Republicans are finding it difficult to articulate a position about what they will do after repealing The Patient Protection and Affordable Care Act (PPACA) aka, “Obamacare”.   Nevertheless, formulating a policy, which is fiscally responsible and politically strategic, will provide the Republicans a tremendous advantage in the political market place for decades to come. The following are ten reasons  Republicans should embrace a single payer system to replace “Obamacare” and achieve universal healthcare coverage with choice and access to quality affordable care for all Americans.  To implement a single payer system, the Republicans may select from popular existing examples:

1. The Veterans Health Administration, a government-run system that provides healthcare for our veterans,

2. Medicare, the popular government administered healthcare system for the elderly and disabled,

3. Federal Employees Health Program, a healthcare arrangement that our elected officials and other government workers enjoy.

Should they need more ideas for their single payer system; the Republicans can study the healthcare systems of Canada, Germany, France, Israel, and most other industrialized nations that cover all their citizens at a significantly lower cost and mostly comparable if not better quality and potentially increased options for choice of  providers for care.

Reason # 1: Jobs

By replacing “Obamacare”  with a single payer  system for healthcare  the Republicans can help employers, especially small businesses focus on what they do best, making products and provide  services, rather than worry about employee health benefits. Removing the burden of having employers pay for healthcare insurance for their employees and meet all the expensive administrative and regulatory costs associated with that, will allow small businesses to use the savings to hire more employees.  Avoiding healthcare costs, employers will hire more workers rather than having current employees work overtime.  Corporations and other employers, will have clarity as to what their future obligation regarding healthcare will be, virtually nothing, and can more effectively plan and execute their business plans.

Reason #2: Bend the curve of the US debt 

The rapid growth of federal healthcare spending is the primary driver of long-term deficits and the unsustainable US debt. A single payer healthcare system, according to many economists, will “bend the curve”. Eliminating administrative inefficiencies, profits by middle persons that do not contribute to improved value, making healthcare services available at an earlier stage of the illness, will all have a significant impact on the overall cost of healthcare.  Adopting a single payer system will diminish the cost of healthcare provided to public employees and pensions in the public sector, strengthening the ability of local, state and governments to provide other needed services for their constituencies.

Reason #3: Demonstrate a commitment for a free market system

The republicans’ commitment to a single payer healthcare system will reinforce their belief in the importance of free markets. The current dysfunctional healthcare system is complex and influenced by many interest groups that have corrupted the playing field to achieve an advantage in the healthcare market place. Obamacare has largely maintained the role of the oversized importance of special interests in the healthcare sector. Healthcare stakeholders such as AARP,  The US Chamber of Commerce, unions, insurance companies, Pharma and healthcare providers, are about maintaining the crony capitalism that governs the inefficient healthcare sector. A single payer system, operating with transparency and accountability of all stakeholders, will create a truly free market where citizens and consumers can make meaningful choices about healthcare value. Many options such as vouchers to select among qualified insurance companies, a plan similar to the Federal Employee Benefits can maintain choice and control by the healthcare user and promote competition.

Reason #4: Promote competiveness

The US economy’s success is due to the opportunities available to anyone to compete in the marketplace. The ability to start a business, to innovate, has been the bedrock of our national success. A single payer system where individuals will not be shackled to employers that provide them healthcare will promote competition, and create new products and services. On a national level, it has been well documented that our current healthcare system has impact on our company’s international competiveness.

Reason #5: Promote liberty

The past few years have rightly focused the political debate on the issues of liberty and the importance of individual choice. The current healthcare system, as well as “Obamacare”, highlights the limited choices that Americans have when it comes to healthcare.  Americans receiving healthcare benefits through Medicare and Medicaid, are restricted by choices dictated by congress and state governments, Americans receiving insurance through tax-exempt employer plans have little say in the choice of plan, and our veterans get care defined by the Veterans Administration. A single payer system does not mean just one choice; it will allow for various plans and all Americans will be able to choose directly the health plan that most serves their need.

Reason #6: Competence and problem solving

Americans are eager for politicians that are dedicated to solving the problems facing our nation. Republicans have an opportunity to deliver on this expectation. With a Romney presidency, a business oriented approach to the healthcare problem will identify the hundreds of billions of dollars of inefficiencies and waste that contribute to healthcare costs. A recent report by the Institute of Medicine, estimates that $750 of our nearly $2.5 trillion dollars spent on health care do not improve health. With everyone dependent on the same healthcare system, including our politicians, the barriers to achieve an efficient healthcare system will be easier to overcome. The result will be an appreciation by the public of the ability of the Republicans to solve problems rather that just offer ideologically motivated sound bites.

Reason #7: Shrink the government

Shrinking the government has been a long standing goal for many Republicans and more recently for many Democrats. The fragmented healthcare system requires a federal and state bureaucracy to oversee the multiple programs that have been built patchwork over the years. A single healthcare system will require less government bureaucracy to administer. How refreshing will it be to see a simple organizational chart that describes the federal and state governments’ agencies that oversee our coordinated healthcare system? Building a publically available user-friendly system for monitoring the outcomes of the healthcare system will prevent the excessive of growth of government.

