
                             USER PAY, USER WAIT

                              By ROBERT WALKER
                               Calgary Herald

     HOUSTON, Tex. - When Freed Little showed up at the Texas Heart
     Institute with chest pains, he didn't have to worry about going on
     a waiting list.

     The 64-year-old oil consultant only had to guarantee he could pay
     before his operation was scheduled for the following day.

     Robert Huff, a 57-year-old Atlanta house painter, wasn't so lucky.

     He died last January after X-rays revealed a tumor in his lung the
     size of a fist. Because he didn't have health insurance, he had
     delayed seeing a doctor for a cough for 13 months.

     These are the two faces of American health care.

       See <13health> for detailed discussion of the U.S. health system

     At its best for the rich, the U.S. system responds to the clink of
     cash with health care that's often superior to anything else in the
     world.

     For those unable to afford increasing expensive insurance, illness
     too often means bankruptcy or death.

     North of the border - where patients are often forced to wait many
     months for things such as elective heart surgery - Canadians often
     envy the care instantly available to patients like Little.

     Albertans face a six-month wait for elective heart surgery,
     Manitobans eight months. In B.C. and Ontario the waiting lists are
     so bad some patients are sent to the U.S. for treatment.

        See <03health> for a discussion of the Canadian health system

     Rationing is never a problem for those Americans who can afford it.

     The main concern at the privately run Texas Heart Institute - the
     biggest cardiac centre in the world doing 3,500 open heart
     operations a year - is finding a continuous flow of patients in a
     highly competitive market.

     ``Waiting is the only fear I have of a socialistic-type program,''
     says Little, who earns enough income to afford private health
     insurance. He left hospital 16 days after being admitted -
     confident four insurance companies were picking up a tab he
     estimates will total about $80,000.

     But those who have no health insurance at all number 34 million -
     more than the whole population of Canada.

     Roger Widmeyer, spokesman for Ben Taub county hospital, a few
     blocks from the Texas Heart Institute, says the two publicly funded
     facilities have over 1,000 Medicaid and other patients on their
     waiting lists.

     Some have waited since 1988 for operations for hernias, cancer,
     orthopedics, and other elective surgery. Total hip and knee
     replacements and transplant surgery are not done at all, Widmeyer
     says, because they cannot afford it.

     A recent study by Harvard University researchers found that a heart
     disease victim covered by U.S. government Medicaid is 40 per cent
     less likely to receive need surgery than a privately insured heart
     patient.

     ``People say we don't want to get into rationing health care
     here.'' says Widmeyer. ``But we are already rationing.''

     The high cost of getting insurance is only one of many problems
     dulling the lustre of advanced U.S. health care.

     While Canadian politicians bemoan the cost of our universal system,
     leading Canadian health economist Bob Evans says Canadians spend 25
     per cent less on health care than Americans. Compared to its
     neighbor's, Canadian costs are well under control.

     Evans, a professor at the University of British Columbia, also
     says:

      - The more expensive U.S. system does not result in better
     health south of the border, where people live shorter lives and
     have higher infant mortality.

      - Compared with Canada, virtually all extra spending on health
     care in the U.S. is on additional administrative costs, higher
     doctor incomes and the intensity of service in hospitals. Extra red
     tape in the U.S. costs about $30 billion.

      - There are huge variations in the U.S. in rates of bypass
     surgery which suggest ``much of the surgery is inappropriate.''

      - More Californians die having unnecessary heart surgery than
     Canadians die waiting for it, according to one U.S. commentator,
     cited by Evans.

     Dr. David Low, president of the Texas Health Science Centre, and
     recently recruited from the University of British Columbia, says
     U.S. health care is in chaos.

     A leading expert in the two systems, he says U.S. hospitals have 10
     times more accountants than Canadian hospitals to deal with
     insurance.

     There are thousands of companies ``each with different forms,
     different eligibility requirements, different billing procedures,''
     says Low. He himself recently spent less than a day in hospital for
     cardiac catheterization. His bill was $7,500.

     ``I still don't know what it's for. It's terribly confusing and
     unbearably frustrating whether you're a patient or a provider,''
     says the former professor of neurology.

     Low says competition between facilities means the Texas Medical
     Centre and its 14 rival hospitals have between them six $3-million
     MRIs (magnetic resonance imaging scanners) - as many as the whole
     of Canada.

     The Canadian system may not be in such bad shape compared with the
     States, but heart patient Freed Little reflects a widely held
     belief in the U.S. that a Canadian-style system involves too much
     government meddling.

     ``I think we need some drastic improvements in our system to make
     it broader based and cheaper,'' Little says as he recovers in his
     private room.

     ``But the way to do it is to keep the government out.''

     His heart surgeon Dr. Grady Hallman agrees.

     ``The government is not the solution to the problem. The government
     is the problem.''

     Little's case illustrates the huge costs that are crippling ready
     access to U.S. health care.

     For Little's quadruple bypass, Hallman charged $5,200 (US) compared
     with, for example, $1,975 (Cdn) paid by Alberta Health Care
     Insurance Plan to that province's heart surgeons.

        See <08health -coronary> for discussion of bypass surgery

     The average U.S. surgeon makes between $220,000 and $250,000 after
     office expenses but before tax, according to the American Medical
     Association.

     Heart surgeons in Alberta, for example, bill the health care plan
     on average $312,000 including office expenses, ending up with far
     less than their U.S. counterparts.
