The Kettering Foundation, along with Public Agenda and the National Issues Forum Institute, held what they billed as a novel experiment in public thinking about health care and the environment this week. We attended the health care event -- a half-hour film of focus groups around the country of ordinary people talking about the trade-offs of health reform, followed by a panel discussion by nine experts in public opinion or public policy (but not necessarily in health policy). They plan on holding more discussions across the country in the coming months.

We certainly laud dialogue on health care -- particularly recognition upfront that it involves tough choices and tradeoffs. One of the pitfalls of previous reform efforts, we think, is that people were asked if they wanted to improve the system but not immediately confronted with all the implications of that choice -- and then they backed off in a panic.

That being said, we didn't think the focus groups on the film necessarily framed all the issues correctly. For instance, the dialogue seemed to pose a choice between a health care system that stressed individual responsibity versus a "we're all in this boat together" society. We don't think they are mutually incompatible. We can and should have a health system that stresses wellness, prevention and responsibility. But we can also have a society that values offering everyone quality, affordable health care. Not all health problems, after all, can be eliminated by a smoke-free lifestyle of fresh vegetables and plentiful exercise. Similarly, the Kettering discussion seemed to debate the status quo (which few people in the focus groups were enamored of) versus a "socialized" medical system. Those are not the only options. We also thought some of the options in their discussion guide were a bit overstated -- although using these extra stark contrasts might be a useful tool for discussion. (For instance, as a practical versus purely theoretical matter, few right-wing politicians are really advocating scrapping the entire job-based insurance system in the short-run, and a publicly-funded Medicare-style system for everyone is not the only way we can cover everyone). We don't see a summary report yet on the session on Kettering's web site, but we'll check back and update this post if and when one becomes available.