Social Movements and
the Transformation of American
Sandra R. Levitsky and Jane Banaszak-Holl
The paradoxes of the U.S. health care system are well known: The United States spends more money on health care than any other advanced industrialized country,1 and yet it ranks among the worst on many key indicators of health care quality.2 Forty-seven million Americans—or 16% of the population—remain uninsured, whereas in other industrialized nations all citizens are generally covered by insurance. In the U.S. health system, many patients receive more care than they need,3 many receive less care than medical practice guidelines prescribe, and many receive the wrong kind of care.4 There are few contemporary social problems in the United States that affect more people on a day-to-day basis than the inefficiencies and inequities of the U.S. health care system. The pervasiveness of these problems—and the widespread public dissatisfaction they engender—suggests a social arena ripe for collective reform efforts.
But scholars who study social movements and American health care reform have generally disagreed about the prevalence—and effectiveness—of social movements in health care reform. One perspective sees health-related collective action everywhere: from workers’ campaigns to promote occupational safety and health (see also Rosner and Markowitz 1987), the civil rights movement’s claims for racial equality in health care (Quadagno 2000), and feminist challenges to gender bias in medicine (Morgen 2002), to health claims relating to abortion (Luker 1984; Staggenborg 1991), breast cancer (McCormick, Brown, and Zavestoski 2003; Taylor and Van Willigen 1996), smoking (Nathanson 1999), AIDS (Epstein 1996), disabilities (Fleischer and Zames 2000; Shapiro 1994), and environmental justice (Bullard 1993). A second perspective, in striking contrast, despairs of the absence of collective action: despite the rapidly growing ranks of the uninsured and underinsured and