child live. And once I have crossed the line, where do I stop? Who am I to decide when one person can be saved and another not? It's just not in my character to make those decisions.

Joseph Lofthouse wrote:

It's another one of those conditions that seems to be most common in people that have been poisoning themselves for a long time, such as those with diabetes, cancer, alcoholism, drug abuse, smoking, etc.

Absolutely not the case with my dad. He has no vices, eats healthily - loves his "veggies" - has not gained a pound since he got out of the Navy, jogs nearly every day and regularly enters 5K races. He's 85.

I want to mention also that he's not just some old guy but a valuable member of his community - he volunteers three days a week at the Christian Dental Clinic downtown.

Robyn Holmes wrote: And once I have crossed the line, where do I stop? Who am I to decide when one person can be saved and another not? It's just not in my character to make those decisions.

In the case of parents deciding to withhold conventional medical care from a child who subsequently dies, the parents can be tried for manslaughter, even if it is their religious belief to refuse "modern medicine." So the wider community may not agree that it is even our right to make those decisions, even if it is in our character or spiritual beliefs. When one's personal belief crosses over the line to endanger another person, is when religious liberty may be curtailed, apparently.

(hope that doesn't break too many permie rules)

The way I understand permaculture is that it is based on the idea that we are running out of stuff: That it is impossible to have infinite growth on a finite planet. And that the best way to deal with that is to localize production, and minimize consuming things that were manufactured by the use of complex technologies in far away places.

It seems to me that at some point, there will not be enough stuff to pay for the kind of medical operations and procedures that have been available in recent decades. My strategy, and that of my tribe is to collapse now, while we still have some control over what that collapse looks like, rather than waiting to be swept away by events. It doesn't require the end of the world to dramatically reduce population, it only requires one or two extra deaths per year in my circle of acquaintances. It seems like the medical establishment is not sustainable, specifically because it is growing faster than real things can be made. Something has to be mined, extracted, or manufactured in order to pay for medical care. That is not happening, therefore, eventually medical care will be simplified. It's impossible to do things in the quaternary economy when the more basic economies are not capable of providing the inputs. My best guess as to when we passed the tipping point was about when I was in elementary school.

A quick lesson in how I understand economics as it relates to health insurance...

The primary economy is the ecosystem: The soil, air, plants, animals, manure, water, etc... This economy operates pretty much regardless of anything puny man does or can do.

The secondary economy is the extractors: farmers, miners, lumberjacks, hunters, gatherers, etc...

The tertiary economy is the people that add value to things collected by the secondary economy: truckers, manufacturers, craftsmen, herbalists, cooks, builders, etc...

It seems straight forward to me that each of the previous economies depends on the more basic economy to function... For example a farmer can't extract more food from the Earth than the ecosystem is able to provide. An oilman can't extract more oil than is available for extraction. A basket weaver can only make as many willow baskets as the ecosystem is able to produce willow twigs. Sure the ecosystem can be tricked, for example by importing tons of mulch to a small garden. But the price must always be paid... If I am importing mulch to my garden, then I am making the surrounding ecosystem poorer.

The quaternary economy is bureaucratic... It deals with things like insurance, law, finance, money, sports, entertainment, loans, regulatory compliance, accounting, schooling, etc... It does not produce anything. The quaternary economy has been growing tremendously faster than the more basic economies. That cannot continue indefinitely. Because the price always has to be paid. Something has to be grown, extracted, or manufactured in order to pay for it. The quaternary economy grows by impoverishing the more basic economies. Eventually the quaternary economy will start shrinking because there is not enough real stuff to pay for it.

The only way that I can envision society being able to pay for health care in the long term is if it is produced at home or in the local community. If that means that me and my people have to be stoics regarding death, then that's fine. None of us get out of this life alive anyway. Eventually I expect that decisions about who gets medial care and who doesn't will come down to who can produce the care in their own homes and local communities.

Thanks for all the responses. Right now, I'm pretty much trying to take in all this information with as open a mind as possible. I'm in the very early stages of forming an IC, and the model we use to keep ourselves healthy and functioning is obviously going to be important for us to develop. This subject will likely require much further reading, but thanks again for providing some tangible threads to follow.

