D&D 5E How would you handle a healing economy?

[Bacon Bits]

Or maybe remove curse only works for a short time before the curse returns. It doesn't sound like the cause of the curse has been removed. Maybe those subject to the curse enjoy only a brief respite with remove curse.

 

[CapnZapp]

This is a perfect chance to quote one of my favourite answers ever from RPG.stackexchange.net (https://rpg.stackexchange.com/quest...-healing-how-can-sick-crippled-or-otherwise-u) in response to essentially this exact question:

"You need not change anything about the default setting in order to have people "left out" of the benefits of clerical magic.

I don't think that clerical spellcasting is as easy to come by as you make it out to be. In other words: you can easily have your harsh and gritty world. In what follows I'll always lean toward the more-utopian interpretation of things, lean on the rainbows-and-unicorns end of numerical ranges, and I think you'll see there's still plenty of room for gritty/harsh living conditions. Obviously, then, if we dial back any of those happy-happy-joy-joy assumptions we can make things even harder for people.
Demographics

You've told us you want a harsh, uncaring setting. Luckily, much of our history on this planet has been conducted in that setting so we've got lots of data to go on. I'll point you toward my favorite such tool--Medieval Demographics Made Easy--which helps us imagine D&D's pseudo-medieval implied setting using the tax rolls of 13th-C France.

This gives a baseline of one "clergy" per 40 population, and one "priest" per every 25-30 clergy. For your purposes I'm going to interpret "clergy" as an unleveled acolyte, and a "priest" as a leveled cleric.1 That means that we find a leveled cleric every 1000-1200 population.2
Villages/farmlands/wilds

Villages (according to MDME) top out at about a thousand people, so let's assume we've got a 1000-person village with one L1 cleric serving as its priest. That's two first-level spell slots per day for a thousand-person village.

In the case of illnesses remember that we can only cure two people per day. I don't feel like running a full S-I-R model here,3 but we don't need too-extreme of infection and recovery rates to overwhelm the "bonus" recovery from spellcasting. And curing an illness requires a second-level spell slot, requiring a third-level cleric!

In the case of extreme injury, just remember we only need three people seriously injured to overwhelm our poor country cleric. I've never erected a barn or taken down a tall tree, but I can easily imagine three simultaneous injuries. If a cleric can heal two but has to wait until the next day to heal the splinted broken ankle, there's your limper.

Accidental death. Let's talk size: sticking with medieval France we get a population density in arable lands of about 100 ppl/mi2

. So this village and its lands occupy about 10 square miles, or about a 3-mile (diameter) hex. Recall that without help you may only have 21 seconds of life left once you hit 0hp. The odds are not good that this accident happened within 20 seconds of our cleric =(
Cities

Cities (again, using MDME's classifications) range around 10,000 people.4 Using the same numbers as above we see that a 10K-person city should enjoy only ten leveled clerics.

But notice that the underlying numbers don't really change all that much. Travel times may go down, and with more casters we'll have some of higher levels (and more slots). But there are just so many people...

Again being generous, let's assume one cleric of each of levels one through ten, and that they use fully half their slots on daily petitioners. That's 45 spells to cast for ten thousand people, or 93 spell-levels for hoi polloi. All you need is more than one percent of the population to "need" something on a given day and you'll overwhelm the daily petitioning system. 2% would overwhelm the entire clerical-magic capacity of the city. One disease, a fire, even just a day when one of the high-level clerics is tied up in bureaucratic argle-bargle will leave some unfulfilled.
Turning the dials

Let me briefly summarize the assumptions made, and how changing them will change things:

"Clergy" are not casters, only "priests" are. They are as abundant in D&D-verse as in medieval France. Obviously, in a world where the gods walk the earth there might be more priests. But keep in mind (a) there's also the lure of arcane casting; (b) clerics are also needed to deal with the undead hordes/curses/magically-fueled religious wars inherent in such a world; and (c) somehow the D&D-verse hasn't figured out any better agricultural technology than the moldboard, so we still need 90% of people to be involved in food production.

Farmland is really rich so the region/kingdom/world is pretty densely-populated. Drop population density down to 30 ppl/mi2

(like 13th-C. England) and one's proximity to a cleric drops commensurately.

