Health Care and Deliberation

Deliberative forums could provide crucial insights into what the public thinks about reforming the health care system. The Kettering Cousins Research Group, an ever-changing group of Kettering staff and associates, has been looking into the impact of federal policies on the ability of citizens and communities to carry out their responsibility in a democracy. Health care is one of the issues in the study. It has been getting more attention recently because the country is entering a crucial phase in renewed efforts to reform the system. Today, more attention is being given to involving citizens, but how they are to be involved and the kind of influence they will have are still open questions. What initiatives citizen groups do or don’t take will be telling as will the forms of their initiatives. This situation creates a special challenge for those groups that promote public deliberation because the conversations about reform may or may not be deliberative. That certainly includes the groups using the National Issues Forums issue book Coping with the Cost of Health Care: How Do We Pay for What We Need? The last time the federal government attempted to reform the health care system in the early 1990s, Washington badly misjudged where the public was, and the reform effort stalled. Given the prospects for another try at reform in the near future, it is important to know where the citizenry is on this issue today. Listening to what people want is useful, though not sufficient. For the reforms to be sound and successful, there needs to be a better understanding of how people define this issue using their own terms, of what is most valuable to them, and of how citizens weigh various options for reform. There is also a need to know what people think they should do themselves. Deliberative forums, where people have to grapple with difficult tradeoffs, could provide critical insights into how the public goes about making up its mind on this all-important issue.