How many patients can one doctor take care of per year? How many people can one farmer feed a year?

Was just thinking that there should be doctor clubs, where a bunch of people pool their money to hire a dedicated general physician. Or to have a shared tailor, or group cafeteria, or whatever.

The ratio of people covered to specialists would probably determine whether it’s feasible. You’d want the specialist to still get paid a healthy (and guaranteed) salary and to have a more satisfying relationship with customers. And the members of the club to get better service / product than they would otherwise with middlemen taking a cut.

Moobythegoldensock,

What you’re describing for healthcare would be direct primary care with a capitation pay model.

Traditional wisdom is that about 1% of a doctor’s patients need care per day, so a doctor with 2000 patients should see about 20 patients per day. This is about standard for your office-based, 20 minute appointment doctors. For direct primary care the number per day is lower: for example, if the doctor does 1 hour appointments, you’d be aiming to see about 8 patients per day, with a panel of about 800.

The doctor is likely going to expect to be paid about $400,000, possibly more if they have employees working for them.

Skotimusj,

Doctor here in general practice.

This works well in principle. One of many problems here is healthcare need is not spread around uniformly. In your example you just consider number of people and number of providers. This is ok of you are just thinking of primary care (it works like this in many places). It breaks down when there are surges. What happens during flu season? What happens if there is a fire and 30 people need treatment for smoke inhalation. What happens when the doctor needs to take a vacation or gets COVID during flu season? There is redundancy built into a larger healthcare system which makes access more robust over a wider range of conditions.

Also, doctor’s don’t always want to work in all places.it can be harder to recruit doctors to some areas.

There are a whole host of issues here. I agree though that having a middlman take a large cut of money to “grease the system” does contribute to it’s inefficiency. The healthcare system is broken on so many levels that any one change like this would be set up to fail. We need a major overhaul.

LesserAbe,

Thanks for commenting! Having experienced the difficulty in getting traction on a state level campaign for an unrelated issue, I’m discouraged about the prospects for a nationwide overhaul of our health system, although that’s what I’d prefer to see.

Do you have any thoughts on what the pathway for such an overhaul would look like?

Skotimusj,

The system we have is built like an unsteady house of cards which is cemented together using ridiculous amounts of money. To dismantle and rebuild it without having to close inner city and rural hospitals would take a decade or more. This means the first step is campaign finance reform and overturn citizens united since the change would have to outlast more than one political regime. Then maybe work one single payor and universal medical record. Many steps from there.

moistclump,

No one is answering your question.

I live in a town of about 5,000 people. General practitioners near me make about $500,000. If everyone was forced to pay in that would be $100 each a year.

But then there would be a lease and an administrator doing the appointments etc… Hopefully the administrator can handle the payments too. Lease $5,000 a month and administrator $5,000 a month. Ooh medical supplies. I’m not sure. $2,500/ month? Still only adds $30/year for those 5,000 people.

1 practitioner would be available on average 20 minutes per person a year (assuming 4 weeks off and 40 hour work weeks) but I bet there’s around 500 people who take up most of the doctors time with their stuff and then thousands that only see them once every couple of years.

To scale up would add another $100 a year per doctor per resident of this 5,000 person team and probably up to 3 or so doctors the other costs wouldn’t change significantly.

It’s an interesting thought. Thanks for asking!

perviouslyiner,

…wikipedia.org/…/List_of_countries_and_dependenci…

…wikipedia.org/…/List_of_countries_by_total_healt…

Consensus seems to be around 40 doctors per 10,000 population, costing about $6000 per person per year (about half of what the USA currently spends)

Hillock,

I am sorry but this just sounds like today's society with nothing new added to it. You just said there won't be any middleman anymore. And just magiced away a lot of issues, which often are solved by the middleman.

The doctor's club would still need people to run the club. There needs to be someone your farmers can approach to find an available doctor. They can't just shout it into the wind.

Your farmers won't have the logistics to bring their food to the people. They won't know how much to bring where. They won't have the equipment to do so. And if you solve all of these issues they won't have enough time to farm anymore.

Universal healthcare isn't a new concept and doesn't require people to buy exclusive access.

And you still talk about compensation but based on your explaining money would be useless. Everyone has free access to these shared specialists.

