American healthcare consumes nearly twice what other developed nations spend while delivering worse outcomes-wasting more annually than the entire Russian economy. Communities across America have solved this crisis, and this book shows exactly how they did it.
Dave Chase identifies two structural flaws at the heart of U.S. healthcare dysfunction: the rigid separation of healthcare and social care funding, and governance stuck at the wrong scale. These flaws interlock, ensuring reform efforts consistently fail regardless of ideology. Community-Owned Health Plans address both flaws simultaneously, drawing on the cooperative principles that transformed rural electrification a century ago.
The evidence spans decades. Rosen Hotels in Florida saved $570 million over 30-plus years while managing a workforce where 65% of pregnancies are high-risk. Alaska's Nuka System cut emergency visits by 50% and hospital admissions by 53%, sustaining 97% customer satisfaction for over a decade. Ashtabula, Ohio's small school district saved $2.4 million in year one while eliminating deductibles and preventing teacher layoffs. More than 10,000 employers covering over five million Americans have adopted these approaches, with track records spanning 5 to 30-plus years and cost reductions of 20% to 50%.
Guided by Father Jos?Mar燰 Arizmendiarrieta's cooperative wisdom, Chase maps a practical path from broken system to community ownership. The Basque priest built the Mondragon cooperative network of 100-plus worker-owned enterprises. If cooperatives transformed a war-scarred town under fascism into a thriving democratic economy, American communities can reclaim their rivers of healthcare dollars.
As AI displaces millions of jobs, this book reveals how communities can capture the "AI Catalyst" by redirecting healthcare waste into workforce development and social investment rather than paying an "AI Tax" of unemployment and decline.
The blueprint exists. Nautilus Health Institute democratizes the tools. Success stories multiply. What communities need now is the courage to act, community by community, until the transformation becomes unstoppable.
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