Health Care and Congress: It’s Time for a Walk in the Woods

by Leonard J. Marcus, PhD, Barry C. Dorn, MD, and Eric J. McNulty

A Democratic Congress passed health care reform. A Republican House of Representatives is bent on repealing it. The latest Republican budget proposal calls for significant structural changes in Medicare and Medicaid. We have already seen that the back-and-forth is going to be contentious and acrimonious. We have been in negotiation and conflict resolution involving health care issues for more than twenty years and would like to offer a more productive alternative.

Republicans, Democrats, and Independents: we’d like to invite you on a Walk in the Woods.

The Walk in the Woods in a method for interest-based negotiations named for the now-famous 1982 encounter between Paul Nitze, representing the U.S. and Yuli Kvitsinsky, representing the Soviet Union, during arms control negotiations in Geneva, Switzerland. The talks were at a seemingly insurmountable impasse when a break was called. Nitze and Kvitsinsky met outside of the conference center and went, literally, for a walk in the nearby woods during which they achieved a genuine understanding of each other as human beings as well as what the two countries faced in an escalating arms race. This, in turn, led to a breakthrough in negotiations and the delegations reached an agreement. While the deal was ultimately rejected in both Washington and Moscow, the meeting has come to symbolize how it is possible to uncover new possibilities for agreement through interest-based negotiation.

The Walk is a straight-forward four-step process that we have used with hundreds of groups in a wide variety of situations. It involves: 1) Identifying the Self-interests and needs of each party and putting them on the table for all to see; 2)A second step called Enlarged Interests where the parties see that there are two categories of interests: agreements and disagreements; 3) The third step, Enlightened Interests allows each party to look at the disagreements and try to reframe the nuances of them until they reach agreement; and 4) This then allows them to choose those options most likely to achieve the overarching goal of health care reform – the Aligned Interests.

In the many times that we have led opposing parties through this process, we have invariably found that they agree on more points than they disagree. In this case, we can imagine that all 100 Senators 435 Representatives would agree that an estimated 45,000 Americans should not die each year for lack of health insurance and would be in favor of steps to reduce that number. All would agree that wasteful spending should be reduced, that the country should improve in the global rankings for life expectancy, child mortality, and health outcomes per-dollar spent, and that illness should not be a significant cause of personal bankruptcy. And these are just a start.

Seeing that the list of agreements is longer than the list of disagreements disengages the parties from stalemating through “us vs. them” posturing. It puts the process in a positive light and spurs creative thinking. It allows them to imagine scenarios in which each feels that they have gained something from the process. It lets them explain the benefits of the final accord to their constituents as gain/gain rather than win/lose.

We don’t want to suggest that this Walk will be easy. There are numerous parties who like the combative atmosphere of the current situation: on both sides, lobbyists collect lucrative fees, advocacy groups raise money and acquire members, and the media boost ratings.  However we are willing to bet that if legislators on both sides return to the self-interests and needs of the country expressed at the beginning of the Walk, none of those will be found among them.

We recognize that there are individual Senators and Representatives who see potential personal benefit simply from defeating the other side. However, it has been our experience that those who approach negotiations with a “they must lose so we may win” attitude often find the victory achieved does not meet the needs of the people they represent. After all, they have not solved the underlying problem that originally brought the parties to the table. Those they have vanquished come to the next issue focused on retribution and revenge rather than a constructive negotiation designed to accomplish the overarching goals.

As the Congress continues its intensive work, we hope they consider taking a Walk to include President Obama and the American people. We cannot afford otherwise.

~ An in-depth discussion on The Walk in the Woods concept and technique appears in Chapter 7 of Renegotiating Health Care: Resolving Conflict to Build Collaboration.


  1. Barry C Dorn says:

    Although I agree entirely with Eric about the Congress taking a Walk in the Woods, I have another thought. I think it is time for President Obama to make a simple outline, easily understandable to the American People, as to what our health care system could look like under the Affordable Care Act and what it would look like without it. And I don’t mean the Act which has been decimated by Republican Congress People; I mean the original that Congress passed. I believe that if the American People are given the true facts rather than the “interpreted” facts perpetrated by right leaning news outlets, they will make the correct choice. It is time for President Obama to act a little like Harry Truman and take this negative do nothing Congress to task.
    This represents my views alone and not necessarily those of my fellow authors.
    Barry Dorn

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