Reason #8: Politics

Offering a single payer solution to the healthcare and fiscal challenges makes for good politics. It can provide a “Nixon going to China” moment in our politics. The republicans have made it clear during the healthcare debates that they believe in affordable healthcare availability for all Americans. Promoting a single payer system with policies to make it affordable for all individuals and our national economy makes sense. This approach will gain support from the nearly 60% of Americans who supported universal healthcare prior to the introduction of the individual mandate and the relentless and effective campaign to discredit “Obamacare”. The Republicans will maintain the support of the Tea Party members who want to keep government out of Medicare. They may gain support from progressives, who support a single payer system and believe Obama no longer represents them. Regardless, few in the Republican base will consider ever voting for Obama.

Reason # 9: Cripple the Unions

A single payer system that guarantees access to quality care to all Americans regardless of type of employment or union membership can lead to further weaken the union movement.    It is well known that the unions are the natural base of the Democratic Party as they contribute both financially and with grass root support to electing democratic politicians. A key justification for the unions is their ability to achieve (extract) generous healthcare benefits “Cadillac plans”, from their employers for current and retired employees. Without the need to collectively bargain for these benefits, it is likely that unions will further lose their reason for existing in our market place. In the post Citizens-United political world, the impact of corporate political speech with union inability to engage in the public debates, will further serve the Republican agenda.  In addition, the weakening of labor unions will satisfy the hatred that many conservatives have for unions.

Reason #10: Religious freedom 

A single payer system will make the position of the Catholic Church and other evangelical Christians less conflicted. These stakeholders benefit from paying no taxes as religious institutions, and they will be relieved of the moral challenge of needing to provide contraception and other reproductive healthcare services to their employees.


The Republicans have made repeal and replacing “Obamacare” a central political objective for this election. By embracing the single payer healthcare system as an alternative to Obamacare, the Republicans can achieve electoral success in November and be positioned to implement legislation that will serve many of the core conservative values of the Republican Party.  Adopting the single payer approach will position Romney, should he be elected, to  drive out inefficiencies in the pre-” Obamacare”  healthcare system and usher in quality affordable healthcare for all Americans at a cost that is affordable.

Healthcare is local and personal with hospitals providing medical services in nearly every community across the US. Informed citizens, armed with meaningful data about hospital performance and other relevant information, can engage with their healthcare professionals, local hospital leadership, boards of directors and other healthcare stakeholders including state and federal government officials responsible for healthcare oversight. Joining with others in their community, motivated citizens can identify and act together to solve local healthcare challenges and more actively participate in addressing the national healthcare challenge.

The conversation appearing on the Shrink the Government blog will support our Citiens4health initiatives.

We start with the following question

What can we do as citizens, to achieve a healthcare system that is affordable, accessible and provides quality healthcare for all of us?  

The following questions we be explored in future posts:

How can we make hospitals and other healthcare organizations safer?

How can we improve the quality of services at  hospitals?

How can we improve the value and cost of healthcare?

How can we improve public reporting by hospitals?

How can we improve the health of our communities utilizing  community benefit activities by  non profits hospitals?

In a July 2 nd Op Ed that appeared in the NY Times David Brooks, makes the case against the ACA and offers a Republicans alternative. Here is a response to his concerns… A brief version will appear in the comment section of the article. Continue Reading »

I am a United States citizen. I take that role quite seriously. The past few years — with the financial meltdown, polarized political debate over health care, and now the concerns about the financial future of the country — have made me realize that voting in elections is not enough. Now more than ever, I realize that citizenship requires more active engagement in the political process. As an engaged citizen and psychiatrist, I am able to contribute a unique voice to the current political conversation. I started Citizens4health  to provide a vehicle for my civic engagement and to reach out to others who share my belief that motivated citizens can have an impact in our political system.

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.

But my passions and experience go beyond ideologies. In other roles as a healthcare provider, a consumer of healthcare services, and a patient, I have had particular interest in the healthcare debate that led to the passage of the Affordable Care Act (ACA). I followed the debate closely in the print media, watched hearings and news conferences on C-SPAN and various news shows, participated in town hall meetings, and discussed developments with fellow healthcare providers and citizens. What I came to realize was quite distressing: Rather than being based on facts, the debate was driven by opinions and lies crafted by highly paid experts to assure the continuation of the status quo. Rather than achieving solutions, the healthcare debate, leading to the ACA and the subsequent political fallout, have poisoned our political environment. Instead of contributing solutions to a major problem, it has further entrenched the political gridlock and made solutions to an urgent problem that much more elusive.

More than anything, the most discouraging aspect of the current political environment is what it says about how our political representatives view us, their fellow citizens. I felt that these politicians’ actions and speeches were quite demeaning, tapping into our pessimism rather than our optimism.

So when the president and other politicians ask the public for ideas, my understanding of psychology and involvement in the healthcare system gets me engaged. I want to change the way legislators look at the issues. I want to change the conversation. My mind reels with action plans that leverage digital technology to allow every citizen to contribute and share ideas that will lead to solutions.

If you share my concerns about the current state of the political environment and feel as I do that we need to tap into the American optimism, not pessimism, I invite you to join me and my fellow citizens as we engage in a deliberative process that will achieve lasting solutions that work for us.

Join me in reclaiming a political voice and exercising our citizenship on the important issues of the day.

Shimon Waldfogel


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