One factor that helps keep medical bills down is that farm work and other manual labor keep Amish active for most of their lives, making them less susceptible to chronic conditions like diabetes and heart disease that plague the often-sedentary US population, Bergen said.
Amish children are more susceptible to recessive genetic disorders, the result of a small and largely insular population.
For the biggest bills, Amish communities often turn to benefit auctions, nicknamed “mud sales” because of the conditions of the fields where they are held.
On a recent Saturday auction in Gordonville, Pennsylvania, 16km east of Lancaster, young Amish men bid for used buggies priced at more than US$4,000, while hand-made quilts sold for several hundred US dollars.
Most mud sales and benefit auctions are for specific institutions. The one in Gordonville helped pay bills for the volunteer ambulance company, but a series of five held across the state each year help fund the Center for Special Children, a world-class pediatric genetics clinic.
Many Amish at the auction said they had relied on hospital aid to pay their medical bills.
“It’s not stressful,” an Amish man at the auction said. “It’s there when you need it.”