Can't believe that I forgot to mention one of our most basic tenets for maintaining good health: Get about 20 minutes of direct sunlight over as much of the body as possible at about mid-day, every day. That helps to maintain vitamin D levels, and is especially helpful in my northern climate during the winter. My philosophy is that during the winter, the most important activity that I can do during a day is to take some sunlight if it is available. I'll drop every other activity if the sun peeks through the clouds. Doesn't matter if it's just before sunset, or if it's freezing cold. If the sun hasn't been visible for a week I'll take whatever I can get whenever it's available. I'll drive shirtless in the car if I'm on the road. The high importance I place on getting sufficient sunlight is part of the reason why I think that intentional communities should be nudist friendly.

When we have our intentional community discussions, healthcare is often a very popular discussion. We have decided that the best option would be to return to the community doctor model. As soon as we can afford it we would hire our own doctor and nurse and set up a clinic for the community. They would take care of all of the basics a small clinic would. We would also want to create our own community single payer plan for those needs the clinic would not be able to provide. We want to build a community that will work well for food production and healthy people. We don't intend to turn our backs on technology such as quality medical care and high speed internet, or even cool toys like drones. They can succeed together. We'll prove it.

R Scott wrote:How do the Amish do it?

In my area, the Amish seem perfectly willing to be on Medicaid.  In the case of a sick kid that would not survive by any means but modern medicine--this is the right choice.  He can now go on to be a productive member of the society instead of a tombstone marking.

To the OP's question, I think setting up the medical fund is the best idea at least for emergencies or more expensive treatment.  You would definitely have to be really clear on the rules around this fund so people don't cheat or use it incorrectly.  Just make a portion of your dues go to the fund.  I would also recommend using available resources that your taxes get you.  If you qualify for medicaid, medicare, or an inexpensive insurance policy, then I would use that when possible and then use the community fund as a backup.  You are already paying for those services, why not use them?

Learning a method of alternative health care that you can contribute to your community.  It can also be a source of outside income.  Outsiders pay the standard rate but members of the community pay according to their ability.  As a massage therapist I specialise in caring for the wear and tear on the body inherent in the permaculture lifestyle.

I'm not part of much of a community, just my family, so we won't have much of a pool, and won't be able to afford insurance once the ACA is repealed.  I don't have a plan of how to deal with this, so, I reckon if something more seriously wrong gets me, I'll be dying slowly or possibly more quickly.  I'll definitely share my experience here.

Difficult not to worry about it, even though I know worry is bad for health.

This is a very interesting discussion. In the first part of the following video, and important insight is discussed which is that humans are the only living creatures that fear future suffering or death, which makes them preconditioned to servitude to others.



When it comes to "dropping out" of society in one way or another, overcoming these fears is the primary obstacle. It's ironic that we make ourselves sick with our modern, industrial life style, so in turn we become reliant on the industrial medical system to keep us functioning (I'm avoiding using the word "healthy" here because most of us are not, despite the availability of "health care"). If you truly want to leave the system, then you are going to have to leave the bad habits behind as well. For those that have stated they don't have the willpower to drop the bad habits so they need the healthcare: you can't have it both ways. You can't leave the system and simultaneously rely on the system's safety net.

I'm certainly not above any of this and I have the same fears. It has become clear to me that the primary obstacle to true freedom is my own mind and my societal conditioning, not any external factor.

Speaking to the enslavement to the social medical system language has been developed to keep others enslave to the system by faar. For example we all have many arthrose [joints] but only medical personnel are allowed to know what an arthrose is and the suffix itus is a frightening mystery. So you go to a doctor and tell him this joint hurts all the time and he pronounces you have arthritis. How dose he know? You just told him this arthros is irritated.  He/She just translates it into a diagnosis so that legally a treatment can be prescribed. Do you take the prescription out of fear or understanding of the benefit versus the harm?

You are responsible for your health care or you are enslaved to a healthcare system.