Geriatric specialist reflects on health-care overhaul proposals, cites inadequacies

EDITOR’S NOTE: In response to comments made by AARP Arizona President Len Kirschner in the Sept. 18-19 editions of the Daily News-Sun, Dr. Robert Fitzgerald, a Sun City physician, discussed health-care reform Tuesday with the Daily News-Sun editorial board.

A Sun City physician said Tuesday proposed legislation to overhaul the nation’s health system would lead to rationed care and slowly bankrupt the Medicare system as more and more Baby Boomers apply for coverage.

Dr. Robert Fitzgerald, who specializes in emergency room care with a focus on seniors, told the Daily News-Sun editorial board he believes proposals for the overhaul of health care don’t address the primary problem.

"The bottom line is that I believe those bills need to be scrapped and started over again," Fitzgerald said.

His comments came on the same day that liberal Democrats failed in two efforts to include a government-run insurance option in the legislation before the Senate Finance Committee.

Fitzgerald said the proposed legislation, including the bill proposed by Sen. Max Baucus, D-Mont., the finance committee chairman, are based more on financial changes rather than the systemic overhaul the health-care system requires.

And a main problem, he said, is the flood of Medicare-eligible Baby Boomers who soon will be tapping into the funding pipeline.

The doctor said 12,000 Boomers a day will be added to the rolls beginning in 2012 and that will continue for more than a decade.

"Getting everybody an insurance card doesn’t really necessarily mean you’re going to have the right level of care," he said. And since 30 percent of Medicare dollars are spent during the last year of a person’s life, that would mean rationed care, something proponents of the current reform plans dismiss.

"Can all of these patients be admitted to the hospital or can they be sent to skilled nursing facilities which would cut down on the costs?" he said, adding that decisions would have to be made about who would receive what type of care and when.

Fitzgerald said the government should have prepared for some type of reform at least 25 years ago, but there was no political advantage for elected officials to do so.

Now, he said, Congress and the president are talking more about "health-care payment reform" than they are overhauling a system that needs to be fixed from top to bottom.

According to Fitzgerald, there is a need for some public involvement — "it’s important to have a safety net somewhere" — but the private sector needs to be a primary player in any reform.

"To be honest, there isn’t one individual solution to solve all of these problems," Fitzgerald said.

Some of the options to improving health care, Fitzgerald said, include opening up insurance from state-to-state for competitive rates and making the risk pool larger.

In proposed legislation, insurance policies could not be canceled if people get sick. Insurers would not be able to deny coverage for pre-existing conditions for the millions who lack insurance — or have trouble getting it after being laid off or deciding to start a business.

Government subsidies would be available to make premiums more affordable, but individuals would be required to get coverage, and employers would have to contribute.

Ultimately, Fitzgerald said, decisions will have to be made on what type of care Americans want and need.

While the health systems in England and Canada provide acceptable basic care, they are slow to administer more specific treatments, he said. While it could take three weeks for a woman with a lump on a breast to be X-rayed and, if needed, see a surgeon, a similar process in Canada could take months, Fitzgerald estimated.