LesserAbe,

Well, fair criticism aside, I didn’t say money would be useless. The idea is if one doctor can see a thousand people a year, then a thousand people pool their money and hire their own doctor. Not an infinite service for finding a doctor. (Of course you’re right they still need to find each other and then find that one doctor, which sounds like real middleman stuff) But sort of this less abstract relationship - as it is you pay thousands to health insurance, not a specific doctor, and then when you go to see a doctor they pop in for 5 minutes then off to the next patient.

Wasn’t saying farmers would hire the doctor, was throwing out examples of services. Another one might be a neighborhood cafeteria - how many people can one or two people prepare lunch for everyday, then pool that many guests. Kind a very specific consumer coop.

If you see my other replies here I’m interested in universal healthcare. More was thinking about options because doesn’t seem to be an intermediate step for how far away the U.S. at least is from universal healthcare.

z00s,

Congratulations you’ve invented communism lol

LesserAbe,

Lol well I am a socialist. But to be fair in this formulation money is still changing hands

0ddysseus,

Just turned to my buddy and said exactly this and came back to see your comment. Literally lol’ed. Fuck whoever is down voting you

burntbutterbiscuits,

Farmers specifically? One doctor could probably take all the farmers within a couple hour drive on the interstate. That would only be a few land owners but the workers too with a nurse

Khanzarate,

The logic is sound, but as you extend the idea, the group starts selling access to their doctor, and you basically pay a subscription for a doctor, and then you just have insurance by another name. It wouldn’t be corrupt like modern insurance, but that’s just because it’s new, not because it won’t get there, unless specific steps are taken to prevent that.

Really, the only thing thatt actually accomplishes here is you’ve removed profit and CEO nonsense from the equation. A community that implemented and organized all these potential communal services would just be a commune. Nothing wrong with that at all, we need more communist principles in our lives.

LesserAbe,

I think if it started to get bigger the other factor that would come into play is the entity could be democratically controlled, which is another thing we don’t get with typical insurance.

Khanzarate,

Yeah, definitely some benefits to it, even without extending it to communism. The usual term for these is an insurance cooperative, if you wanna research them more. A lot of unions do this, too.

morganth,

Here’s the problem. Let’s say you have a doctor club, where everyone pays the same amount regardless of how often they use the doctor. For people who need the doctor a lot, that’s great. They pay a lot less than they would if they had to pay per visit. For people who just need one checkup a year, they end up paying a lot more than if they just paid for their annual checkup. And they would quickly figure that out, and drop out of the program.

So now the people who are all basically healthy aren’t in your pool anymore. They’re paying for their annual checkup at another doctor. So only the people who need the doctor a lot are paying in. So you have to hire more doctors and increase the cost of the program, because everyone who is in it needs a lot of doctor time.

But then the same thing happens again. People who need more visits a year are getting more out of the program than they are paying in, and people who need fewer visits a year are getting less than they are paying. So the people who need the fewest doctor visits drop out. And so on as the cycle repeats.

You get the idea. There’s a game theory term for this that I am forgetting, but the result is spiraling costs and more dropouts. This is why the ACA (for you non-Americans, that’s the Affordable Care Act, which was attempting to reduce US healthcare costs) had a health insurance mandate. Requiring everyone to be part of the program is the only way to make something like this work.

LesserAbe,

You’re right. Health care needs are more uneven than the other services I mentioned. What about piecemealing the services? So not universal healthcare for Smalltownsville, not MRIs or designer drugs initially, but everyone at least gets a general physician visit. Potentially still a better experience for doctor and patients. But not thinking just about healthcare, what about a neighborhood cafeteria or tax service, or any commonly used service?

morganth,

I feel like the cafeteria is the best scenario, because there isn’t an imbalance of needs like this. Pay a flat fee per year and get a lunch every day, or every work day, or whatever. Economy of scale would mean that it would save the subscribers money.

…huh, this could actually work. The one downside is that people nowadays expect variety in their food and cafeteria food tends to be samey. But if you could solve that, this is a good idea.

half_built_pyramids, (edited )

This is single payer healthcare. Instead of the drama and cost of a million little co-ops of a few hundred people making doctor patterns Patreons there’s just one tax collection arm and one payer arm.

LesserAbe,

I want universal healthcare. I was thinking about this since maybe a town or community could actually get something in place while nationwide universal healthcare seems decades away in the U.S.

LesserAbe,

Also not thinking just about healthcare…

wintermute_oregon,

I support single payer. Just realize your taxes will go up significantly in a single payer system. At least 20%.

