Correction Appended

A Wall Street Journal story in late June — reprinted in today's Business section — rapped two area hospitals and illuminated an issue long in the shadows: the catastrophic effects of skyrocketing health care costs on Amish and Old Order Mennonites.

It is a problem Plain communities have struggled with for at least a decade, and one destined to get significantly worse unless something is done soon, says a leading expert on Amish culture.

But others say it isn't an issue unique to the Plain — but rather, a similar problem for anyone without health insurance.

The Journal article, published June 28, detailed the ordeal of Amish and Old Order Mennonites here, who, due to their faith, rarely carry health insurance. A major illness can crush the faithful beneath mountains of hospital and medical bills.

Making things worse is intermarriage in the small communities, making life-threatening genetic disorders far more common than in the general population.

While health insurance companies negotiate lower fees on behalf of their customers, the Amish are on their own. Plain patients can get a discount on their bills — for paying early or paying in cash — and Lancaster General Hospital offers a "guaranteed discount" of at least 25 percent for all uninsured patients, including the Amish, hospital spokesman John Lines said.

The hospital also has a financial assistance program that last year provided "substantial discounts, subsidies and re-payment plans" to more than 6,000 people, including members of the Plain community, Lines said.

But when medical bills run into the hundreds of thousands of dollars, as is often the case with Plain sufferers of genetic diseases, the cost of care — which is still lower for most covered by health insurance — can be debilitating.

"It is really getting to the point where it's getting out of hand," said one local Amishman in an interview last week. "We sit down and negotiate with the hospital and the doctor, and if [the cost] is still out of hand, we get together and make a Christian approach, doing a benefit auction" or something similar.

"That's the way people did things in the old days," he said. "But what's upsetting is with the amount of money [LGH] made last year, and they're just charging us unbelievable rates" for care.

The hospital posted a record surplus of $136 million for the fiscal year ending June 30, 2007, according to the Pennsylvania Health Care Cost Containment Council — a 27.5 percent boost over the previous year's total.

In the WSJ article, D. Holmes Morton, who runs the Clinic for Special Children that treats Plain children with rare gentic diseases, called upon LGH and Penn State Milton S. Hershey Medical Center to offer half-price discounts to Amish and Mennonite patients. LGH Chief Executive Officer Tom Beeman told the WSJ that the request was unrealistic and unfair, merely shifting the burden to everyone else.

Through Lines, Beeman declined to be interviewed for this article.

But Lines noted that the hospital donated "about $40 million to care for patients with little or no health insurance and to cover the unpaid costs of services and state programs to financially disadvantaged patients" in 2007 alone.

Over the past 20 years, he said, the hospital also has contributed "significant funding and medical supplies" to the Clinic for Special Children, which treats members of the Plain community suffering from genetic diseases.

He said the traditional Amish "safety net" — family, church and community —may simply not be enough today.

The Amish themselves realize this, said Dr. Donald B. Kraybill, a professor and senior fellow at the Young Center for Anabaptist and Pietist Studies at Elizabethtown College, and one of the nation's foremost experts on Plain communities.

"With the exception of some very small groups," he said in an e-mail, Old Order Mennonite and Amish groups "have informal, internal mutual aid plans to assist families with health-related expenses. What they often don't have is coverage for catastrophic costs."

Those costs, which can even drive farmers off their land if the bills aren't paid, are "a major problem that all of the Plain communities have struggled with in the past 10 years," Kraybill wrote. Now, many are trying to find other ways to cover the bills.

These might include reducing treatment, because it's simply too expensive. It could also include "creative" approaches, like a pioneering effort now under way in Ohio called Immergrun Inc.

Immergrun was founded about a decade ago to help negotiate lower medical bills for Amish, Mennonites and others who, because of their religious beliefs, don't have medical insurance. The charitable organization has cobbled together a network of physicians and specialists who have agreed to keep fees down for Plain patients, and has contracts with medical care facilities and testing services.

The group's founding physician, Dr. Edwin Nirdlinger, started the Great Lakes Hernia Center in 1989 in Toledo and was stunned at the number of Plain patients who came in for treatment.

"Literally, the number of people we treated just doubled" in the first few years, said Immergrun administrator Cindy Siedler. "And as we treated them, we'd talk to them, and the stories you'd hear were amazing."

One 7-year-old girl came in for treatment and appeared sickly. The center discovered she was in renal failure. The Amish "are often waiting a long time [to seek care] because they can't afford it," she said. "They're so willing to pay their bills, but in a way, they're almost penalized" because of their religious beliefs.

That makes them "cash cows" for hospitals and other providers, she said.

But it's not just the Amish, said Nora Johnson of Medical Billing Advocates of America, an organization representing uninsured and underinsured citizens socked by high costs. "Religion is not germane to this issue," she said. "Anyone from any group that doesn't have insurance" faces the same problem.

Hospitals "are just rolling in the dough," she said, and often the figures they cite for the amount of care they've provided to the community are based on what they'd bill for the procedures, rather than actual cost.

Lines said the $40 million donated by the hospital to help those with little or no insurance was LGH's cost. "It is not based on charges, which would be a higher figure," he said.

Johnson said that in cases where her organization represents someone who's had a lien filed against his property by a hospital, Medical Billing Advocates of America will file a counterclaim and demand "discovery," which would force the medical system to disclose its actual costs.

Hospitals often settle after such a move, she said.

Some sort of nationalized health care system, she said, may be the only way to address the inequalities in the current system.

But Kraybill, the Elizabethtown College-based expert, said the Amish might eschew that, too. "They opted out of Social Security," he said, and might respond the same way to universal health care because "it violates a basic tenet of their Christian faith that members should help each other with material needs and not rely on government or commercial plans."

"That's what we'll have to do, just pray more," said the local Amishman.

"And pay our bills."

Correction July 13, 2008

Tom Beeman was incorrectly identified as chief operating officer of Lancaster General Hospital. Beeman is chief executive officer of the hospital.