Town hall meetings being held on health care legislation across the country are exploding with emotion, frustration, and conflict. Citizens are showing up in throngs to speak out, and sometimes to shout, about health care—turning the meetings into a vivid demonstration of what's missing from American democracy.

Many of the most vocal protesters at town hall meetings are motivated not by the legislation itself, but by their fears and sense of exclusion from the process. The health care debate has illustrated the need for a better method of public input–not only to help prevent those feelings of alienation, but also to produce legislation that actually meets the needs of citizens.

At the National Coalition for Dialogue and Deliberation (NCDD), our members are involved in a flurry of discussion about how we can encourage public engagement that’s more participatory and more productive than what we’ve seen in the news lately.

Scrap the typical “town hall meeting” format

"The term 'town hall' conjures up images of townsfolk gathering in some New England hamlet, writes deliberative democracy scholar Jim Fishkin. But today's typical "town hall meetings" don't live up to that tradition. They don't allow citizens to feel they've been truly heard, or to discuss issues in any depth. Like public hearings, town hall meetings tend to largely be gripe sessions, where the most passionate and bold attendees take turns giving three-minute speeches—usually after enduring long speeches from the front of the room.

Arkansas Senator Blanche Lincoln, one of the members of Congress who did not plan a large town hall meeting during the recess, has suggested that the raucous nature of the town-hall-style sessions has made them counterproductive. “If people genuinely wanted to have a constructive conversation, then that would be a different thing,” she said. “But that has not been what we’ve seen.”

She's right on one count: the town hall design sets the stage for activist groups and special interest groups to try to 'game' the system and sideline other concerned citizens in the process. As Martin Carcasson, director of Colorado State University’s Center for Public Deliberation, recently pointed out, “the loudest voices are the ones that get heard, and typically the majority voices in the middle don't even show up because it becomes a shouting match.”

False accusations and misinformation have certainly played a role in fueling the furor, but they might not be as effective if people hadn’t already felt cut off from the process. As Tom Atlee, founder of the Co-Intelligence Institute noted, many of the recent town meetings were originally organized to promote the Democratic health care agenda, not to provide opportunities for real dialogue with and among citizens. “So in a sense they invited disruption from those who felt unheard,” he said. And when a person or group feels ignored, their frustration often shows up later “with increasing and often dysfunctional energy.”

Upgrade to higher-quality meeting formats

So how can officials hold more effective open-to-the-public meetings with their constituents? Dozens of effective public engagement techniques have been developed to enable citizens to have authentic, civil, productive discussions at public meetings—even on highly contentious issues. These techniques have names like National Issues Forums, Study Circles, 21st Century Town Meetings, Open Space Technology, and World Cafe, to name just a few.

When done well, these techniques create the space for real dialogue, so everyone who shows up can tell their story and share their perspective on the topic at hand. Dialogue builds trust and enables people to be open to listening to perspectives that are very different from their own. Deliberation is often key to public engagement work as well, enabling people to discuss the consequences, costs, and trade-offs of various policy options, and to work through the emotions that tough public decisions raise.

Skilled facilitation is key to almost all forms of dialogue and deliberation. Alexander Moll, who is facilitating a health care deliberation using the National Issues Forums method in Washington, D.C. later this month, describes his role this way: “My job is to elicit the best ideas from each of you, regardless of ideology... I do not ask 'leading' or 'loaded' questions that bias the conversations; instead I'll ask questions like, 'Why do you believe this to be true?' or 'Can you explain your position further?’” Skilled facilitators know how to translate conflict and anger into specific interests, needs and concerns so that what's behind the emotion can actually be understood and addressed.

“Ground rules” or “agreements” are also par for the course in dialogue and deliberation. Typical agreements establish a kind of golden rule for everyone present, asking people to treat each other as they would want to be treated. By refraining from interrupting each other and by listening with the intent to understand rather than to seek points to argue with (two typical ground rules), participants are more likely to be heard and to hear each other.

To involve a broader representation of the public, events should be publicized widely and thoughtfully enough so a variety of people attend (not just the usual suspects). Furthermore, it’s helpful to organize participants into smaller groups (fewer than 10 at a table is ideal) to ensure each person gets the chance to speak and to make it less likely that one individual or interest group will dominate the whole meeting.

No matter what technique is used, legislators can help all attendees feel heard by diligently recording what citizens say, and being clear about how they plan to use the information gathered (perhaps to share with other constituents or with fellow legislators). Another proven strategy is to “reflect back” the concerns, values, and desires they are hearing. Ideally, public officials join in the dialogue as participants, after which they can publicly reflect on some of the things they've heard. The more thorough and authentic they are in doing this, the more impact it will have on those attending.

Reflecting back, using ground rules, working with facilitators, and having people engage with each other in small groups are all basic but critical elements of quality public engagement. To allow people to deliberate, or wrestle with the complexities of the issue, some important work must also be completed before the public meeting. Balanced information must be provided about the issue at hand, and a fairly-framed spectrum of possible policy choices can be put on the table for attendees to discuss.

Perhaps most importantly, the legislator hosting the meeting must genuinely be open to learning from what his or her constituents think should be done to address the issue at hand. One major barrier to putting these ideas to play right now is that public input should be requested—and heeded—much earlier in the policy-making process. Now that there are draft bills floating around, citizens (rightly) would not trust that their nuanced input would have much impact on what happens in Washington. At this point in the policy process, loud voices and outrageous accusations actually are more likely to impact health care policy—but not necessarily in a productive way.

Atlee observed that “when people are only invited to participate when there is a final battle between (for example) Republican and Democratic proposals for health care, this fact alone invites polarization. When an issue is in crisis mode, it is easier to manipulate people with fear and extreme language and imagery; there is less time to get information and issues clarified; there is less patience on all sides to delve into the actual complexities; and nonpartisans get the sense they are being sold false alternatives.”

One NCDD member recommended asking two legislators from different parties to co-host deliberative events on contentious issues like health care reform. Many citizens on the right distrust politicians on the left—and vice versa. A joint deliberative forum held early in the decision-making process can help build trust beyond party lines, and help legislators get a sense of what their constituents are willing and unwilling to support, and why.

It is also vital to find ways for attendees to wrestle with the trade-offs inherent in all complex policy issues. As President Obama said at a town hall meeting in Grand Junction, Colorado, “there is no perfect, painless silver bullet out there that solves every problem, gives everybody perfect health care for free. There isn't.” Americans need to discuss the trade-offs involved (in the proposals as well as the current system) with each other and with policy-makers, to clarify the values that are embodied in different approaches to health care reform, and to identify the needs that are most important to them. Legislators need to trust us enough to listen.

Most Americans feel strongly that the voice of the people should have an influence on public policy and that the right to speak up and dissent is anything but “un-American.” A recent joint statement by several leading organizations in the field of participatory democracy noted that “beyond simply having a voice, people should have a chance to be informed, to hear each other, to work through tough decisions with each other and their elected officials, and to use democratic processes to figure out how to solve the problems that face us.”

Though it may not seem like it when we watch clips from health care town halls, the truth is that people can come together to have a positive impact on national policy, not only in spite of our differences, but because we can use those differences to make better decisions. It is my hope that what may have seemed like a utopian ideal a few weeks ago—democratic debate in which the people are informed and involved from the beginning—may now seem like a necessary but long-overdue upgrade in the way we do politics.