TRANSFORMATION OF STATE
FINANCING AND REGULATION
While one of the purposes of this book is to demonstrate the diversity of health-related social movement activity directed at institutions other than the state, we begin with the state, as the government plays a key role in establishing the legal and bureaucratic rules that regulate at least some aspects of most health institutions in the United States. The state is therefore both a familiar and important target for social movement activism.
The American political system provides multiple opportunities and venues for social movement activism. Its federated system of state and national governments—each with its own executive, legislative, judicial, and regulatory venues for pressing claims—as well as a strong cultural commitment to freedom of association and speech, voluntarism, and civic participation, have long encouraged political claims making against the state. And yet, as the authors in this section elaborate, the American political system also presents a number of formidable obstacles for social movements seeking to influence the development of public policy. Within each political venue, social movements must compete for attention and resources with other interest groups and advocacy organizations, many with considerably more resources and closer ties to policymakers. And in a context in which political influence with policymakers depends on the size and resources of social movement constituencies—as well as the scope and ambition of reform goals—social movements also face the organizational and strategic challenges of forging coalitions among diverse constituencies, and adapting goals and tactics for particular institutional forums. The papers in this section examine these and other obstacles faced by social movements seeking health care policy reform at both the national and state levels, and in both legislative and regulatory arenas.
In chapter 2, Constance Nathanson examines the challenges of mobilizing for health policies that address the needs of the poor. Nathanson argues that socioeconomic and racial inequalities in the health of Americans are both profound and largely invisible in public and