The Case of the Frustrated Citizen

Identifying Information

My name is Shimon Waldfogel. For the past decade I have experienced increasing frustration associated with the national political scene. Seeking to be an engaged citizen, it appeared my choices were limited. For too long I have felt marginalized and disengaged from politics as the dialogue has become more and more partisan, answering to the demands of extreme constituencies on the left and right. Citizenship requires a basic understanding of the complex issues that face our nation, and we must hold our political representative accountable for solving them. Yes, ideology plays a role in framing the challenges and provides the tension needed for active political dialogue of differing opinion. It is when ideology becomes rigid that the conversation turns disrespectful and misleading. That puts our very foundations as a democracy in danger. Voting on a regular basis, yet observing the dysfunctional national political scene left me with few choices.

1. To become cynical as a consumer of news and filtered information,

2. To seek to understand more deeply the factors contributing to the seeming dysfunction and potentially engage more effectively in politics.

Improving the state of democracy by building on an understanding of the structures and information flow in complex adaptive systems. Influenced by the work of David Easton, I’m exploring the use of biologic systems approach to cancer to describe and target “treatments” for “pathology” in the US political system. (The James Madison Project/ United States 4.0)

In particular exploring ways to reframe the role of the “citizen” as an actor within the civic/political ecosystem and to better understand the behavioral factors affecting individuals in interaction in the political arena (political behavioral economics). Through the project and related “civic” involvement seeks to leverage governmental initiatives in the area of “smart disclosure” of public data and utilize digital technology for development of citizen engagement tools (such as “choice engines”, crowd sourcing, social networking) to address challenges in our politics in general and in the US healthcare system in particular.

Chief Complaint: (Problem)

Most concerning is the loss of trust that the American public have in their government and that they do not trust that elected leaders can lead at times of crisis. Furthermore there is a growing recognition that the “political bargain” between the government and the citizens is rigged in favor of select groups. Without effectively addressing the underlying “cancer”, any “treatment” will not change the destructive path we are on as a nation.

Define the Problem:

Marginalized, Alienated, distrustful, concerned need for optimism process that started years ago in Philadelphia… To make it better… ongoing project to be a more perfect union… The process of having dialogue different opinions to achieve a more perfect union.

Polls show that faith in government is near all-time lows. In a Gallup survey, voters listed dysfunctional government as the nation’s №1 problem. In fact, American voters’ traditional distrust has morphed and hardened. They used to think it was bloated and ineffective. Now they think it is bloated and ineffective and rigged to help those who need it least.


History of Present Condition:

I’m an “un- affiliated” citizen living in the Philadelphia area.(In my day job, I’m a full time psychiatrist at Abington Memorial Hospital, trained at Jefferson Medical College) For the past few years I have been interested and actively pursuing ways to have an impact on the politics of healthcare. I have come to realize that to truly have an impact, I would need to have a better understanding of the political ecosystem in which change will occur, and to find ways to impact that system as a citizen. I embarked on a journey into the “the DNA” of our political system… the US Constitution and have developed a framework, inspired by James Madison’s writing (mostly Federalist 10 and 51), that looks at the political challenges we are facing through Complexity lens.

I’m a full time psychiatrist with a hobby in civic engagement and citizenship. Interest addressing the many challenges in our healthcare system, has led me to get more engaged in the political realm. I have used skills of understanding psychological function and formulating plans to overcome negative emotions. As a psychiatrist, I was particularly interested in the psychological aspects of political life. Over the decades I have had the great fortune to learn about and utilize the psychological understanding to the complexities of individuals and family lives in the clinical setting.

  • I participated (hosted) in a house meeting on health care coordinated by the Obama/Biden transition team.

  • I attended the first town meeting about healthcare reform at the Constitution Center with (deceased) then senator Specter and the Secty. of HHS, Sebelius, where I first experienced the passion of the emerging “tea party”.

  • I participated in American Speaks event about the budget sponsored by the Peterson Foundation.

