08.24.09

A Better Way to Debate Healthcare Reform (and Other Fiery Issues)

Negotiation experts know that building consensus through a fair and deliberate process that allows all views to be aired is essential when dealing with tough issues. Today's discussions about health care reform too often end up as shouting matches. Here's another way to think about them:

If members of Congress want to know how their constituents are thinking about health care reform at the moment, they can commission scientifically representative polls. If they want to make their own views known, they can spell them out on a web site or in mailings to their constituents.  

So, what could they possibly hope to accomplish at the town hall meetings we've been hearing so much about?   I think they are trying to accomplish two things: to get everyone to pay more attention to the health care debate and to stimulate a give-and-take that might lead to a clearer sense of the political limits within which Congress will have to work when it resumes its legislative efforts in the fall.? ?The right wing talk-meisters have helped them accomplish their first objective. Controversy of any kind is good when you want to push an issue up the "issue-attention cycle". Unfortunately, the town hall approach isn't of much help when you want to encourage a dialogue.  

Here's a different format that might accomplish the second goal more effectively:  
  1. Select 5 volunteers at random to come up on the stage to make whatever statements about health care they think are important. Pick ticket stubs (from those who want to be considered) out of a hat. Tell them that the ground rule is that each person has the microphone for no more than three minutes.  (Make sure someone is controlling the mike and make it clear that it will be shut off after three minutes.)  
  2. After those five have spoken and gone back to their seats, choose five more people and ask them if they have something different to say.  Invite them up. Apply the same ground rule. 
  3. When all 10 have spoken, whoever is hosting the meeting should then re-state each point that was made in the most empathetic way possible to demonstrate that they have been listening. They should ask those who made the statements whether they have captured the gist of their concerns. If they say no, spend a minute or two trying to clarify.   
  4. Then, the person hosting the event should take no more than 3 minutes to respond to each of those points. Indicating whether they agree, disagree, or don't know where they stand at this point. Anyone who disrupts, should be asked to leave. If the whole crowd is unruly, indicate that the meeting will come to an end and the "host" will publish his or her responses on line.  Our experience is that by offering those who came to speak a chance to speak first, the audience will side with the host who asks for the courtesy of an opportunity to respond. 
  5. Call on three knowledgeable commentators (selected in advance) -- with differing views -- five minutes each to offer their reactions to everything that has been said. Their role ought to be to inject as much factual information about health care delivery in the region where the forum is being held into the conversation.  They also should highlight the points of agreement and disagreement that emerged (without explicitly staking out positions of their own).     
  6. Hand out a short one page questionnaire (constructed during the conversation) to everyone in the room. Include short questions aimed at getting reactions from everyone in the room to the issues that were discussed.  Leave room for people to enumerate other issues of concern to them. Indicate that the host of the meeting will be commissioning an overnight scientific survey of everyone in the district to see whether the views represented at the forum match those of the district as a whole. Use an overnight telephone survey of 100 people in the district to see whether the points raised in the forum match the views of the population in the district thinks. Publicize the results.   

If the goal of a town hall meeting is to get people to think about where they stand on an issue, then the suggestions above will accomplish that. If the goal is to "educate" people on where a Congressperson or host stands on an issue, this is better accomplished by distributing a pre-prepared statement. If the goal is to generate a thoughtful dialogue, the typical town hall meeting is essentially the wrong format.  If the goal is to hammer out a consensus within the district, it will be necessary to tap a professional mediator to undertake a district-wide conflict assessment to generate a "map" of all the relevant stakeholder groups and then invite representatives of each key category of groups to participate in an ongoing discussion.  Over several meetings a group of 25 - 30 could formulate a shared statement of policy that their representative could carry forward into subsequent legislative debates. I want more news