“..., I agree to this Constitution, with all its Faults, if they are such; because I think a General Government necessary for us, and there is no Form of Government but what may be a Blessing to the People if well administered; and I believe farther that this is likely to be well administered for a Course of Years, and can only end in Despotism as other Forms have done before it, when the People shall become so corrupted as to need Despotic Government, being incapable of any other.”
Benjamin Franklin, speech to the delegates at the conclusion of the Constitutional Convention September 17th, 1787
Americans are experiencing a political environment where passions have become the main driver of political discourse. Information and facts are replaced by opinions and self serving statistics. A multi decade coordinated and well executed effort by ideologically and financially driven individuals and institutions has been successful in delegitimizing and vilifying the federal government. A multifactorial, complex set of circumstances has contributed to the increasing dysfunction of our national institutions, further fueling many Americans distrust of the federal government and many other social and political institutions. It is not surprising that at this political moment, according to polls, many citizens believe that the political system is rigged.
There is growing resentment that the citizen voice in the political process has been replaced by a corrupt political process that benefits the elites of the country. There is more openness to consider non democratic- authoritarian if not despotic political structures for governing. Yet the challenges facing our society such as climate change, social challenges like growing economic and social-political and wealth inequality, mass incarceration, poor health and health care system, deteriorating infrastructure and a changing global financial system serving fewer and fewer, are met with inaction from our elected leaders and the paralyzed institutions set up to promote the general welfare. Increasingly, it seems that the challenges facing our nation’s diseased body politic are insurmountable.
231 years after the ratification of the constitution, this remarkable yet imperfect document that provides the architecture for our governmental institutions, it may serve us well to examine the political and social circumstances that have contributed to our current situation. In particular to examine the role citizens may undertake to be part of the “treatment” for the challenges facing our nation and to consider remedies for emerging challenges in an ever increasing complex world. Although there is renewed awareness and efforts of citizens to make their voices heard, through marches, online organized campaigns, editorials and comments in MSM, social media posting, there are powerful factors that limit their impact. These barriers, often erected by manipulating and corrupting constitutional DNA, have stifled the will of the majority of our citizens.
It has become clear that a different framework for the political conversation is needed for meaningful citizen
engagement. What is needed is a framework that provides a vehicle for citizens to reclaim their central role in the political ecosystem. A safe space that facilitates dialogue and deliberation informed by an understanding of the complexity of the political ecosystem that has evolved from the constitutional DNA. A deliberative process that is built on credible facts and information. A framework and tools to facilitate, collaborative, identify, analyze, develop, implement and monitor a solution-based “treatment plan” for social and political challenges and problems facing our nation. Citizen friendly dialogue that leverages advances in digital technology to enrich the body politic rather than infect it with partisan toxins. And most importantly, citizen driven process that builds on an understanding and respect for the role of passion in a diverse public. In other words a citizen culture that cultivates the remarkable achievement of our republican democracy that the founders of our constitutional framework bequeathed us. A process informed by the corruption that has emerged in the body politic defined by the constitutional DNA. Most important, a framework that enhances and celebrates the citizen’s role in the function of government and the body politic.
Perhaps influenced by my medical training (during which I developed an appreciation for system thinking and interaction within the body) and my professional life as a psychiatrist ( understanding passions and irrational if not delusional thinking) and , having treated countless number of people with a wide range of pathologies, I recognize the importance of having a framework to understand complex challenges in general and social political challenges in particular. I have come to realize that a major barrier to achieve the vision for the citizen within our democracy is a lack of an organizing framework for participation in the political ecosystem, a democratically consistent approach that builds on citizen engagement. Inspired by James Madison’s contribution to the diagnosis and remedy for the “mortal disease” of republics , “the violence of factions”, I have “borrowed” from his experience to address the “mortal disease” in our body politic. Similar to Madison’s exploration of the challenges and shortcomings of the government established based on the Articles of the Confederation, to examine the pathology that has infected our democracy. Incorporating advances in our understanding of psychological process that have been made in the nearly two and a half centuries since Madison recognized the impact of psychological processes in the body politic, guides our understanding of the processes and psychological drivers of human and organizational behavior to address the pathology of 2019 US body politic.
