Community Supported Healthcare

doctorI wonder what it would take – if would even be possible – to create a truly community-supported health center that would achieve all of the following:

  • Provide basic healthcare – office visits, immunizations, birth control, in-office procedures (biopsies, vasectomies, mole removal, minor stitches, etc.), and simple lab work (urinalysis, blood draws, ob/gyn, bacterial cultures, etc.), and referrals to specialists
  • Offer appointments and walk-ins on extended hours, maybe 6:30am-9pm, 365 days per year (or close to it)
  • Pay an adequate number of doctors, nurses, nurse practitioners, and full support staff a competitive living wage
  • Be funded by the surrounding community on a “subscription” model. You pay a monthly or yearly fee to the clinic, and you can partake of all the services of the clinic all year for free, or a minimal co-pay per office visit. No insurance would be accepted or billed; the idea is instead of paying a middleman, you support the clinic directly.

Could this work? Could it be entirely outside of the current insurance setup? If there was no insurance billing, would it save money or drive away potential clients? Would Americans go for this? How many practitioners would be needed? How many subscribers would be needed to support this? What if you added a chiropractor and/or physical therapist into the mix? Often, those aren’t covered by insurance anyway, so you might get some people to subscribe for that service only who would help to support the rest of the clinic.



  1. techsamaritan said,

    June 22, 2009 at 2:07 pm

    Funny, I have had this same idea floating around in my head lately. I love the idea, but am not sure what to do about law suits and malpractice. Ideally, neither would be an issue. A contractual agreement for members and practitioners that provides recourse for the latter to eliminate the need for the former?

    A wellness network that focuses on wellness but still provides basic healthcare for it’s members? Wellness coaches?

  2. Robyn M. said,

    June 22, 2009 at 4:10 pm

    Just FYI, but while I was at the Consumer Cooperative conference about a week ago, the Sen’s from Iowa were proposing a “cooperative-based” option to the healthcare debacle. And apparently they mean the cooperatively-owned variety of co-op, cause they had the president of the National Cooperative Business Association there to testify for it (which is why he wasn’t at *my* conference–hmph!). I honestly haven’t looked at the actual proposal at all, and don’t have a clear idea of what cooperative-based healthcare might look like, but given how sold I am on the co-op model already, I suspect it’s a good thing, probably similar to what you’re proposing above. Maybe… ?

  3. Emily said,

    June 22, 2009 at 8:05 pm

    Maybe we’re onto something…

  4. June 23, 2009 at 3:08 pm

    There was a similar model, as I recall, called the Summit Medical Clinic which was on Summit St. in A2 in the late 70s/early 80s. It was run by Dr. Marlis Pacifico, who is still around, but I believe is currently working for IHA. You might want to get in touch with her and get her take on all this.

  5. EdgeWise said,

    July 1, 2009 at 12:46 pm

    Something like the The Ithaca Health Alliance ($100 a year) can cover basic health maintenance and preventative care. One community cannot create it’s own drugs and equipment, and do much more than the bare basics. Specialists are rare and expensive, as are many drugs.

    National single payer is able to balance out the power of monopolies like drug and equipment patents to cut costs, as well as reduce the bureaucracy every doctor’s office must deal with 350 different plans and insurance providers.

  6. Cipollina said,

    July 23, 2009 at 10:35 am

    Found your blog by serendipity, and had to stop here because my mind boggled at the mere thought that it is possible to doubt that community-based healthcare can work. It is what countries like Norway has had a great success with for ages (but I guess in American ears it has sounded too much like Communism or at least Marxist-derived to really be of interest). Unfortunately, even in the Scandinavian countries the community effort (as in the country/region/county/municipality/smaller fraction/etc) is on the retreat because you can’t get rich from it (these days you earn money, you don’t provide a service…), and it’s up to the individual to look for and privately pay for many services that before was covered by the general taxes. The local health care center where I grew up (a village of then 4000 inhabitants) worked in a very similar way as how you describe it here, apart from the “fee” or “subscription” – the costs were paid through taxes, but then you had everything covered as a birthright. How much the state and region chipped in, I do not know. Now, you can’t even be born in this village, women in labour have to be driven two hours away to give birth, and the midwife see you and your child only once or twice. The village has grown to 6000 inhabitants, but the good community services have diminuished or disappeared. I wish you the best of luck and hope you succeed in your work – growing up in such a place was both haven and heaven.

  7. John said,

    September 9, 2009 at 10:38 pm

    I’d like to know more about the co-op idea. I think I would rather put into single-payer insurance than for-profit insurance. But ideally, I’d like to hand my money directly to the doctors and nurses and skip the bureaucracy.

  8. February 16, 2011 at 11:44 am

    […] This post was mentioned on Twitter by master of rituals, Evan Schoepke. Evan Schoepke said: RT @TrailerParkGirl: #Permaculture #CSH #CommunitySupportedHealthcare: I'd love to see this! […]

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