City-based clerics spend half their spellpower helping "commoners". This one I see as a fun dial to twist. If I know anything about bureaucracy at least one or two of them definitely aren't getting their hands dirty. Perhaps some orders are martially focused and so are embedded with a standing army and none of their clerical spells go to (directly, immediately) help common folk. Perhaps some order devotes 100% of its divine power to such works. Perhaps some order has grown world-spanningly-huge and spends much of its time maintaining its own bureaucracy. These are huge cultural differences that can really change how the world feels.

The cleric in a village is a L1 caster. But one can imagine that a village where a L15 cleric has retired would be a little green patch of paradise: he attends all childbirths, so mother and infant mortalities aren't a thing. Droughts/blights? Create food and water'll sustain people and seed crops well enough to get through. Village festivals (to the cleric's god, obviously) come with a Hero's feast.

Bringing it back to reality:

The situation you describe isn't fundamentally different from our own world. There are people with physical troubles, and there are some with the power to alleviate those troubles. Why, then, do we see people in difficult circumstances? Proximity, access, cost, &c all play their roles. The same is true in the D&D-verse.

In some places charities step in. In some places social structures embody greater sympathy/antipathy toward the problem. But spell slots are a limited resource and so will evolve into their own economy, just like anything else.

1 - This, effectively, is exactly what [MENTION=48131]Tims[/MENTION]ter argues for in his answer.

2 - If it seems I've queered the deal from the outset by declaring "priests" to be leveled clerics rather than "clergy" (and thus dialing back by a factor of 25 the number of available clerics), I urge you to consider the alternative: 2.5% of people are leveled clerics. Given twelve classes and assuming clerics are one-twelfth of leveled characters we see 30% of the population is leveled.

Sticking with pseudo-medievalism we've got to have ~90% of the population involved with agriculture, though. So not only could you have every non-farmer a leveled NPC, one out of every five (roughly) farmers would still be, too! That's not really the setting implied by most published material. (But it's kinda a cool one, methinks. Every time you stop for dinner you've got to listen to the barkeep's old campaign stories, then the stablehand's old campaign stories, then the lamplighter's old campaign stories....)

3 - okay, that's a lie. I really want to run an SIR model incorporating a clerical healer and I did. Assuming the cleric (a) doesn't get infected ever, (b) can get to and heal two people per day, (c) healed people now have immunity and can't re-infect, and (d) the same epidemiological parameters as the SARS outbreak in Hong Kong in 20035

, we get a peak infected population of ~15% the total population; 150 people have this disease on the outbreak's worst day. The cleric, healing two a day, just doesn't do very much for those people; there's plenty of room for some disfiguring illness to scar people. (The cleric does have a huge effect on ramping down the "long tail" at the back end of the outbreak.)

Admittedly, the underlying SIR parameters may be badly constructed for this setting: people are less-densely packed and don't travel nearly as much. But then again, hygiene and sanitation are much worse and the population may be starting at a less-healthy baseline. In short, I'm not a medieval epidemiologist, just an amateur mathematician with a copy of MATLAB.

4 - This may seem small to us--it's the size of the suburb I grew up in, for instance--but "a typical large kingdom will only have a few cities in this population range." (MDME)

5 - Razum, Beecher, Kapuan, Junghauss. "SARS, Lay Epidemiology, and Fear." The Lancet, May 2, 2003 + analysis of these data in one of my modeling classes in grad school.

I will never understand the lengths people are willing to go to in order to justify the D&D spell model, and not to have to change it.

Instead of doing all of the above, how about simply acknowledging that D&D isn't geared for gritty or real, and simply change/remove the spells...?

Sent from my C6603 using EN World mobile app

 

[Charles Rampant]

It's worth noting that the exact situation you're dealing with there is not your common or garden variety disease. From what I saw in the Neverwinter MMO, the Spellplague was basically chaos mutation (like Warhammer, which I suspect it was inspired by) that was caused by the shattering and messy healing of the Weave. The Weave is the fabric of magic, the thing that magic-users manipulate to cast spells; when it was shattered, it created areas of nasty magic that messed people up in ways that were not solveable by just casting spells. (At a guess, because it was caused by magic gone wrong, magic can't fix it).

So, notwithstanding the excellent and interesting above analysis, I'd just present the affliction as one that just can't be touched by the priests.

 

[Rhenny]

It's worth noting that the exact situation you're dealing with there is not your common or garden variety disease. From what I saw in the Neverwinter MMO, the Spellplague was basically chaos mutation (like Warhammer, which I suspect it was inspired by) that was caused by the shattering and messy healing of the Weave. The Weave is the fabric of magic, the thing that magic-users manipulate to cast spells; when it was shattered, it created areas of nasty magic that messed people up in ways that were not solveable by just casting spells. (At a guess, because it was caused by magic gone wrong, magic can't fix it).