So what is to be done?
“If we could first know where we are and whither we are tending, we could better judge what to do and how to do it.”. Lincoln’s ‘House Divided’ Speech,” 16 June 1858
The role of the citizen in our democracy is complex and challenging. There are many issues, and stakeholders seeking to capture the citizens energy and support their cause or them as political actors. The recent political environment has escalated the challenge of citizenship and highlighted the need for an effective structure for citizen engagement. To reclaim the vision that energized the deliberation at the constitutional convention, we need a framework that allows us to reframe our political conversation, to focus on how to achieve and maintain a well functioning democracy, to strive for improving the general welfare and contribute to general happiness and the various aspects of human flourishing. What is needed is a framework and process that is informed by the ideals of the revolutionary Declaration of Independence, the “modern” understanding of human nature, the DNA of the US Constitution, an examination of the current “Vices of the political system” i.e the pathology of the function of the body politic. Additionally to utilize advances in technology with tools to embrace crowdsourcing and other collaborative activities to address challenges in our society.
The Role of Public Opinion in American Democratic Life
Madisonian informed-citizen focused “treatment plan” as well as tools to enhance citizen engagement with stakeholders in their political ecosystem are explored and tested. Furthermore, although the founders recognized the importance of public opinion and active participation for the legitimacy of democratic government, the US constitution didn’t come with a user’s manual.
In affirming the authority of public opinion, in other words, Madison was preaching majority rule but not simple majoritarianism. Majority opinion would hold sway, but the majority opinion that should hold sway had to be more than the fleeting passions or preferences of the moment, more than the unreflective reactions of a transient majority of citizens.
Dr. Colleen Sheehan explains:
“Madison did not simply equate public opinion with the will of the majority. Public opinion [was] not the sum of ephemeral passions and narrow interests; it [was] not an aggregate of uninformed minds and wills. Rather, public opinion require[d] the refinement and transformation of the views, sentiments, and interests of the citizens into a public mind guided by the precepts of reason, resulting in ‘the reason . . . of the public’ or ‘the reason of the society”
A central assumption in the political world is that information, data and details are too complex for the ordinary citizen. That there is a need for expertise that can only be provided by experts and elected representatives.
These beliefs, perhaps relevant in the era of less access to public education, media etc., provide for an environment where the broader public is manipulated through well orchestrated campaigns of interest groups, captured politicians, NGOs, the media. In the actual legislative process representatives engage with each other and selected experts to frame policy and laws that seem to benefit select groups with excess to the elites at the expense of marginalized groups. A few arguments sustain this reality.
Increased complexity of issues
The belief that general public is unable to engage meaningfully in complicated policy issues (Imagined public inability to engage politically)
Lack of public interest in policy issues
Lack of time and motivation of the public
Development of new media platforms and communication vehicles
Citizens are expected to participate in juries where the are asked to deliberate on extremely complex issues in the criminal justice system, business and other areas of public importance. Additionally, most people are able to discuss fairly complex and nuanced issues as Noam Chomsky points out, an hour of listening to sports-talk radio revealed the astounding sophistication that “ordinary” members of the public could bring to analysis of complex questions.
Previous efforts to engage citizens in deliberative process about a complex issue such as the public discussion about the health care system in 1995. An effort designated by congress associated with Medicare part D legislation. The federal requirement for public comment for pending rules. Yet, these vehicles for public opinion and feedback are rarely utilized to meaningfully contribute to incorporating the citizen voice into government process. A missing element is a structure for the process of creating meaningful public input.
Most importantly to provide an organizing idea, citizenism, a citizen manual of sorts and a tool box for reclaiming the role of the citizen in the political ecosystem. After introducing citizenism in greater detail, I offer a number of experiments and activities to test and refine the role of citizens in a healthy body politic.
