Permission to speak freely

In the seemingly endless debate about the future of healthcare in America, one of the biggest challenges is one for which communication is particularly well-suited: the need for a broad, honest conversation about difficult issues.

In the seemingly endless debate about the future of healthcare in America, one of the biggest challenges is one for which communication is particularly well-suited: the need for a broad, honest conversation about difficult issues. The absence of balanced debate among stakeholders and the imposition of policies that draw from the well of middle-class pocketbooks have created disaffection, despite the majority's interest in fairness.

What do we know? The inability to find a rational solution for providing broad access to insurance coverage has fueled a serious moral dilemma. The failure to gain control over health spending threatens the nation's economic future. Behavior and lifestyle contribute to health conditions that create a financial burden for all, and intensive services for end-of-life care risk increasing human suffering while draining resources from other pressing needs. But attempts to manage costs are likely to limit access to care and stifle medical progress.

These are legitimate and well-made points, but they are asserted independently of each other and on behalf of specific constituencies. Advocates represent patients, pundits state political positions, business interests defend their roles – and this is all quite valid. A great deal of media coverage, heavily weighted toward the politics of healthcare rather than the policies that affect peoples' lives, fails to clarify the core consequences and trade-offs. Everyone has a voice, but no one is really heard.

These are extremely difficult topics: matters of life and death, seemingly beyond control and weighted by financial stress. PR can't resolve the fundamental conflicts inherent to the debate, but communicators are singularly capable of fostering a broad, honest conversation about the right issues, in which all points of view are evaluated with context and through balanced arguments.

The primary obstacle to having such a discussion lies in the fear of backlash or special interests hijacking the conversation. The subjects are too personal or taboo, and every attempt to discuss change is likely to be tagged as an attempt to kill the dying, blame the victim, or dump the poor. Since clarity and objectivity are paramount, facilitators can adopt a principle known to the military: “Permission to speak freely,” which allows a respectful and candid conversation to take place without fear of retribution.

Of course, communicators cannot do this unilaterally. A number of organizations can provide the forum where interests can speak frankly. In fact, health institutes that represent multiple constituencies operate in California, New Jersey, Texas, and New England, as well as other parts of the country. A coalition of these could join ranks as co-conveners in a discussion where legitimate interests can speak candidly about what's on their minds.

We should have no illusions about the difficulty of the conversation or its chances of success; diplomacy is difficult after all. But it has taken almost a century to enact reform that will fundamentally alter the American approach to health. Those changes and their impact must be made clear to citizens, and research shows that if the public understands the consequences of policy decisions, they are apt to modify their views.

Our profession has proved that we know how to start and lead collective conversations, and we should take the chance to do so in a time and space that truly matters. We won't necessarily arrive at the right answer, but perhaps we can start the discussion needed to get there.

Daniel McIntyre is the worldwide health practice leader at Hill & Knowlton. He has spent three decades in health-care public policy and communication, including pharmaceuticals, biologicals and biotechnology, diagnostics, and providers.

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