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“Tough Choices in Health Care” is a project of the Governor’s Office of Health Policy and Finance (GOHPF) in its responsbility to direct Dirigo Health Reform, of which the State Health Plan is a key component. “Tough Choices in Health Care” is one piece of a 5-part public process to engage the public in developing the State Health Plan.
GOHPF is advised by the 11-member Advisory Council on Health Systems Development. Council members include health care experts and representatives from the health care community: hospitals, physicians, consumers and experts in public health, mental health, long term care and quality. The Council was appointed by Governor Baldacci following a public nomination process and approval by a Legislative committee.
GOHPF and the Advisory Council are joined by several institutions assisting in the development of Tough Choices. They include:
Margaret Chase Smith Center at the University of Maine – The Center is functioning as project manager, with Tish Tanski is the project lead. Ms. Tanski and her staff are helping to organize Tough Choices and identified several of the partners involved in the project, including AmericaSpeaks. In addition, Ron Beard at the University of Maine Cooperative Extension is coordinating the recruitment of facilitators.
Muskie School of Public Service at the University of Southern Maine – The Muskie School and its survey department, under the direction of Allan Leighton, are managing the random sampling of 25,000 Maine people and the identification of respondents who make up a cross section of Maine people. In addition, Beth Kilbreth, a published professor in health care policy at the Muskie School, is helping to develop the Participant Guide and advise the development of the Tough Choices discussions.
AmericaSpeaks – Since 1995, AmericaSpeaks has sought to transform democracy as we know it by engaging citizens in the most important public decisions that impact their lives. More than 65,000 Americans have participated in 21st Century Town Meetings organized by AmericaSpeaks to link the public to decision-makers. Each forum integrates intimate, face-to-face discussion with state-of-the-art technology to provide a new kind of venue for the public to be heard. More about AmericaSpeaks...
National Academy for State Health Policy (NASHP) – NASHP is based in Portland, ME, and is a nationally recognized firm that assists states’ policymakers in implementing health care reforms to increase access to coverage, improve quality of health care and reduce health care costs. NASHP, with project leads Cynthia Pernice and Laura Limoge, is assisting in meeting logistics and development of the Tough Choice Participant Guide and other discussion protocol.
Lake Snell Perry
and Associates – With the firm’s partner Michael
Perry, LSPA is leading the development of the Participant Guide and the discussion
protocol. (need web info or contract justification language and website).
21st CENTURY TOWN MEETING
AmericaSpeaks’ 21st Century Town Meeting restores citizens’ voices
to the public decision-making process by creating an opportunity for the general
public to give leaders direct, substantive feedback on key issues. Each meeting
effectively restores the balance of the “political playing fi eld”
by engaging thousands of general interest citizens at a time (up to 5,000
per meeting), effectively and quickly summarizing citizen input and widely
disseminating the results through media coverage. AmericaSpeaks’ role
as neutral convener increases confi dence among citizens and decision makers
that the content, process and outcomes are fair and balanced.
The 21st Century Town Meeting focuses on discussion and deliberation among
citizens rather than speeches, question and- answer sessions or panel presentations.
Diverse groups of citizens participate in round-table discussions (ten to
twelve people per table), deliberating in depth about key policy, resource
allocation or planning issues. Each table discussion is supported by a trained
facilitator to ensure that participants stay on task and work democratically.
Participants receive detailed, balanced background discussion guides to increase
their knowledge of the issues under consideration.
Technology transforms the individual table discussions into synthesized recommendations representative of the whole room. Each table submits ideas using wireless groupware computers and each participant can vote on specifi c proposals using a polling keypad. The entire group responds to the strongest themes generated from table discussions and votes on fi nal recommendations to decision makers. Before the meeting ends, results from the discussions are compiled into a report, which is distributed to participants, decision makers, and the media as they leave. Decision makers actively engage in the meeting by participating in table discussions, observing the process and responding to citizen input at the end of the meeting.