The Framework: Citizenism
Citizenism is the recognition and the exploration of the role of the citizen within the political ecosystem. Citizenism aims to enhance our democracy, to reclaim the citizen as a central stakeholder in the political ecosystem and strive for deliberative dialogue as understood by the founding fathers, where the people are the ultimate sovereigns. It builds on the founder’s view of the active citizen continuously participating in their government, locally and nationally. It studies the nature of the citizen rights, responsibilities and the influences that make the modern citizen. Citizenism borrows from other fields and disciplines, including human behavior, medical science, social science, political science, philosophy (Pragmatism) and is Informed by network science, complexity and translational democracy. Citizenism is positioned to respond to a troubling array of problems facing our nation’s political system.
Citizenism is not limited to a theoretical realm, but rather it offers a citizen user’s manual of sorts, a tool box, for reclaiming the the centrality of the citizen from subjects, consumer, taxpayer, voter, elector and related roles that have defined Americans. Citizenism is rooted in the belief that an engaged citizenry, informed, passionate and respectful, is essential not only for our democratic process, but also to achieve result that reflect the “common good” and achieve greatness for our nation.
To operationalize citizenism, we provide a structure, tools and activities, a citizen’s owners manual of sorts, to collaboratively address challenges in our political system. The Pain Opioid Project will be briefly introduced as an actual experiment, a case study of sorts, for citizenism. Before introducing the Pain Opioid Epidemic Case, the following assorted general features and concepts of citizenism are described,
Starting with a vision: The Why
Outlining a path: The Strategic Plan
A format for citizen engagement: The Medical Case Presentation
The complexity lens: Ecosystem & Stakeholders
Framing the challenge: Citizen Briefs
Data and information
Crowdsourcing, Collaboration and Deliberation
Network the body politic: Digital Technology
Monitor the process: Tracers
Celebrate the outcomes: Health of the Nation
Celebrate: Rituals and Holidays
Citizenism in Practice
Putting Citizenism into practice with The Pain Opioid Epidemic Project
Starting with a vision: The Why
“We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness — That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed, — That whenever any Form of Government becomes destructive of these ends, it is the Right of the People to alter or to abolish it, and to institute new Government, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness.”
A central aspect of the collective effort to achieve change and enhance the body politic is to define and align around a central vision that unites the participants in the national body politic. Values (vision) provide a why to participate in the body politic. As we are approaching the 250th anniversary of the birth of the radical experiment that is the USA, we can reconnect with the vision of its creation. We can seek to “update” he vision to address the challenges of the present moment.
At this point, one of the challenges confronting our nation is the lack of shared collective vision for the United States of America. America does well when its leaders and citizens are inspired by a unified vision. Starting with the vision articulated in the Declaration of Independence and enshrined in the hearts and minds of generations since, we can create a renewed vision to unite people in a common cause.
Outlining a Path: The Strategic Plan
“If we could first know where we are, and whither we are tending, we could then better judge what to do, and how to do it.” Abraham Lincoln “house divided” speech
James Madison had a clear strategy to address the challenges confronting the people of the united states in the birth of the republic. From confronting the challenges of citizens in his native Virginia, calling for and influencing the constitutional convention and its outcome and subsequently having the constitution ratified by the people of the 13 states comprising the early republic. The political structure he helped create for the American body politic, with all its faults, has evolved and has provided a blueprint that allowed for the enormous growth of the USA in so many aspects of political, economic and cultural life.
There are numerous citizen action groups advocating for narrow as well as broad public agenda issues. In our chaotic political ecosystem the citizen is marginalized called upon to respond to an agenda made by stakeholders driven by economic and ideological consideration that serve their interests. An agreed about citizen oriented strategy can serve as a roadmap to understand the current challenges confronting the body politic and to better define a framework for continued involvement within the political ecosystem. A citizen oriented strategic plan, can help focus resources and provide a path to enhancing the vision and the social contract that binds Americans together at a time of growing political partisanship, economic inequality and cultural-religious strife. The strategic plan will include a collaborative process as well as “rituals” that build on the shared vision and agreed upon institutions.
