How Should You Respond to the Noisy Health Reform Critics?

Imagine you are one of the members of Congress running a "town hall" meeting to discuss pending health care reform legislation during the current legislative break. You are confronted by some very angry citizens. They are shouting at you!

"How dare you!

Don't you take my doctor away from me! Don't tell me what medical services I can and can't have!

If you think the Canadian system is so great, why don't you go live up there. People have to wait months to see a doctor in Canada.

Shame on you! I don't want some faceless government bureaucrat deciding whether my parents live or die!

I'm a small business owner. You're gonna bankrupt me if I have to pay for health care for my four or five employees.

Our health care system is already too expensive! You're going to raise my insurance premiums if we have to pay for everyone who won't take care of themselves!

The deficit is already out of control. You're bankrupting the country.

Look at what happened in Massachusetts after they passed their health care reform. Costs exploded! They can't cover everybody. Their taxes are going up.

My tax money shouldn't be used to pay for abortions.

Don't you cut my medicare benefits!

It's greedy trial lawyers who driving up the cost of health care.

There a bunch of things you want to say, but every word out of your mouth is met with another round of boos and chants of "No New Taxes," "Let Doctors Decide," and "Keep Your Hands Off." You feel obliged to set the record straight on each and every point:

No one will have to give up the health care provider they have now.

We are not proposing a single payer system like they have in Canada. The proposed reforms

passed by the House and being considered in the Senate will offer more choice for more people, not less choice. (Besides, the claims about long waits and government telling doctors what they can and can't do in Canada are bogus.)

This whole Sarah Palin "death panel" thing is a complete fabrication. There's nothing in the proposed legislation that would tell doctors or patients how to handle end-of-life decisions. There are provisions that make it OK for doctors and patients to talk about the most compassionate ways of helping people who are dying. But everybody wants that.

We are going to exempt small business or rebate some of the costs to small businesses who help their employees get health coverage.

The cost of health care keeps going up. We can't afford not to do something to bring the costs under control. Other countries get better medical results at lower costs than we do. One of the best ways of reducing the continued growth of health care costs is to get everyone into an insurance system that compensates providers for keeping people healthy (not for spending as much as possible on unnecessary procedures once you are sick)! We need a system that can bargain with powerful pharmaceutical companies to keep the costs of drugs down.

We may have to increase public spending in the short term to reform our health care system, but in the long term this is the only way to bring costs under control. We need to put the system in place and give it couple of years. Then the costs will start to come down for everyone.

Actually, Massachusetts has reduced the cost of providing health care to everyone in the state. It's not true that the new state system (that covers everybody) is breaking the budget or causing tax increases.

Abortions are legal in the United States. People covered by publicly supported health insurance need to have the same choices that people covered by private insurance have.

We are not talking about cutting medicare benefits or medicare spending. What we are trying to do is get more people who don't have insurance covered by something like medicare.

Yes, legal reform is necessary to reduce unscrupulous malpractice claims that drive up medical costs.

But, it's pointless. As soon as its clear that you mean to disagree

with what one of the questioners has said, the boos and chants begin. Nobody is listening to anything you say. And, even if you managed to get the words out, they wouldn't believe you. They have been briefed by their favorite talk radio hosts. And, many of the people there have been bused in or organized by political action groups. They have their talking points. Many of them believe fervently what they are saying -- that proposed reforms will bankrupt the country, that their medicare benefits and choices are about to be cut, that they will be forced to abandon their local health care provider or limit their medical services.

So, what's the best advice we can give a Congressperson in such a situation? Most aren't going to get the easy ride that President Obama got in New Hampshire. Hard as he tried, he couldn't get any of the 1600 people present to challenge what he was saying.

Here are five suggestions that grow out of what we have learned about facilitating public dialogue in politically charged situations:

1. Begin by saying that you want to hear what the audience has to say. Ask 5 volunteers to come up on the stage to ask whatever questions or make whatever statements they think are important. Invite them up. Make it clear that you don't know any of these people and you are just trying to find out what people who bothered to come to the town hall meeting have to say. Pick five who raise their hands and appear to represent different age or other groups. Let them speak. Tell them that the ground rule is that each person has the mike for no more than five minutes. Invite them to sit on the stage with you. (Make sure someone is controlling the mike and make it clear that it will be shut off after five minutes.) Don't try to respond to each statement. Just listen.

2. Then, after those five have spoken and gone back to the audience. Ask for 3 more people who have different points they want to make that don't repeat what has already been said.

Again, choose three from those who indicate a desire to speak. Invite them up. Same ground rule. Let them speak. Don't respond to each person.

3. When the eight have spoken (it could be 10 if you want), make a list of the key concerns or criticisms that have been raised. Re-state each argument in the most empathetic way you can -- as if you believed each claim or criticism. Show that you have listened. When you have played the points back, ask those who stated them originally whether you have understood their concerns. If they say no, spend a minute or two trying to re-state their points.

4. Then, announce that you are going to take no more than 3 - 5 minutes to respond to each of those points. Since you have given those who have concerns a chance to voice them, you expect to be given the same courtesy. If people disrupt, remind them of this ground rule. If the whole crowd continue to be unruly, indicate that you will end the town hall and broadcast your responses on the web and the radio. See if that gives you the "space" you need to have your say.

5. If you manage to get through all eight points. Then, open the microphones -- people

need to stand in line to use them one at a time -- so that anyone can rebut what you have said, respond to one of the original statements, or raise any additional question they like. Promise that by the next day, you will make available to anyone who provides an email address or a snail mail address a written version of your responses to all the questions raised.

6. Hand out a survey form to everyone in the room. Include three or four open ended questions about people's reactions to the parts of the proposed reform legislation that you would most like input or advice on. Say that you will read all the responses. Indicate, that you will also be doing a scientific survey of everyone in your district to see whether the views represented at the town hall are representative of the district as a whole. Then, do a quick overnight telephone survey of 500 people in the district to see whether the key points raised in the town hall match up with what the population of the district thinks. Publicize the results.

If the goal of the town hall is to hear what people have to say, then the suggestions above will accomplish that. If the goal is to "educate" people on what the Congressperson believes, he or she should have a handout ready with a detailed statement and evidence to backup their claims. If the goal is to generate a thoughtful dialogue, a town hall meeting is the wrong format. Better that the Congressperson selected a small statistically representative sample of residents to talk with in an extended conversation for several hours. It might also make sense to encourage the kind of "study circles" that have been used so successfully in Scandinavia to get thousands of people thinking and talking about the issues framed in a study guide. If the goal is to hammer out a consensus with regard to the district's views, it will be necessary to tap a professional mediator to undertake a district-wide conflict assessment that will produce a "map" of all the relevant stakeholder groups vis a vis the health reform issue and to involve representatives of each of category of groups in formulating an agenda, ground rules, and a process of joint problem-solving.