The City of Dayton spends $25 million a year on health insurance for its employees and dependents. The county may spend just as much. Throw in the other municipalities- and it’s got to total somewhere around $100 million.

That should buy a lot of health care. In fact- since the insurance companies skim off between 25 and 35% for their overhead- buying direct from the medical professionals should instantly give the communities a huge discount.

Now- take it one step further- who brings most of the severely injured patients to the hospital? Our fire departments- that’s right. Imagine, if the ambulances stopped rolling up to the door bringing the hospitals customers? What if they took their customers to “County General” instead? (Hmmmm, remind you of ER on TV?). That’s right- some places have “public hospitals”- that are run as true non-profits and actually serve everyone in the community the same way whether you have insurance or don’t.

There isn’t another business in the United States that can sell you something without stating the price up front. There isn’t another business in the United States that can sell services at one price to members of a private club, and a much higher price to those who aren’t members. In any other business- these practices would be called unfair, monopolistic and anti-competitive as well as discriminatory.

Yet, our duopoly of medical care- continue to build new expensive facilities, with taxpayer support, while paying no property taxes to support the services that actually bring them customers. Pretty nice gig if you can get it.

The cost of health care for our government employees is a big part of what’s breaking the bank. It’s time to reevaluate our health care equation. Here are some suggestions:

• End discriminatory pricing for the uninsured. Hospitals must charge uninsured patients the same price as for insured patients.
• Imagine if we treated hospitals the same way we do towing companies, making them bid for the opportunity to treat/tow? The hospital with the highest bid- gets the most patients? It’s time for the hospitals to subsidize their patient delivery systems with a fee back to the city. Otherwise, we will deliver only to publicly owned facilities- or to property that pays taxes (see next suggestion).
• In the same way that Charter Schools are expected to pay property taxes while public schools do not, hospitals that are privately owned must pay property taxes. The tax break for hospitals, which are making huge property grabs must stop- or only be granted for actual treatment space- and only those treatments that adhere to the equal billing principle above.

The public hospital will provide services at a fixed price system directly to businesses and residents of the co-op/mutual hospital, giving local business a third choice for medical insurance, without the overhead of the private insurance companies. The two choices are a la carte services at the fixed price- where all services must be paid for in advance, or- covered through a mutual pool, from membership in the system (yes- a mutual community insurance pool)- with profits either being reinvested or distributed back to the shareholders. Bonuses would be given to medical practitioners based on the community’s health).

We already have a “public health” authority in the county – but its scope and services are limited to services provided to those who can’t pay – doing a service for the corporate hospitals. It’s time to take the duopoly on.

We can’t afford not to.