It's getting close to decision time.

Do you want a hospital to stay in Glen Rose?

Do you want the county to keep footing the bills – and the losses?

Do you want to create a new taxing entity to fund it?

Do you want another company to take over operations and see if it can turn the red ink into black?

Do you want to see it closed down?

After years of batting these questions around, it's become clear that things can't keep going on the way they have been.

Many of the taxpayers I talk to on the one hand say they want a medical center in Glen Rose. They just don't want public money spent on it. Or they don't want so much public money spent on it.

That means private ownership or elimination. In these times of declining reimbursements, the federal and state governments dug into a tug-of-war over which entity will fund what service and financial pressures on small hospitals that don't have the leverage of large instittuions, if you don't go private, you pretty much have to go public or at least have some public help.

The Reporter has been running an online poll – certainly not intended to be “official” – to gauge public sentiment about a hospital district. When asked whether they favored a hospital district, 76 percent of respondents said “yes,” 22 percent voted “no” and 1 percent said they didn't know. (These figures are as of Tuesday afternoon before the Reporter went to press.)

No doubt hospital employees, many of whom are fearing for their jobs, have been voting. Probably, some folks have voted multiple times. Take that wide margin of error into consideration.

County commissioners are beginning to explore the options.

On Monday David Orcutt, the CEO of Lake Granbury Medical Center, began to make his case for non-profit GRMC partnering with his for-profit operation. Scott & White is another health care provider mentioned as a possible interested party. There may be others.

Unless the county Hospital Authority Board decides to move forward with a lease with a hospital management company and county commissioners give their blessing, it looks like the next most likely option is to call another election for a hospital district.

In February 2009 the special election to create a hospital district failed. The vote was 597 against, 336 in favor.

So what's different now versus 2009?

For one, the previous GRMC CEO, Gary Marks, has retired. Marks, son of the medical center's co-founder Roger Marks, who launched the medical facility with Dr. Robert English, was a lightning rod for criticism. Some folks felt that Gary Marks ran the medical center as “his” hospital. The vote likely was as much against him as against the district.

For another, efforts to create a hospital district this time are going to be a lot more transparent. Public input will be taken, at some point, and citizens already have been able to hear presentations by GRMC physicians, supporters and at least one particularly vocal opponent.

Public dissention isn't something you see a lot in Glen Rose and there have been some tense moments in the county commissioners' courtroom (see today's front page story). But that's sure better than having voters feel like plans are being made behind closed doors. Get it all out in the open.

If those who favor a hospital district want to win this time, they should take lessons from the past and make sure that the public is kept in the loop and that differing opinions are aired – hopefully, with civility – and at least listened to before making up one's mind.

I don't know which option is best. David Orcutt made a lot of sense and he's right – the biggest roadblock right now to his operation winning over people here is fear. But GRMC physicians who put together a video making the case for a hospital district painted a bright picture of the future, too. They presented a big wish list – the question is how much all that will cost.

It sometimes feels weird to talk about health care and life-or-death decisions as a “business,” but that's what it is today. The days of kindly doctors making house calls and taking fresh vegetables as payment are gone. These days it's all about managed care, reimbursement rates, co-pays and who's got the best insurance plan. And how to treat patients who qualify for indigent care or charity cases with the least amount of expense.

Sounds rather cold, but that's the way it is.

Glen Rose is fortunate in that its medical center has some fine physicians, nurses and other staff who truly care about their patients. People aren't treated like numbers there. Often, it's a neighbor or church member in that hospital bed.

But if the medical center doesn't generate enough money, someone has to pay for it. The question is who?

So this community needs to do some soul searching in addition to perusing pocketbooks and decide once and for all what is the best course for this medical center.

As things move forward, attend public meetings and hearings. Make your voice heard. Be part of the process. After all, some day you may find yourself in medical trouble. When that happens, where do you want to go and what do you want to see when you get there?

Not an easy decision. But a really, really important one.