AMERICANS DISCUSS SOCIAL SECURITY
AmericaSpeaks introduced its innovative approach to citizen engagement as
part of the Americans Discuss Social Security (ADSS) project in 1998. ADSS,
a nonpartisan effort funded by The Pew Charitable Trusts, directly engaged
Americans of all walks of life in the dialogue about Social Security reform
and urged Congress to support legislation that refl ected citizen preferences.
The outcomes of the ADSS project demonstrate that citizen engagement efforts
can and should be an essential component of any critical policymaking decision.
ADSS Executive Director and AmericaSpeaks founder Carolyn Lukensmeyer developed
a first-of-its-kind national deliberation. Over fi fteen months, the project
engaged nearly 50,000 Americans in every state in direct discussions on Social
Security reform and reached more than twelve million through the project’s
media and public education efforts. Participants refl ected the rich regional,
ethnic and generational diversity of the country. Special efforts were made
to engage seniors and young adults – the populations most signifi cantly
impacted by the proposed reform options. The project directly engaged formal
and informal decision makers at every stage of the process. President Clinton
and 120 members of Congress actively participated in town meetings and teleconferences,
giving them a unique opportunity to discuss the issue with a diverse group
of constituents. In addition, key stakeholder groups, think tanks, and advocacy
organizations representing all major perspectives on the issues participated
on the ADSS Advisory Board. This group reviewed all ADSS public education
materials to ensure balance and accuracy.
Americans Discuss Social Security created a national conversation by involving tens of thousands of citizens in deliberation across more than thirty states. ADSS had an immediate and direct impact on the Social Security debate. The project demonstrated the intense public interest in the future of Social Security reform and showed that Americans had more of a “middle ground” approach than special interests or lawmakers had believed. For example, contrary to insiders’ expectations, participants overwhelmingly supported raising the cap on payroll taxes. These results were considered credible because of ADSS’ neutral stance on the issue, the diversity of participants, and lawmakers’ direct involvement in the process. Eventually, each of the major reform proposals considered by policymakers included raising the cap on payroll taxes.
LISTENING TO THE CITY
In 2002, AmericaSpeaks was honored with the responsibility of providing
thousands of New Yorkers a meaningful voice in the process of rebuilding the
World Trade Center site. To help city leaders develop a consensus around the
future of the site, AmericaSpeaks designed and facilitated a groundbreaking
citizen engagement effort that included a 21st Century Town Meeting and a
two-week online dialogue in the spring and summer of 2002. To solicit input
on the site plans, “Listening to the City” engaged 4,500 members
of the general public who closely reflected the demographic diversity of the
region. A two-week online dialogue involved another 800 New York City residents,
who reviewed the site options in small cyber groups.
AmericaSpeaks worked with decision makers from the Lower Manhattan Development Corporation and the Port Authority to co-sponsor “Listening to the City” and incorporate it into their official public engagement process. When participants in the meeting voiced strong disapproval of several elements of the initial site plans, the decision makers immediately responded. They went back to the drawing board and began an international competition for plans that embodied the public values, development priorities and the spirit that New Yorkers articulated at the meeting. Many elements of Daniel Libeskind’s winning design honored these elements and directly responded to public concerns about the first set of plans.
“Listening to the City” demonstrated that it is possible for thousands of citizens to come together, deliberate difficult issues and reach consensus within a charged and complex decision-making process. It was praised by many decision makers, the media, and architecture and planning leaders as a model for the future and it significantly impacted the outcomes of the rebuilding process and site design.
Several months after the 21st Century Town Meetings, in a speech to the architecture
community, New Yorker architecture critic Paul Goldberger called the meeting
“incredible.” He said, “I would be tempted to call it a
turning point in the story not only of the World Trade Center, but of American
planning in general.… Thousands and thousands of people talking seriously
about urban design is something I never thought I would see.”
