Although he's not an intimidating figure at sight, hospital administrators should fear Darrell Douglas, the human resources honcho at Blue Ridge Paper Products in Canton. Douglas is on the verge of signing a deal with Raleigh-based IndUShealth that would give Blue Ridge employees the option of going to India to receive care for company-insured medical procedures.

Why would Blue Ridge want to do that? Simple -- money.

Health care costs in India are routinely 80 percent cheaper than in the United States. What that means, Douglas told me, is that Blue Ridge could send an employee to New Delhi to fix a leaky heart valve for $28,000 tops. And that includes, travel, lodging, meals and recovery. Compare that to the $64,000 to $128,000 estimate he received from the University of Iowa, the only American hospital Douglas found that would give him a quote.

Still, saving the company money may not be enough incentive for some employees to fly halfway around the world for medical care, so Blue Ridge is considering a nice carrot: depositing up to 25 percent of the cost savings directly into the employee's pocket. For Douglas' hypothetical leaky heart valve patient, going to India would mean not only a fixed ticker but a possible $25,000 payday. So much for worrying about paying for the deductibles and co-pays.

But what about the quality of care? It's as good, if not better, than what can be delivered in the U.S, according to Tom Keesling, IndUShealth's president, who ran hospitals in this country for 10 years. IndUShealth has partnered with Indian hospital chains that are internationally certified, employ numerous U.S.-trained doctors and are designed to cater to the international market.

That's right -- market.

India now regards part of its health care services as a commodity to be sold on the world market. It intends to export its high-quality, low-cost and exceedingly efficient health care system by importing patients. It's called medical tourism, and some government experts predict India's health care system could generate $25 billion in annual revenue from abroad.

This isn't just a plan. Earlier this month, a collection of Indian government agencies staged a Medical Tourism Expo in London. In addition to the high-cost U.S market, India has its sights trained on the socialized Western European and Canadian systems, where citizens can see their conditions severely deteriorate as they wait for care.

The tourism label isn't a euphemism. Travel agencies are teaming with Indian hospitals so patients can take a side trip to the Taj Mahal before or after they get their medical procedures.

Cool idea, but providing medical vacations isn't what interested Douglas. It's the savings. Blue Ridge self-insures 2,000 employees and about 3,000 dependents. Its medical and drug costs per employee are up to $9,200 per worker annually and that price tag is growing. And times are not good at Blue Ridge. Over the past five years the employee-owned company has lost a reported $92 million. The way Douglas figures it, offering his employees an Indian medical option could shave 20 percent off the company's medical costs.

The prospect of that type of corporate savings has accelerated IndUShealth's business plan. The company started out marketing to individuals and hadn't intended to go after commercial clients until 2007. But businesses, fed up with little control over medical expenses, have come rushing to IndUShealth's door. By year's end, the firm could be under contract to serve 100,000 corporate employees.

Hospital administrators and policy makers better get ready for that scenario. The deal Blue Ridge Paper and IndUShealth are about to strike has the potential to reform the bloated, overly complicated U.S. health care system far more than any legislation in Washington or Raleigh. For the first time in modern history, medical providers may find themselves having to compete for business, not just trying to figure out how to shift costs.

If foreign competition reaches it potential, legislators finally may have to accept tort reform to keep our medical system competitive. Because of strict caps on malpractice claims, an Indian heart surgeon pays only about $4,000 a year in malpractice insurance, compared to what can be six-figure premiums here.

Lawmakers should resist any temptation to restrict this market-based reform. Let competition work its magic and deliver what could be the start of truly affordable health care.

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