Posted by Sandy Heierbacher | June 13th, 2010This article was written by Sandy Heierbacher at the request of Yes! Magazine (and published here on August 21, 2009). Sandy also created two abbreviated versions of this article and a one-page ready-to-print flier for public officials, encouraging NCDD members and others to use the resources freely for blog posts, letters to the editor, etc. during and after the contentious August 2009 town halls on health care. All four of these resources are based on insights and tips shared by NCDD members during this controversial time.
Town hall meetings being held on healthcare legislation across the country are exploding with emotion, frustration, and conflict. Citizens are showing up in throngs to speak out about health care as well as dozens of other topics, but it seems the louder voices get, the less people are actually heard.
The meetings have become a vivid demonstration of what’s missing in American Democracy.
Members of the National Coalition for Dialogue and Deliberation (NCDD) have been sharing insights and tips–on NCDD’s listservs and in their own writings–on how legislators can engage citizens in ways that are more participatory and more productive than what we’ve seen in the news lately…
Focus on building trust between citizens and government
While Americans’ distrust of government is playing out in obvious ways at town hall meetings across the country, another level of distrust is less frequently acknowledged: government officials’ lack of trust in citizens’ ability to grapple with complicated issues and trade-offs. Government officials often don’t see citizens as peers who, when given the opportunity, can talk reasonably together across partisan and other divides and come to agreement even on elements of highly divisive issues like healthcare, gay marriage, and abortion.
Matt Leighninger, author of The Next Form of Government, often says that government has a “parent-child” relationship with the people when what’s really needed is an “adult-adult” relationship. Citizens are savvier than ever, and they have higher expectations than ever for a government that is of, by and for the people.
Scrap the typical “town hall meeting” format
The term “town hall,” as deliberative democracy scholar Jim Fishkin wrote in a New York Times op-ed, “conjures up images of townsfolk gathering in some New England hamlet.” But today’s typical “town hall meetings” don’t live up to the traditional New England Town Meetings they’re named after. They don’t allow citizens to feel they’ve been truly heard, or to discuss issues in any depth.
Arkansas Senator Blanche Lincoln, one of the members of Congress who did not plan a large town hall meeting during the recess, has suggested that the raucous nature of the town-hall-style sessions has made them counterproductive. “If people genuinely wanted to have a constructive conversation, then that would be a different thing,” she said. “But that has not been what we’ve seen.”
She’s right on one count: the town hall design sets the stage for activist groups and special interest groups to try to ‘game’ the system and sideline other concerned citizens in the process. As Martin Carcasson, director of Colorado State University’s Center for Public Deliberation, pointed out in a recent radio interview on WHYY-FM in Philadelphia, “the loudest voices are the ones that get heard, and typically the majority voices in the middle don’t even show up because it becomes a shouting match.”
But does that mean people don’t want a constructive discussion? What if they had been invited to dialogue about the various problems, trade-offs, and options surrounding the issue of health care from the beginning—say, before over 1,000 pages of legislation were presented to the House? Tom Atlee, founder of the Co-Intelligence Institute, noted on his blog that many of the recent town hall meetings were originally organized to promote the Democratic health care agenda—not to provide opportunities for real dialogue with and among citizens. “So in a sense they invited disruption from those who felt unheard.”
Upgrade to higher-quality meeting formats
Dozens of effective public engagement techniques have been developed to enable citizens to have authentic, civil, productive discussions at public meetings—even on highly contentious issues. These techniques have names like National Issues Forums, Study Circles, 21st Century Town Meetings, Open Space Technology, and World Cafe, to name just a few.
When done well, these techniques create the space for real dialogue, so everyone who shows up can tell their story and share their perspective on the topic at hand. Dialogue builds trust and enables people to be open to listening to perspectives that are very different from their own. Deliberation is often key to public engagement work as well, enabling people to discuss the consequences, costs, and trade-offs of various policy options, and to work through the emotions that tough public decisions raise.
Skilled facilitation is key to almost all forms of dialogue and deliberation. Alexander Moll, who is facilitating a healthcare deliberation in Washington D.C. later this month using the National Issues Forums method, describes his role this way: “My job is to elicit the best ideas from each of you, regardless of ideology…. I do not ask ‘leading’ or ‘loaded’ questions that bias the conversations; instead I’ll ask questions like, ‘Why do you believe this to be true?’ or ‘Can you explain your position further?’” Skilled facilitators know how to translate conflict and anger into specific interests, needs and concerns—so what’s behind the emotion can actually be understood and addressed.
“Ground rules” or “agreements” are also par for the course in dialogue and deliberation. Typical agreements establish a kind of golden rule for everyone present, asking people to treat each other as they would want to be treated. By refraining from interrupting each other and by listening with the intent to understand rather than to seek points to argue with (two typical ground rules), participants are more likely to be heard and to hear each other.
