On process and outcome: How public dialogue shapes policy preferences for health system reform

As health care reform once again nears the top of the public policy agenda, we are challenged to not just to develop new health policies – but to develop good health policy. Achieving consensus on the definition of “good” is, of course, the hard part. This session presents findings and conclusions drawn from a series of public dialogues which were designed to explore public perceptions and preferences for health system reform, and identify solutions the public, business and civic leaders will support when given the opportunity to consider value-based choices and tradeoffs. Key findings included a shift from initial preferences for comprehensive, employer-based coverage to strong support for universal coverage through a basic insurance plan, administered by a single public insurance agency and funded through a combination of personal and business income taxes and consumption taxes. In addition, these forums revealed public perceptions, misperceptions and assumptions which were quite different from those of experts, even as citizens clearly understood the tradeoffs of security, choice, cost and access inherent in health system reform. Equally important, analysis of the forums themselves offers insight into how dialogue both reveals and shapes policy preferences, and teaches valuable lessons about public engagement and leadership, and their practical application in the context of health and healthcare policy. Citizen engagement through facilitated dialogue provides a basis for anticipating how the broader public will resolve issues when given the opportunity to come to grips with them, and insight on how to lead the learning process on a larger scale.