Community Values in Vermont Health Planning Most observers of America's health care system agree that change is necessary. Although we spend more per capita on health care than any other country in the world, the health of our population falls short of many other countries. We are unable to successfully manage costs; and universal access, available in every other industrialized country except South Africa, still eludes us as thirty-one million Americans remain uninsured. Our public policies are riddled with conflict as a result of the public's own conflict about health care. We expect that the best medical care be provided for all, while we resist with every breath paying the price that such a policy entails. Vermont Health Decisions, a statewide public education and discussion project sponsored by the Vermont Ethics Network, is designed to explore public attitudes and values that underlie health care and the public's priorities in the allocation of health resources. The Vermont Ethics Network is a group of approximately sixty citizens interested in the ethical issues surrounding the delivery of health care. The Network is sponsored by the Vermont Health Policy Council, Vermont's legislatively created health planning agency. Launched in late 1988, Vermont Health Decisions was modeled after an earlier project called. "Taking Steps." This project focused on the need for individuals to make their own treatment preferences known in an increasingly complex, technologically oriented health care system. It involved specially trained discussion leaders, who conducted over 170 community meetings reaching nearly 3,500 people. For Vermont Health Decisions, we recruited twenty-five specially trained discussion leaders from each of the geographic areas of the state, who were then provided with special training during a two-day meeting organized specifically for that purpose. Each discussion leader was given a leadership training package which included professional articles, information about the health care system, and guidance on leading discussions. A professionally produced videotape discussion starter designed to introduce audiences to the topic was prepared, and a questionnaire soliciting participants' opinions on a series of issues on resource allocation in health care was designed. A program brochure was prepared and distributed, and a press conference was called to announce the start of the program. As in the Taking Steps program, meeting scheduling focused on existing community groups which constituted ready-made audiences for the project. Ethical and Social Issues. For several months prior to the initial two-day training program for discussion leaders, Network members and staff struggled to conceptualize the project. What were the ethical issues in health care policy? How do we design a community discussion when few people have much in-depth understanding of the organization and financing of health care? How do we avoid appearing to promote a specific political agenda or "solution"? How do we avoid focusing exclusively on the current "hot topic" in health care or fixing blame on the current health care villain? How do we address more fundamental, enduring issues? The project seeks to focus public attention on the following issues and problems: * political leaders' desire to hear from the general public on health issues; * the resource allocation crisis in Vermont and the rest of the country, and the rationing involved when the uninsured are excluded from participating in the health care system; * the need to make explicit choices about health care based on priorities and values; * the difficulty individuals and employers have keeping up with health insurance costs and that providers face in offering free care; * the need to examine our own health care values in developing societal goals for health care. …