There are few attractions to closing Lakewood Hospital, ultimately. It leaves Lakewood with fewer jobs, much-reduced local healthcare, and an economic headwind for years to come. It’s difficult to deny that we deserve a better deal.

But are there really other options, besides the Cleveland Clinic’s offer of minimal services and a small share of hospital property which we already owned? There are obviously other hospital systems besides the Cleveland Clinic, but is it plausible that one would come to Lakewood?

It’s more than plausible, because hospital systems aren’t like cable companies.

Cable firms have essentially divided up markets among themselves, and simply will not enter each other’s territory to compete. Comcast doesn’t offer service in Cox’s territory, and vice versa. Although big hospital systems’ approach may look similar, it’s much less static.

Reasonable people can argue over how well market competition works in healthcare, overall, but hospital systems definitely compete. The Cleveland Clinic makes great fuss about its first hospital in Lorain County, but there are other hospitals already in the area; opening Avon Hospital is a perfect example of one system trying to expand into others’ territory. It’s by no means unique, and Becker’s Hospital Review is full of such maneuvering.

Unlike cable lines which are generally locked up by one company, hospitals simply don’t have such built-in monopolies, no matter how much they might like them. This is why the Cleveland Clinic has pushed for a noncompete clause in Lakewood: without it, competition is a very real threat.

Competition is possible even if MetroHealth and University Hospitals should decline a new invitation to operate Lakewood Hospital. There is more to Northeast Ohio healthcare than UH, Metro and the Clinic. Out of Ohio’s 100 largest employers, fully 15 are hospital systems. (Children’s hospitals account for a few more). Besides Cleveland’s big three, another four systems already operate hospitals within an hour’s drive of Lakewood.

These and more distant hospital operators are plausible bidders for Lakewood’s market, also. Surgical Development Partners remains formally committed to bidding on Lakewood Hospital if given the chance, despite being based in Tennessee. And why not, given that the Cleveland Clinic operates in Florida, Central America and Abu Dhabi?

Appeasing the Cleveland Clinic with a mini-monopoly, out of fear that Lakewood has no other option, isn’t being realistic. It’s being pessimistic as well as irrational; a noncompete clause is only valuable if competition is a real possibility, after all. For Lakewood healthcare it absolutely is, and it’s a possibility we should embrace with confidence. With so many potential bidders we will only benefit from a true, open bidding process.

We can get a better deal. Let’s defeat the noncompete, and vote against Issue 64.