The conventional wisdom that Americans are unwilling to discuss limits to healthcare resources or tolerate any restrictions on treatment choices presents a formidable barrier to implementing policies that would reduce healthcare cost growth. Typical explanations for the conventional wisdom are plentiful, but not entirely useful in providing guidance for appropriate policy responses. In this paper, we analyze an organizational theory known as the Abilene Paradox to explain the lack of public engagement and the paucity of research concerning public values and preferences on difficult healthcare issues such as the use of medical technology. The analysis suggests that one strategy for improving policymaking would be to expand on recent research efforts concerning public participation in decisions about medical technology. These efforts demonstrate that when structured, deliberative methods are employed, members of the public are both willing and able to engage as social decision makers for allocating limited resources.