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PUBLIC HEALTH THEN AND NOW
Because of the importance of grassroots social movements, or "change from below," in the history of US reform, the relationship between social movements and demands for universal health care is a critical one.
National health reform campaigns in the 20th century were initiated and run by elites more concerned with defending against attacks from interest groups than with popular mobilization, and grassroots reformers in the labor, civil rights, feminist, and AIDS activist movements have concentrated more on immediate and incremental changes than on transforming the health care system itself.
However, grassroots health care demands have also contained the seeds of a wider critique of the American health care system, leading some movements to adopt calls for universal coverage.
THE UNITED STATES IN THE 20th century witnessed the flowering of social movements demanding access to the American Dream. Women, workers, African Americans, seniors, and welfare recipients, to name just a few, organized to change a society that made them second-class citizens. Although each movement had its leaders, each relied on grassroots participation, or "change from below": they were made up of ordinary people demanding reform, often on their own behalf.1
Yet no movement of comparable size or intensity has arisen in the United States to demand universal health care. Labor unions, senior citizens, socialists, and other groups have certainly participated in campaigns to redesign the health care system, but the campaigns themselves have most often been initiated and run by elite organizations and individuals with little connection to a popular base of support Public opinion has generally run in favor of health care reform, but popular approval has not been matched by the rise of a large-scale, activist popular movement for change.2 Because of the importance of grassroots movements to reform in the United States, it is important to ask why there has never been such a movement for universal health care, and whether and how one may emerge now and in the future.
This article brings together some recent historical depictions of struggles for universal health care in the 20th century, with an emphasis on the role of popular mobilization-or lack thereof-in these struggles. It offers a new understanding of social movements and health care reform. Many grassroots...