Tradeoff Negotiation: The Importance of Getting in the Game; Comment on “SwissCHAT: Citizens Discuss Priorities for Swiss Health Insurance Coverage”

SwissCHAT’s playful approach to public rationing can be considered in terms of deliberative process design as well as in terms of health policy. The process’ forced negotiation of tradeoffs exposed unexamined driving questions, and challenged prevalent presumptions about health care demand and about conditions of public reasoning that enable transparent rationing. While the experiment provided grounds for optimism that public deliberation can contribute to the design of fair insurance servicepackages, it also left unanswered questions. What are the ethical and policy implications of nonconsensuses? What is the presumed relationship between process and justice of outcome?