A Format for Citizen Engagement: The Medical Case Presentation
The Medical Case Presentation has evolved as an essential framework and structure for a focused and disciplined approach to clearly present, define, and collaborate in addressing medical problems. Healthcare professionals use the medical case presentation to identify, analyze, develop, implement and monitor a solution based “treatment plan.” When used effectively, it allows healthcare professionals to communicate and share information among clinicians and other stakeholders of varied clinical disciplines to develop testable hypotheses for simple and complex problems. The framework allows for clearly identifying pathologies and providing objective data to support the diagnosis and “treatment plan” (including biological, psychological, social and spiritual factors). The Medical Case Presentation is uniquely positioned to address systematic changes over time. Through progress notes addressing specific problems, practitioners are able to adapt to new issues and data to clearly identify problems and potential solutions. As the Brandeis Brief and the business plan refocused discourse in their fields, the Medical Case Presentation, and the accompanying Citizen Brief (Bellow) are uniquely positioned to put the citizen back into We the People.
The Complexity Lens: Ecosystem & Stakeholders
In order to actively participate in our politics, local, state and nationally (Globally) we need to be informed about political and public institutions, our representatives and other government officials. Furthermore, to address the political, social and cultural challenges we face, an understanding of the complexity of the political ecosystem that has evolved from the constitutional DNA. Similar to the scope of the field of exploration undertaken by Madison, and the complexity of the political ecosystem, citizenism uses the complexity lens to explore the challenges and to identify the stakeholders and processes that are crucial to function and outcomes. The complexity lens allows us to examine the challenges associated with social problems such as the opioid epidemic we are able to more clearly recognize the components and process that evolved over the decades from the constitutional architecture.
The ecosystem view assists citizens in developing a richer understanding of the social and political systems affecting their lives. The citizen can learn about their representatives, organizations and other relevant influences on their local, state and federal (or global) systems and more easily engage with them. In addition to providing an educational overview to the complexity of the political ecosystem and highlighting the pathology that occurs in the Political Ecosystem, we provide user-friendly tools to better understand and engage with the various relevant stakeholders. More specifically, the tools are personalized o the citizen’s particular local, state and national characteristics.
Data and Information
Current political decision making and citizen assessment of government performance suffers from information asymmetry. Data is crucial for an objective presentation of a problem, not just to help the diagnosis, but also to decide on a course of treatment and monitor results. It is crucial for decision making to have relevant, accessible, reliable and timely information. The challenge with data is to agree upon what is important and relevant. Data is not an opinion; good data is reproducible and verifiable. Data is a tool for more informed decision making about, not a decision itself. The challenge is to present the information in a simplified manner that allows for utilization into the decision making.
Indicators play an important role to monitor progress and to define outcomes. Most western societies measure Gross Domestic Product (GDP) a measure of productivity of the national economy. What is not measured is the well being of the people.
We will provide information where available and to seek to create a political process to develop the needed data sources for public use.
"A brief, usually an appellate brief, that utilizes economic, sociological, or other scientific and statistical evidence in addition to legal principle when presenting arguments in a case. Named after Louis D. Brandeis, who filed such a brief with the United States Supreme Court in Muller v. Oregon (1908) during his successful defense of a state law limiting the maximum workday of female laundry workers."
Brandeis brief — Legal Definition n.
