While the debate in Congress over heath care rolls on, affordable, world-class heart operations can be had for cheap in India, and coming soon to the Cayman Islands.



Please consider The Henry Ford of Heart Surgery.



Dr. Shetty, who entered the limelight in the early 1990s as Mother Teresa's cardiac surgeon, offers cutting-edge medical care in India at a fraction of what it costs elsewhere in the world. His flagship heart hospital charges $2,000, on average, for open-heart surgery, compared with hospitals in the U.S. that are paid between $20,000 and $100,000, depending on the complexity of the surgery.



The approach has transformed health care in India through a simple premise that works in other industries: economies of scale. By driving huge volumes, even of procedures as sophisticated, delicate and dangerous as heart surgery, Dr. Shetty has managed to drive down the cost of health care in his nation of one billion.



His model offers insights for countries worldwide that are struggling with soaring medical costs, including the U.S. as it debates major health-care overhaul.



At his flagship, 1,000-bed Narayana Hrudayalaya Hospital, surgeons operate at a capacity virtually unheard of in the U.S., where the average hospital has 160 beds, according to the American Hospital Association.



Narayana's 42 cardiac surgeons performed 3,174 cardiac bypass surgeries in 2008, more than double the 1,367 the Cleveland Clinic, a U.S. leader, did in the same year. His surgeons operated on 2,777 pediatric patients, more than double the 1,026 surgeries performed at Children's Hospital Boston.



Over the next five years, Dr. Shetty's company plans to take the number of total hospital beds to 30,000 from about 3,000, which would make it by far the largest private-hospital group in India.



At that volume, he says, he would be able to cut costs significantly more by bypassing medical equipment sellers and buying directly from suppliers.



Then there are the Cayman Islands, where he plans to build and run a 2,000-bed general hospital an hour's plane ride from Miami. Procedures, both elective and necessary, will be priced at least 50% lower than what they cost in the U.S., says Dr. Shetty, who hopes to draw Americans who are uninsured or need surgery their plans don't cover.



Some in India question whether Dr. Shetty is taking his high volume model too far, risking quality.



But Jack Lewin, chief executive of the American College of Cardiology, who visited Dr. Shetty's hospital earlier this year as a guest lecturer, says Dr. Shetty has done just the opposite -- used high volumes to improve quality. For one thing, some studies show quality rises at hospitals that perform more surgeries for the simple reason that doctors are getting more experience. And at Narayana, says Dr. Lewin, the large number of patients allows individual doctors to focus on one or two specific types of cardiac surgeries.

Senate Democrats Battle On Health Care

Moderate Senate Democrats threatened Sunday to scuttle health-care legislation if their demands aren't met, while more liberal members warned their party leaders not to bend.



The dispute among Democrats foretells of a rowdy floor debate next month on legislation that would extend health care coverage to roughly 31 million Americans. Republicans have already made clear they aren't supporting the bill.



Final passage is in jeopardy, even after the chamber's historic 60-39 vote Saturday night to begin debate.



"I don't want a big-government, Washington-run operation that would undermine the ... private insurance that 200 million Americans now have," said Sen. Ben Nelson, a conservative Nebraska Democrat.



Nelson and three other moderates -- Democratic Sens. Mary Landrieu of Louisiana and Blanche Lincoln of Arkansas and Connecticut independent Joe Lieberman -- agreed to open debate despite expressing reservations on the measure. Each of them has warned that they might not support the final bill.



One major sticking point is a provision that would allow Americans to buy a federal-run insurance plan if their state allows it. Moderates say they worry the so-called public option will become a huge and costly entitlement program and that other requirements in the bill could cripple businesses.



"I don't want to fix the problems in our health care system in a way that creates more of an economic crisis," said Lieberman.



Sen. Dick Durbin of Illinois, the No. 2 Democrat in the Senate, said the health care bill must be passed by the end of the year so that President Barack Obama and lawmakers can shift their attention to the economy and improving employment rates.