A Dialogue on U.S. Health Reform

In September 2008, Families USA, a national nonprofit organization advocating for high-quality health care, convened 20 interest groups (see Appendix) for a dialogue on the possible contours of health care reform. At the time, reform was a key issue in the presidential race and was expected to be high on the legislative agenda the following year.

Organizational representatives met eight times between September 2008 and March 2009. The Keystone Center, based in Keystone, Colo., facilitated these meetings. The participating organizations formed four working groups, which met dozens of times on their own, to discuss key aspects of reform:

  • Access and coverage issues
  • Systems restructuring
  • Financing
  • Preventive care and wellness

The process, termed the Health Care Dialogue, resulted in a report signed by 18 of the 20 participating organizations. (The two labor unions in the group did not sign the report.) The report reflected broad agreement on a range of concerns, but no consensus was reached on several key issues, including:

  • A possible mandate that employers provide insurance for their employees
  • The establishment of a public insurance option
  • Sources of funding for the reforms

Key Recommendations

  • Expand coverage by building on the existing pillars of employer-paid insurance and public safety-net programs such as Medicaid:
    • Expand Medicaid eligibility, funding and enrollment.
    • Provide tax credits or other subsidies on a sliding scale for individuals and families to purchase adequate and affordable coverage, including effective preventive services.
  • Focus attention and resources on wellness, prevention and primary care:
    • Ensure that more people receive the most effective preventive services.
    • Provide incentives to use health information technology for improved prevention.
    • Establish health promotion and disease prevention as core priorities of health care providers, businesses and the public sector.
    • Promote sharing of information on how best to improve people's health behaviors.
  • Aim to deliver the highest-quality care as efficiently as possible:
    • Improve treatment of chronic disease.
    • Research the comparative effectiveness of treatment options.
    • Pay for quality rather than quantity, beginning with Medicare.
    • Reform the liability system for both patients and providers.
    • Provide public information on performance.
    • Create a robust health information technology infrastructure.
    • Use payment reforms to transform the delivery system.

Lessons Learned

  1. Get stakeholders to agree to a detailed mediated conflict resolution process. The process should be designed to stress areas of agreement while bringing differences to the surface so that they can be resolved. (Project Director)
  2. Build multilevel working relationships among stakeholder groups. Small working groups can involve additional staff from stakeholder organizations, which helps build trust among members while exploring concrete options that move beyond initial ideological positions. (Project Director)


The Robert Wood Johnson Foundation (RWJF) supported this project from August 2008 to September 2009 with a grant of $500,000.

Appendix: Participating Organizations

  • Advanced Medical Technology Association
  • American Association of Retired Persons
  • American Cancer Society Cancer Action Network
  • American College of Physicians
  • American Federation of State, County and Municipal Employees*
  • American Hospital Association
  • American Medical Association
  • American Nurses Association
  • American Public Health Association
  • America's Health Insurance Plans
  • Blue Cross and Blue Shield Association
  • Business Roundtable
  • Catholic Health Association of the United States
  • Families USA
  • Federation of American Hospitals
  • Healthcare Leadership Council
  • National Federation of Independent Business
  • Pharmaceutical Research and Manufacturers of America
  • Service Employees International Union*
  • U.S. Chambers of Commerce

*Did not sign final document