Media resisting the unavoidable bow to the democratic future of media ownership are being shown up in Britain by, of all people, the bean-counters of medicine — the traditionally conservative, cautious and slow-moving top managers of the country’s most cherished public institution, the roughly £100 billion ($171 billion) National Health Service.

The pinch-me-I’m-dreaming headline at the top of The Independent’s home page on Monday read: ‘New government policy for the NHS could allow doctors and nurses to “own” hospitals’.

Before we get to the reasoning behind that proposal, let us quickly say that inviting readers and commenters – reader-commenters — to become part-owners of media organisations through subscriptions that would also be financial shares — making them small-scale co-owners – is an actual need in this sector, though not in British medicine. The flow of cash into the NHS is assured. It comes from taxpayers. But, as last week’s entry in this blog noted, the advertising revenue on which print journalism depends to pay its bills looks increasingly shaky as a supreme cash cow for online publishing, as it elbows print out of the way.

Moving towards co-ownership — or ‘mutualisation’ — is the one step that the boldest experimenters with new media structures are resisting. Declining to go that far, we pointed out last month, is the single disappointment in the otherwise wildly impressive reports about De Correspondent — the new Dutch publishing enterprise putting commenters at front and centre-stage in its publishing scheme. Nick Denton, the serial online media entrepreneur – most famous for co-founding Gawker in 2003 with Elizabeth Spiers – has perfectly expressed what we also believe, in describing his many excellent adventures in media redesign to Harvard’s Nieman Journalism Lab:

“Publishing should be a collaboration between authors and their smartest readers. … And at some point the distinction should become meaningless.”

These smartest readers are most likely to devote all the time they can to the success of an online publishing enterprise – whether a startup or a famous name in the news business ‘flipping’ co-ownership of a part or the whole of its web site to commenters – if they can justify that to themselves with the hope of sharing in its financial success, some day. Denton’s schemes allow reader-commenters to share the stage with professional writers and journalists. They are designed to make readers feel part of a larger family or club, and – as in the De Correspondent plan — to improve the quality of information disseminated on his sites, and the range of expertise on which it draws.

Giving performance and efficiency a gigantic boost is the ambition behind the remarkable news about the proposal for British medicine:

Ministers are drawing up plans to allow doctors and nurses to own and run the hospitals they work in as part of a radical blueprint to change the way the NHS is run.

Under proposals to be floated tomorrow, staff could be able to take over hospitals and other NHS responsibilities and run them as new mutual companies in the style of the department store chain John Lewis.

Staff would then become “shareholders” in the new company with the power to dismiss the chief executive and board members as well as set policy and targets for the new organisation.

Ministers are not ruling out the possibility that staff could even be given a financial stake in the organisations for which they work – sharing bonuses if their hospital makes a profit on NHS work. The new policy comes after an independent review, led by the independent think-tank the King’s Fund, found what it described as “compelling evidence” that NHS organisations with high levels of staff engagement delivered better quality care. […] Ministers have been particularly taken by the success of Hinchingbrooke Hospital in Cambridgeshire, which had been losing £10m a year and had very low levels of patient satisfaction until taken over by the private provider Circle, which manages it for the NHS. Circle is owned jointly by the staff who work for it and private-equity funders.

… We hope that the people in charge of making the rules for the ‘mutualised’ British hospitals will take care to head off any possibility of repeating one grave mistake in American medicine — allowing doctors to invest in medical testing laboratories, rightly blamed for countless unnecessary tests ordered by many of those doctors. These are notoriously a large part of the explanation for America’s expensive and inefficient health care.

The chief fear for the democratic redesign of media is that it will lead to the collapse of cultural standards; that it will usher in a depressing age of mediocrity. Again, the right rules have to be drafted to ensure that this does not happen. Who says that any such effort would lack supporters? Who says that the least talented co-owners of a media enterprise will not wish to celebrate and promote their most talented comrades, attracting honour, fame and new members?

A few weeks ago, there was news of opera-lovers panicking about performances in some places accompanied not by live musicians but digital recordings. A New York Times reader said, in a letter to the editor:

Live music is being performed by an ever-shrinking elite corps of musicians. This trend cannot be reversed. But it will bottom out. There will always be a market for elite musicians … On some level we want to see humans demonstrating their mastery.

 Who would disagree?