The citizen brief is central to reclaiming the role of the citizen in the body politics. It is a stand-alone document addressing a particular societal challenge, i.e the opioid epidemic. The citizen brief is utilized to establish a framework for a citizen oriented treatment plan that provides a comprehensive, multi stakeholder and multi-phase road map for citizen involvement in their political ecosystem. It is best used as part of The Medical Case Presentation. The complete citizen brief provides a vision for the issue re-frames a problem, provides data, discusses the various issues and proposes actions that can be undertaken by the citizen to address the problem. These actions can be personal, social or political. The Citizen Brief is uniquely positioned to address systematic changes over time. The “Citizen Brief”* can be understood as framework to a process to summon our fellow citizens to address the challenges confronting us as individuals, our communities and our nation. In addition to providing a framework for engagement it includes multiple features to achieve the goals. Divided into sections that contribute information to create an impression and more clearly define the problems and potential solutions.
Crowdsourcing, Collaboration and Deliberation
“Change doesn’t come from thousands of people, all going their separate ways. Change requires bringing people together to work on a common goal. That’s hard for technologists to do by themselves. But if they do take that as their goal, they can apply all their talent and ingenuity to the problem. They can measure their success by the number of lives that have been improved by the changes they fought for, rather than the number of people who have visited their website. They can learn which technologies actually make a difference and which ones are merely indulgences. And they can iterate, improve, and scale.”
The medical case presentation represents a framework that summons our fellow citizens to address the challenges confronting us as individuals, as communities and as a nation. The case presentation approach addresses the many challenges described by modern psychology related to how individuals react in the political arena. It provides a communication approach that leads to improved dialogue. We use the structure and process of the case presentation as a framework for deliberative dialogue to address civic challenges consistent vision and strategic plan.
Building on the case presentation framework and the citizen briefs enabled by user friendly and citizen responsive technology allows for an informed deliberative process based on crowdsourced input. A shared information base framed as a foundation for exploration of possible solutions to challenges is crucially important in collaborative problem solving. It allows for a process to summon our fellow citizens to address the challenges confronting us as individuals, our communities and our nation.
Network the Body Politic: Digital Technology
When it comes to our political life, digital technology has the potential to enrich American Democracy and provide the tools for 21st century solutions to the challenges confronting the United States. From participation in the political process to engaging citizens in decision making and policy formulation, digital technology can be leveraged on the local, national and global level. We discuss utilizing digital technology to strengthen our democracy by improving citizen engagement. Current technology allows us to rewire the body politic through information technology. These tools allow unprecedented opportunity to get access to information, mobilize, challenge misinformation provide for a more deliberative dialogue. Where previously only well connected individuals and organizations were engaged now more of the public can get engaged.
Advances in technology together with new scientific insights on collaboration and decision-making provide for a unique opportunity to redesign our democratic institutions and make them more legitimate and effective. Seizing on this opportunity, leaders and citizens are increasingly collaborating to solve society’s biggest problems. This emerging paradigm is often called “opening governance.” From prize-backed challenges to spur open innovation, to open data portals that provide programmable government-held information to the business community, to participatory budgeting projects – adopted by 1500 cities around the world – that give citizens direct control over the allocation of a portion of discretionary public funds. This shift from top-down, closed government to decentralized, open and smarter governance may be the major social innovation of the 21st century.
Checklists have been used to improve outcomes in various fields. We introduce the checklists to facilitate taking action and interact with various stakeholders. Developing a checklist is a continuous process. When couples with an understanding of the political ecosystem and the stakeholders involved in addressing particular public challenges, the various checklists informed by best practice and proven efficacy, can allow for citizen engagement with their representatives and other individuals and organizations within the ecosystem.
As our knowledge about the world increases, so too does its complexity. And as complexity goes up, so do the opportunities for failure. Medicine is a great example of where our increased knowledge has made things better, but also more complex, with more possibilities for snafus. Before the mid-20th century, medicine was pretty simple. There wasn’t much specialization; when you went to the hospital, there was usually one doctor and a few general nurses overseeing your care.
