Public Input into Health Care Policy: Controversy and Contribution in California

Article excerpt

Public Input Into Health Care Policy: Controvery and Contribution in California

The hypothetical case of "Unclke Ned" comes up as an illustration in point during a California Health Decisions (CHD) group discussions of principles for health care allocation. "Uncle Ned" is ninety-two years old and critically ill. The physician recommends inserting a pacemaker. What guidelines should be used to make this treatment decision? Where does age enter into the discussion? Ability to pay? Quality of life? Patient self-determination?

A white-haired man who has been silent until now raises his hand. "OK," he says, "We've talked about 'Uncle Ned' but I want to know where Uncle Sam comes into the picture." The discussion moves to federal support for health care funding so "Uncle Ned" can avoid "spending down to zero" in order to be eligible for long-term care.

The forty-three people attending this one meeting on this particular evening obviously won't solve the complex and thorny problem of allocating scarce resources. But their discussion is a valuable exercise in community participation. In the five years CHD has been holding these meetings, the message from the public is consistent: Everyone should have access to basic health care, regardless of ability to pay. Now we are preparing to take the next step in the process, a statewide round of community meetings in 1991 aimed at defining "basic" or "adequate" health care.

Developing explicit guidelines for health care allocation is a daunting prospect, intimidating to most policy-makers. The arguments that the task is best left to "experts" centers around a misguided belief that the complexities of the health care delivery system are beyond the understanding of the average citizen. However, our experience shows that public education designed to break the seemingly overwhelming "health care crisis" into manageable, understandable increments allows very constructive dialogue leading to specific recommendations. And while public understanding of the health care issues varies among different groups, we repeatedly find that people have a clear sense of their own values and welcome the opportunity to express them. …


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