Everyone will have to pay to make it work but I hint it’s a solid investment in our country

smort,
@smort@lemmy.world avatar

But your insurance premiums will go down by more than your taxes go up, for most of us working shulbs, anyway.

wintermute_oregon,

No. Not even close. I pay 100 dollars a month for insurance.

If my taxes go up by 20%, that’s more than 100 dollars a month.

Encode1307,

That’s where it gets complicated. Your employer pays a lot more than $100. Your taxes would go up and your employer could be mandated to pass the healthcare savings on to you to largely offset your tax increase. The Wyden-Bennet plan predated the Affordable Care Act and would have mandated that. Obama’s healthcare people were concerned that would be very complex and would go back on his promise to allow people to keep their current doctors and insurance. So we ended up with a huge expansion in Medicaid instead (which was great but didn’t give us the systemic change we really needed).

wintermute_oregon,

Or the employer would have to pay more to balance the system.

All the plans show a large tax increase which I am fine with if we keep a stable system. Doctors have to be paid, along with nurses and that isn’t cheap.

I think employer insurance is an odd system but I get why it happened. I just think it is time for it to die.

Encode1307,

Yeah they were trying to keep it cost neutral. Bennett was a conservative republican.

Employer based insurance is possibly one of the worst systems we could have come up with if we were designing it from scratch.

wintermute_oregon,

I think we have to accept everyone will pay more in taxes but there will be surprise bills if there is an emergency, no delayed care while you switch jobs or the plethora of stupid issues that come up when it’s tied to an employer. People need to stop thinking it will cost less. It won’t and that’s Ok.

burntbutterbiscuits,

You are wrong. Costs will go down compared to health insurance costs in United States right now. Might end up taxing currently uninsured more but for most will be less and folks in poverty will gain more than they lose anyway

wintermute_oregon,

You have a cite that it’ll cost me less? I have never seen a study that suggest that.

burntbutterbiscuits,

All of them actually. The talking point from the right (in the US) is that is will increase debt on the federal level. While this is true, they always leave out the fact that no one will be paying for regular health insurance anymore, which actually costs American tax payers more than what single payer would cost.

It would be more difficult to find one that disagrees with what I am saying

wintermute_oregon,

CIte one. I pay 100 a month for my insurance. Cite me where I will pay less under a single payer system.

Every legitimate cite I have seen says about a 20% tax increase which I am fine with.

burntbutterbiscuits,

I doubt you get much of anything for 100$ a month; I have a free plan at work but my employer pays way more than 100 a month for that one… which is a high deductible plan

wintermute_oregon,

250 dollar deductible. 20-dollar co-pay for specialist. 2250 out pf pocket max. Coinsurance 10%. Emergency room 100 dollars

burntbutterbiscuits,

I’m sorry but you’re lying. Or leaving something out.

wintermute_oregon,

No, that is taken right off the web page.

burntbutterbiscuits,

Maybe if you’re on Medicare or you are ina blue state and you are one welfare and completely broke… but that doesn’t add up. You may be forgetting your employer contributions

burntbutterbiscuits,

If you are arguing that we have a lot of folks living in poverty and their taxes might increase a bit I believe that is a bad faith argument.

If you get health insurance through your employer like most Americans then the employer paid parts will also disappear… but folks are so uninformed that they can’t see it

wintermute_oregon,

Facts are not bad faith. Pretending it will not cause taxes to increase is just silly, and why we have never been able to get it passed.

People like the idea until they find out their taxes will go up considerably. I am fine with that but stop trying to be dishonest. The money has to come from some place to fund the system. That means taxes will increase.

burntbutterbiscuits,

It’s bad faith to lie about total costs. Period. Our current system leaves tens of millions uninsured (most especially children, and many more millions underinsured.

United States is a third world country when it comes to health care for the poor.

Total cost will go down unless you pay basically nothing for health insurance.

wintermute_oregon,

Then cite something.

rpc.senate.gov/…/medicare-for-all-higher-taxes-fe…

Here is a cite using the Democrat Medicare for all numbers. gasp! It shows 20% like all the other cites I have seen.

You are the only one lying about cost. Your claim is that it will cost be less and it won’t. It won’t cost anyone less unless they don’t pay taxes. Otherwise, it will cost them more.

burntbutterbiscuits,

You said you pay 100$ per month for a 250$ deductible. My employer pays 500 per month for a 1500 deductible and I know I have one of the best plans

wintermute_oregon,

Well, it appears mine is better.

burntbutterbiscuits,

I don’t pay anything. I could have the one hundred per month plan and have the 250$ deductible as well or similar etc, but then my employer would be paying like 600-800 per month I believe so yours is actually more expensive as far as the whole system is concerned.

burntbutterbiscuits,

Neither of us would have copay or deductible if we actually had to use our insurance

wintermute_oregon,

Are you talking about a single payer system? They often have co-pays and deductibles.

burntbutterbiscuits,

I don’t obfuscating the point. Neither you or I will be writing the damn single payer legislation. I’m not going to argue about random semantics.