Now when one goes to the hospital, he or she can have several teams taking care of you. Nurses, nurse technicians, radiologists, dieticians, oncologists, cardiologists, and so on and so forth. All these people have the know-how to deliver top-notch healthcare, and yet studies show that failures are common, most often due to plain old ineptitude. For example, 30% of patients who suffer a stroke receive incomplete or inappropriate care from their doctors, as do 45% of patients with asthma, and 60% of patients with pneumonia.
Monitor the Process: Tracers
The US constitution created a political structure that in the past two centuries has evolved into an extremely complex organism, making it nearly impossible for the average citizen to fully grasp and more specifically easily manipulated by individuals and institutions that are able to buy into the system . Processes have emerged, costumes established and laws enacted that enhance the constitutionally defined process for legislation laid out by the founders. The process leading to legislation, implementation and monitoring is complicated and easily corrupted. More so when the motivation and information of the multiple stakeholders are not aligned and often in conflict. Transparency, as a democratic principle for citizen involvement, although with many limitations has the potential, presented properly to allow more meaningful citizen input.
The concept of tracers, more commonly used in the era of RFID codes and other technologic advances to monitor flow throw complex system, provides a framework to more meaningfully engage as citizens in our government. Using the tracer framework, when indicated, we may follow the course of legislation and its implementation course. Recognizing the multiple stakeholders and barriers, provides a structure for transparency available to all. For example, the tracking the impact of the recently passed legislation to address the opioid epidemic. Using tracer methodology allows us as citizens to experience the impact of the legislation at the various levels it was meant to impact. Coupled with checklists, an understanding of the complexity of the particular ecosystem, tools for collaboration, using the tracer approach can significantly inform and lead to outcomes that a responsive to the public.
The specific examples we provide are motivated by evidence based optimal care and best practice. We highlight challenges and focus on resources, assessment, handoffs, interaction with external stakeholders (insurance , criminal justice).
Democratize and Share the Outcomes: Health of the Nation
Current political decision making and government performance suffers from information asymmetry. It is crucial for decision making to have relevant, accessible, reliable and timely information. The Health of the Nation Initiative provides ongoing data and information that is relevant to the challenges facing our nation and the process and resources addressing them. We provide information where available and to seek to create a political process to develop the needed data sources for public use. Taken together, the selected indicators reflect the overall health of the nation and the efficiency and efficacy of our political system. The data allows us to assess how we are doing and what we need to do to achieve excellent outcomes. The initiative will explore and address the challenges of transparency, accountability and public reporting.
In addition to the ongoing information a periodic Health of the Nation event will take place. It can be thought of as a celebration of the benefits of the democratic system as a framework for our body politic.
It is well known that transparent data about function and outcomes is essential for learning about and “treating” complex evolving systems. To have a citizen responsive health care system, there is a need to better understand and leverage the role of public reporting of healthcare outcomes and related performance information about hospitals and other healthcare systems. In particular to test the proposition that reliable, timely actionable data about health care organization’s performance can inform citizens about their health care system and motivate them to play a role in improving healthcare outcomes.
Celebrate: Rituals and Holidays
Americans have in many ways lost the collective vision that provided a container for the diverse body politic established by the constitution. It is not as if the founders had not anticipated the challenges faced by such a diverse body politic.
Rituals can help affirm the social contract established and fought for by prior generations of Americans. Many religions have established rituals that sustain them from generation to generation. The passover Seder as well as other established cultural and religious rituals can serve as a model and framework for a national ritual. As a central part of the ritual, we can build on Washington’s Farewell Address in which he offered call for recognizing the importance of being Americans regardless of the various, multiple identities we hold important that define and energise us. Citizens across the country can initiate a civic ritual, perhaps on February 22nd, a ritual that builds on Washington’s counsel and celebrates our shared values and develops strategies that promote cohesion rather than division. Perhaps July 4th, September 19 are potential dates. The ritual, using a shared document, that is reflective of the “identity of the users” provides an opportunity for civic reflection and strengthen ties among individuals, families, communities and nations. The ritual allow for patriotic reflection and sharing of hope allowing for a more intimate sharing of common bonds.