
           THE NATIONAL HEALTH - UNDER THE WEATHER, UNDER THE GUN

                              By AILEEN McCABE
                                Southam News

     LONDON - Robert Davies had one of Britain's most celebrated
     cataract operations.

     In France.

     The 68-year-old Kent man was front-page news when he decided to
     jump the queue in the National Health Service (NHS) and go across
     the Channel to have his sight restored.

     Plagued by two years of eye problems and deteriorating vision,
     Davies was told in February that he needed a cataract operation. He
     was also told he might have to wait more than a year for surgery on
     the NHS.

     Long time that. He telephoned France and 16 days later he was under
     the knife in Boulogne Centre Hospital.

     There are currently more than one million people on the NHS waiting
     list for elective surgery. For some, it will be just a matter of
     months before their operation is scheduled. For others, a chronic
     problem will become acute and they'll need emergency surgery long
     before their number comes up.

     For many, however, the cataracts, varicose veins or bothersome
     planters wart will have to wait a year or more for surgical
     attention at Britain's busy NHS hospitals.

     State medicare was born in Britain 43 years ago. The brain child of
     Clement Attlee's Labor government, the NHS was immediately welcomed
     as the innovative and far-reaching program it was.

        See <03health> for history of Canadian health system
          see also <28health>

     And nothing in the intervening years has shaken the average
     Briton's faith in the underlying philosophy of Aneurin Bevan, the
     NHS's founding minister, who argued that where illness is concerned
     ``poverty should not be a disability and wealth not an advantage.''

        See also <28health -Douglas> for Canadian health and poverty

     What has changed since those heady days of social experimentation
     is the effectiveness of Britain's health care system. Strikes,
     queues and bed closures are as prevalent as aspirin.

     Critics claim the tax-funded NHS, under which care is delivered
     almost entirely free universally, is and has been chronically
     underfunded by successive British governments.

     They point to comparative figures that show Canada spends almost
     twice as much per capita on health care as Britain, France about 30
     per cent more, the Netherlands almost 25 per cent more and on and
     on.

     This cash crunch is starting to eat away at the foundation of
     Bevan's dream. Between 1979 and 1989 the percentage of Britons
     opting to pay for private health insurance doubled from five per
     cent to 10.

     Former prime minister Margaret Thatcher is a typical case in point.
     When she decided to have painful varicose veins removed she didn't
     have the time to wait in line for surgery. She jumped the queue and
     paid for private care.

     The experience made her no more susceptible to NHS demands for more
     funding but did perhaps influence her decision in 1988 to bring her
     capitalist will to bear on the most sacred pillar of Britain's
     post-war socialist state.

     Although the lady has now departed, Thatcher's reforms live after
     her. On April 1 of this year, the first stage of her potentially
     revolutionary dream was introduced.

     With surprisingly little clamor, the NHS met the free market
     economy and began what is designed to be a slow transition to
     forcibly march in step.

     Like so many of Thatcher's reforms, the principle behind the
     changes in the NHS is competition and cost effectiveness. She
     wanted more value for the almost $60 billion the government spends
     on the system.

     Simply put, hospitals in Britain will now compete with each other
     for patients. When the system is fully implemented, if a hospital
     in the Midlands can replace a hip joint faster and more cheaply
     than one in London, a doctor in London can opt to send his patient
     - and the NHS funding the patient will carry on his back - halfway
     across the country for surgery.

     In theory, this should cut queues, encourage efficiency and reward
     thrift. And, in practice, it may.

     At London's famous Guy's Hospital, one of the 57 ``self-governing
     trusts'' established to pioneer the NHS's leap into the
     marketplace, administrators are taking the spectre of competition
     seriously.

     The hospital is renowned for its specialized - ``expensive'' -
     medical services and now it must convince the new breed of doctor-
     ``budget-holders'' created by the reforms to buy its services with
     their limited funds rather than use cheaper, less-renowned
     facilities.

     One of Guy's initial responses to the competition is to make the
     hospital more user friendly. Better signposts and quicker
     transportation home are on the agenda, as is better elevator
     maintenance.

     The changes are designed to influence patients. Under the new
     system they have no more say in their treatment than under the old,
     but now they can possibly pressure their doctor-``budget-holder''
     to loosen his purse strings to buy them first-class care.

     Critics of the new system, including the British Medical
     Association, see fundamental problems ahead. Not least of their
     worries is that in their drive for cost efficiency hospitals will
     concentrate more and more time treating routine, ``cheap'' ailments
     and leave those with serious, ``expensive'' ailments little choice
     but to seek private care - if they can afford it.

     Moreover, once the single continental market dawns in Europe in
     1992, many worry Britain's new buy-and-sell NHS will become swamped
     by competitors.

     In that context, Robert Davies' cataract operation is seen as the
     tip of the iceberg. If French hospitals can offer cheaper, quicker
     care, British doctor-``budget-holders'' may find them the perfect
     solution for stretching their limited funds. Future generations may
     see the Channel tunnel as the straw that broke the NHS's back.

     By definition, revolutions need revolutionaries leading them and
     the revolution now under way in the NHS is no exception.

     What it has, however, is John Major and he more than anything else
     explains why Briton's are not in the streets today marching in
     defence of their once-proud health system.

     Major uses the NHS, he's a ``kinder, gentler'' politician than
     Thatcher and, anyway, he just may be defeated by Labor when an
     election is held, probably later this year.

     Hence no riots. The Major factor more than Thatcher's revolutionary
     blueprint will likely determine the future of the NHS.

     The current Thatcher-induced flux can't hide the fact that the way
     forward for the NHS really hasn't been determined yet.
