I would also like to provide high quality care to patients for a reasonable price. Presently I charge about $160 for an appointment that takes me about 30 minutes, give or take an hour, to complete. That seems kind of steep. The reason I charge so much is that most of what I do, solving problems over the phone, reviewing tests, consulting colleagues, signing my name about a million times a day, is unpaid work.
An average internist takes care of 1500-2000 patients. That is to say that at any given time, there are that many people who consider a given doctor to be “my doctor.” A doctor like me, who works a more gentle schedule, would probably be responsible for 1200 patients. In my schedule, I would tend to see about 40-50 patients per week, about 50 weeks per year. My overhead is about 50% or a little more, just depending on how things go.
What would be wrong with a plan to cover just visits with me or the folks in my small clinic which would cost $100 a year as a basic fee (to cover the things that I normally do for nothing) and then $25 for an office visit? As I calculate it, that should be a salary of about $120,000 with overhead taken into consideration, and affordable basic health care for whoever was interested in it. Overhead might be considerably lower since these folks would not need to be billed.
People would still have to pay for things like x-rays and blood tests, but much of the really important stuff is not that expensive, and if patients had some stake in bringing the costs of procedures down, or consuming more wisely, things might get cheaper.
“Concierge medicine” resembles this, only with a steeper per year cost and an emphasis on special treatment for the patients involved. Practices that do “concierge medicine” are apparently quite popular in some places, but tend to cater to wealthier clientele.
A system like this could co-exist with insurance: increasing numbers of patients are so underinsured that an office visit would cost them more than $100 to start with, and even the adequately insured patients might like the opportunity to completely bypass the complexity of insurance billing. Most of the uninsured patients I see could afford this.