  • Additionally I participated and/or followed, numerous discussions about healthcare reform sponsored by various organizations on C-Span, The Economist, New York Times and WSJ and multiple other publications.

  • Most recently, I organized “A National Conversation on Health Care” at “People’s Plaza” in Independence National Historical Park, Philadelphia, PA.

  • Coursera courses. Wharton social entrepreneurship, Copenhagen, Wellesley Change the world, NYU, TAU distributive justice, WB engaging Citizens.

  • Advisory Board


The presidential election of 2016 has yielded a radical yet predictable result in the victory of Donald Trump. Like most Americans I have concern about the future of the US. This concern is manifested with increasing frustration, fear and at times anger during the election process that will determine the next president of the US. Most concerning is the deep division that has continued to emerge among various groups, an existential threat…



Data and Facts:

Recent Pew Research has given a statistical credence to what is clearly felt by most Americans, They found that Americans trust in government has reached an all time low. Only 19% of those surveyed believe that government can solve major problems. This finding as well as others surveys have also found that support for politicians is in the single digits.

Review of Systems:

To introduce a conceptual model that addresses the dysfunctional US political system. I will also discuss in greater detail more of the microenvironment of the politics and process including the legislative and regulatory functions. The disease metaphor in general and the cancer metaphor in particular have been used throughout American history to highlight dangers of particular aspects of American life. For more detailed comparison between body and body politic see the table and this appendix.


Diagnosis of the Problems/Challenges:

The US political system is defined by the DNA roughly conscription by the US Constitution. Similar to DNA of body in biological system and the fines the particular rules and regulations that come into existence. Particular interest in the end iterative process oriented unfolding which is often defined by the environment in which the organism finds itself. Cancer antibody organism is a manifestation of Pathology the symptoms include but are not limited to the weakness of the system loss of energy loss of weight t and then malignant tumors eventually that’s that.


Problem List:

United States challenges for the 21st Century

  • Distrust and alienation from the federal government and the toxic political process

  • The fiscal health of the nation: The budget, debt and deficit

  • Unfairness of the tax system: tax code of 64, 000 pages

  • Inequality of opportunity, income, wealth and employment

  • An unjust, dysfunctional and expensive healthcare system

  • An out of control legal system, police and prison system

  • Failure to respond to climate change

  • The surveillance state: Privacy and dignity under assault by government and corporations

  • A decaying infrastructure of roads, and bridges

  • A declining public educational system out of reach for many Americans


Assessment and Plan: 

As we enter into the dawn of the Trump presidency, it as a good time to reflect on citizenship. Many are concerned that we are entering a dark period in democratic governance. Hannah Ardent provides a framework to explore this question.

Treatment Plan:

The James Madison Project is my “treatment Plan” to address the frustration I experience as a citizen with our current political environment and its detrimental impact on most Americans. I found James Madison’s contribution to our national fabric inspiring. Madison’s psychological insights and use of the disease metaphor, likely a consequence of his experience with disease, resonated with me. It is clear to me that what is missing from our current politics is a structure for meaningful “debate”. Madison’s writing in Federalist 10, considered one of the greatest political articles, offered a framework.

The James Madison Project is my effort to become a more informed and engaged citizen.

The Medical Case Presentation is an essential framework for a focused disciplined approach to addressing medical problems. When used effectively, it allows healthcare professionals to communicate and share information among varied clinical disciplines to develop testable hypotheses for simple and complex problems. The framework allows for clearly identifying problems and providing objective data to support the diagnosis and “treatment plan.” The Medical Case Presentation is uniquely positioned to address systematic changes over time. Through progress notes addressing specific problems, we’ll be able to adapt to new issues to clearly identify problems and potential solutions.

Placing the citizen at the center of the complex political / healthcare system.


Progress Reports:

The past few years with the focus on healthcare issues, the budget and the deficit have demonstrated the extent to which our leaders have kept the public in a cloud of misinformation and spin that has fostered an environment of distrust that has led to alienation and tuning out from democratic life by most Americans.

Shrink the Government

Psychological insight about our politics 




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