Single payer is cheaper than what we currently spend in the usa on health care. Period.

wintermute_oregon,

It isn’t. You keep saying that but nobody agrees with you. I gave a cite that showed the democrats plans and all cost more. None show it being cheaper.

burntbutterbiscuits,

Dozens of studies suggest you are wrong.

You don’t know what you’re talking about

wintermute_oregon,

Yet keep babbling but have yet cite Anything. I three different plans evaluated by an economist who weighs their economic impact.

Basically you have no clue what you’re telling about but keep making inaccurate claims.

ricecake,

Taxes go up, but money paid to health insurance goes down.
And you’re already paying most of the operating costs of universal healthcare in the form of Medicare/Medicaid administration taxes, you’re just not eligible to benefit.

So your taxes will increase, but not as much as you expect, and your total deductions will decrease unless you opt to keep private insurance.
Every analysis of the topic inevitably concludes that we’re currently using the most expensive method of providing healthcare.

wintermute_oregon,

I’d expect about 20%. That seems to the number floated around by most the think tanks.

Rhynoplaz,

20% of my taxes is much less than my current employer plan cost.

burntbutterbiscuits,

It would be cheaper than paying insurance actually by a lot

NeoNachtwaechter,

universal healthcare

Nobody can tell how many doctors are needed for the whole universe.

/SCNR

half_built_pyramids,

Maybe.

You mention farmers. They already have co-ops. If you’ve lived around those communities you know people can get apeshit about a semi of corn that might be a little wet.

I wouldn’t want to be on the local board that has to settle the account for aunt murtle’s 5th round of lung cancer while she’s on O2 and still on a pack a day. It’s easier to set guide rails - actually moral and responsible ones like not giving liver transplants to people with bac - when you didn’t grow up with aunt murtle’s kids.

LesserAbe,

Sure, if we can get universal let’s do it. Don’t have to sell me on it being better.

Do you have thoughts on how to move the ball from our current situation to something closer to the ideal?

xantoxis,

Reading into your intention, this is actually more like health insurance than single payer healthcare. Not quite a million little coops, more like a few dozen. And it would end up having most of the same problems of modern US health insurance.

You’ll need someone to administer the program, so you have to give them some power over your money. That means they’d need the power to say “no” to people who are seeking healthcare resources for invalid reasons–things like Munchausen’s syndrome at first, but eventually they’d have to make calls about things that people actually need but can’t prove they need, just like health insurance does now.

If you don’t want do these things, I guarantee your neighbors will insist they be done (ever hung out on nextdoor? those are the people you’ll be pooling your money with). And you’ll go along, because it’s a hassle not to, and hey at least you’re getting your needs taken care of most of the time. If you manage to keep your program free of capitalist influences, you’re going to have to fight corruption instead: “Slip me some dough and I’ll make sure you get seen next.”

So in time you just end up with health insurance, and most of its flaws, if you don’t very carefully watch the people administering your program, if you don’t very carefully fight against the perverse incentives.

The biggest problem, of course, is that existing health insurance would fight it like penicillin fights bacteria. They have had decades to do regulatory capture in their benefit, and if another group comes along that’s almost-but-not-quite health insurance, they’re going to make sure that the regulations they captured keep it from going anywhere, up to the point of trying to make it explicitly illegal.

I think we’re in agreement about single payer, but this ^ is how it benefits us. The government has actual power to fight corruption and isn’t beholden to capital. Now if we only had a way to create a just government.

LesserAbe,

Not saying it would work, but what I’m describing is more bite size than a full health system. So if a group only committed to “everyone gets to see a general practitioner” then people are on their own for MRIs and chemo. Figure out how many patients a type of practitioner can handle in a year, then pool that many people to hire one. Same idea for any other role, like how many cars can one mechanic fix a year?

I’m not married to the idea, but more thinking about how could we take concrete steps towards universal health care, other common services, democratic workplaces. If people see a micro version working then it may inspire more ideas, attract more effort.

lastunusedusername2,

Let’s reinvent trains next!

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