The 1996 welfare reform law, for the first time, connected welfare benefits with an expectation that recipients would work or participate in training. That work requirement led to record increases in employment and earnings and a record decrease in poverty and welfare dependence after it was enacted.

While Obama's economic policies have failed to spur growth, our anti-poverty programs have long failed to promote upward mobility and move people from welfare to work.

Encouraging wellness and prevention helps improve quality of life and can lower costs, too. I saw too many patients who had poor health because of their decisions, but too often, all they needed was a doctor to help point them in the right direction.

This federal welfare system is large, fragmented, and growing in cost. This system may have started out with good intentions, but it has become a confusing maze of programs that are overlapping, duplicative, poorly coordinated and difficult to administer.

We can create more affordable coverage options for all Americans and help patients with pre-existing conditions - without forcing any satisfied Americans to lose coverage they like - through high-risk pools and reinsurance options.