December 1, 2011

Letters to the editor, Dec. 1, 2011
Concierge medicine impractical, unjust

In view of the problems we're having with the cost and availability of health care in this country, ideas about the provision of that care are always welcome. However, the "concierge medicine" model presented on the front page of the Nov. 27 Maine Sunday Telegram has little to recommend it.

click image to enlarge

Dr. Philip Frederick, profiled in The Maine Sunday Telegram, has a concierge medical practice in Yarmouth.

Staff file photo

First of all, for primary care physicians to reduce their patient load from the current approximately 1,800 patients to 600 would necessitate a tripling of the number of such physicians to care for those patients, and that at a time when the ranks of primary care physicians are declining and many people don't have one to start with.

Second, any scheme that promotes two-hour annual "wellness checks" is inappropriate, especially when, again, many people are unable to get any kind of medical check, wellness or otherwise.

Third, at a charge of $1,500 per patient per year, the cost to society for the one-third of physicians who are in primary care would swell to approximately the current cost for all physicians. Put another way, if, as the article states, the concierge physician keeps two-thirds of the $1,500 annual patient charge, and has 600 patients, he or she would make $600,000 per year. For a leisurely practice.

Fourth, the one-third of the $1,500 that goes to the concierge company is spent, according to the article, on "marketing and regulatory support." Admittedly, health insurance companies are taking close to that percentage out of premiums now. But is that the best use of scarce health care dollars?

In summary, if universally applied, this concierge model would be impractical. If selectively applied, it would be unjust. Let's stop wasting our time tinkering with a flawed system, and start changing the system to the single-payer, Medicare-for-all, developed-world kind of plan we're going to end up with anyway.

Daniel C. Bryant, MD

Cape Elizabeth

Local agricultural markets are the wisest investments

World hunger has been personal to me since I served as a U.S. Peace Corps volunteer in Chile (1980-82) and saw hunger and malnutrition up close. I am proud that the United States is the world leader in support for international aid to fight world hunger.

Not only is food aid and investing in agricultural development the right and moral thing to do, it also alleviates suffering and helps others to stand on their own. It is also a matter of our national security. Misery and suffering lead to famine, despair, refugee migration, religious extremism and even terrorism.

The total amount of our U.S. federal budget dollars dedicated for all international aid is less than 7/10 of 1 percent. The World Food Program and other global nongovernmental organizations have learned that investing in local agriculture is a sustainable and long-term solution. For example, their program working with the government of Ghana has accomplished amazing results. There they invested in agriculture education for the small impoverished farmer, initiated school feeding programs that kept children, especially girls, in school, and used locally produced nutritious food to do it.

The U.N. World Food Program was able to avoid costly transport of food from across the globe and the associated storage issues, while boosting local agriculture markets for the poorest farmers. Through this amazing program Ghana was able to reduce its poverty rate from 51.7 percent in 1991 to 26.5 percent by 2008, and hunger was reduced from 34 percent of the population in 1980 to 9 percent in 2004.

Solutions to avoiding famine and world hunger are at hand. I urge readers to contact their members of Congress to tell them to pass a fair and reasonable federal budget that provides level funding for international aid programs.

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