To involve a broader representation of the public, events should be publicized widely and thoughtfully enough so a variety of people attend—not just the usual suspects. Furthermore, it’s helpful to organize participants into smaller groups (fewer than 10 at a table is ideal) to ensure each person gets the chance to speak and to make unlikely that one individual or interest group will dominate the whole meeting.
No matter what technique is used, legislators can help all attendees feel heard by diligently recording what citizens say, and being clear about how they plan to use the information gathered (perhaps to share with other constituents or with fellow legislators). Another proven strategy is to “reflect back” the concerns, values and desires they are hearing. Ideally, public officials join in the dialogue as participants, after which they can publicly reflect on some of the things they’ve heard. The more thorough and authentic they are in doing this, the more impact it will have on those attending.
Reflecting back, using ground rules, working with facilitators, and having people engage with each other in small groups are all basic but critical elements of quality public engagement. To allow people to deliberate, or wrestle with the complexities of the issue, some important work must also be completed before the public meeting. Balanced information must be provided about the issue at hand, and a fairly-framed spectrum of possible policy choices can be put on the table for attendees to discuss.
Perhaps most importantly, the legislator hosting the meeting must genuinely be open to learning from what his or her constituents think should be done to address the issue at hand. One major barrier to putting these ideas to play right now is that public engagement should begin much earlier in the policy-making process. Now that there are draft bills floating around, citizens (rightly) would not trust that their nuanced input would have much impact on what happens in Washington. At this point in the policy process, loud voices and outrageous accusations actually are more likely to impact healthcare policy—though not necessarily in a productive way.
Tom Atlee observed that “when people are only invited to participate when there is a final battle between (for example) Republican and Democratic proposals for healthcare, this fact alone invites polarization. When an issue is in crisis mode, it is easier to manipulate people with fear and extreme language and imagery; there is less time to get information and issues clarified; there is less patience on all sides to delve into the actual complexities; and nonpartisans get the sense they are being sold false alternatives.”
One NCDD member recommended asking two legislators from different parties to co-host deliberative events on contentious issues like healthcare reform. Many citizens on the right distrust politicians on the left – and vice versa. A joint deliberative forum held early in the decision-making process can help build trust beyond party lines, and help legislators get a sense of what their constituents are willing and unwilling to support, and why.
It is also vital to find ways for attendees to wrestle with the trade-offs inherent in all complex policy issues. As President Obama said at a town hall meeting in Grand Junction, CO, “there is no perfect, painless silver bullet out there that solves every problem, gives everybody perfect healthcare for free.” Americans need to discuss the trade-offs involved with each other and with policy-makers, to clarify the values that are embodied in different approaches to healthcare reform, and to identify the needs that are most important to them.
Most Americans feel strongly that the voice of the people should have an influence on public policy, and that the right to speak up and dissent is anything but “un-American.” A recent joint statement by several leading organizations in the field of participatory democracy (Everyday Democracy, AmericaSpeaks, Demos, and Harvard’s Ash Institute for Democratic Governance and Innovation) titled Better Health Care Depends on a Stronger Democracy noted that “beyond simply having a voice, people should have a chance to be informed, to hear each other, to work through tough decisions with each other and their elected officials, and to use democratic processes to figure out how to solve the problems that face us.”
Though it may not seem like it when we watch clips from healthcare town halls on the evening news or on YouTube, the truth is that people can come together to have a positive impact on national policy—not only in spite of our differences, but because we can use those differences to make better decisions. It is my hope that what may have seemed like a utopian ideal a few weeks ago—democratic dialogue in which the people are informed and involved from the beginning—may now seem like a necessary but long overdue upgrade in the way we do politics.
Sandy Heierbacher is the co-founder and director of the National Coalition for Dialogue & Deliberation (NCDD), a network of 2,200 groups and professionals who bring together Americans of all stripes to discuss, decide and act together on today’s toughest issues. She recommends the following resources to those interested in engaging the public in healthcare in more meaningful and substantive ways.
NCDD Members Directory: www.ncdd.org/members
Find a facilitator or convening organization in your region. Or contact firstname.lastname@example.org for help finding someone.
NCDD’s Engagement Streams Framework: www.ncdd.org/streams
This free resource helps practitioners, community leaders and elected officials decide which public engagement methods are most appropriate for their circumstances and resources.
Core Principles for Public Engagement: www.ncdd.org/pep
These seven principles were developed collaboratively by leaders in citizen engagement, and have been endorsed by over 80 organizations.
Discussion Guides on Healthcare
– Coping with the Cost of Health Care: How Do We Pay for What We Need? (National Issues Forums):
– Citizens Solutions Guide – Health Care (Public Agenda):
Millions of Voices: A Blueprint for Engaging the American Public in National Policy-Making:
Offers a plan for National Discussions that will engage more than one million Americans in substantive deliberations about public issues. (link)