So, notwithstanding the excellent and interesting above analysis, I'd just present the affliction as one that just can't be touched by the priests.

This is what I'd do too. If you want the world to be based on the assumption that the disease/curse is so horrible that it needs special conditions to cure/remove, make it so. Tomb of Annihilation does it with the Soul Monger. In that adventure path, the Death Curse can't be cured until the artifact is destroyed. That sets the clock ticking.

Part of the adventure might be for the party to find out how to end the plague/disease/curse, a forensic mystery.

 

[CleverNickName]

It's easy enough to remove a spell from the spell lists. Just inform your characters as they are rolling up their characters that the Remove Disease spell can't be prepared as a spell, it can only be "cast" by creating a potion from certain rare ingredients. (Or whatever works for your campaign.)

Our DM removed Raise Dead, etc., from all spell lists in our current campaign and it hasn't been as horrible as everyone first thought it was going to be. If we ever need to be Raised, we have to take our fallen character to one of a few magical shrines and make the proper offering. Sure, it's inconvenient. But so's being dead.

 

[Ganymede81]

The rules in the Players' Handbook are a conceit designed to allow the players to interact with the game world. They are not designed to model a socioeconomic system.

In short: the rules are for building stories, not for building worlds.

 

[Savage Wombat]

One thing that always bothered me was the way that default games (like video games) assumed that clerical spellcasting required a monetary donation, even in faiths that should be healing everybody freely.

As I read this thread, I wondered if the healing shrines of gods aren't so much the workplaces of spellcasters, they're holy sites where the local acolytes help you perform a ritual of healing, but the magic requires a sizeable offering to power, regardless of the generosity of the deity. Clearly local philanthropists should be donating money to the church so that the cash-poor faithful can get emergency services.

 

[Charlaquin]

I think the second-highest answer in the link you provided is helping me get my answer. I had missed this, but according to the 5th ed. PHB, clerics with true healing power given by their god are truly rare, and "Not every acolyte or officiant at a temple or shrine is a cleric...True clerics are rare in most hierarchies." It goes on to say that clerics are often chosen by their god to essentially go on adventures and recover ancient relics, etc. So it seems that a cleric's god may not want them to spend all their time trying to heal the entire world.

This means that I might need to rethink whether I am going to allow NPC priest healing in temples at all. (But then, that negates the benefit of serving in temples as outlined in Xanathar's Guide, so I donno.)

Remember though, not all people who can cast healing spells are Clerics. Acolytes can cast Cure Wounds, and Priests can cast Cure Wounds, Lesser Restoration, and Dispel Magic. Reading between the lines a bit, the spells listed in their MM entries are just the ones they typically have prepared; an Acolyte is a 1st level spellcaster and the Priest a 5th, so you might rule that they can prepare and cast other Cleric spells of up to 1st and 3rd level respectively.

 

[Dan Chernozub]

On a side note - in case of any wide-spread plague, any place that has "enough" magical healing to help local population will get a huge inflow of people from other places, where they don't have enough healers. Quarantines, refugees storming the gates, moral dilemmas ... all the good stuff.

 

[ArchfiendBobbie]

I would say a healing economy is nearly impossible to properly handle, given the way the setting is set up.

A lot of the focus in the original post is on clerics, which totally ignores the fact there are four other healing classes in the game. Bards can cast Cure Wounds and Regenerate, druids can cast a number of healing spells, rangers have a couple of healing spells, and let's not forget paladins. Even if you limit clerics, you still have all of this other magical healing to deal with.

It's far easier to just make a rule about how many magical healers there are per populace based on settlement size. Here's the numbers I use:

Metropolis- One healer per 50 people. These rare settlements need this healing, as they are likely dealing with multiple plagues and maybe an undead horde or two every single day just due to the population size and all the ills that result.

City- One healer per 100 people. They likely see regular plagues, so they need the higher density of healers to both deal with those and to aid travelers from smaller settlements who come here seeking healing they can't find in their hometown.

Town- One healer per 1000 people. They really don't need magical healing that often.

Village- 0 healers. Likely, the only healer these places see is a traveling bard, traveling cleric, druid in the area, ranger in the area, or adventuring party. Beyond that, it's up to the local wise woman or medicine man with ranks in the Heal skill to cover medical needs.