Beware what you set your heart upon. For it surely shall be yours.
Ralph Waldo Emerson
Today, it is common for politicians and pundits to call for public dialogue to resolve any one of health care's numerous intractable problems or its myriad of moral dilemmas. Whenever I hear the call for public dialogue, a frisson of alternating currents—anxiety and hopefulness—runs up my spine. Having participated in a two-year dialogue regarding health care reform, I am convinced that public dialogue holds the solution to health care's problems. The conviction is paradoxical: Dialogue challenges us to move beyond the existing limits of our relationships and tests our willingness to care for one another.
In 1992, health care reform was a presidential campaign issue. Campaign watchwords included universal health care and quality at an affordable price. For those of us working in health care, it was as though a terrible, fire-breathing dragon were rumbling our way. There wasn't anyone inside health care who didn't sense the high-stakes implications of health care reform. On the outside, the public watched, hoping that health care reform would include some alternative care, nursing home coverage for their elderly parents, and health insurance for the entire family, all at an affordable price. When the smoke cleared, however, health care reform had defaulted to politically correct economic issues, much to the public's sorrow.
Dialogue was finding its way into the U.S. vocabulary, and its effectiveness for facilitating social change was at the exploratory stage. That year, I was one of three women who catalyzed our local community to participate in a research project using dialogue for health care reform. The exper