Mobilizing for Reform:
Cohesion in State Health Care Coalitions
Holly Jarman and Scott L. Greer
Most of the time in American politics, groups seeking small objectives win. Policies change incrementally, no matter how much desire there might be for greater changes. This is why major, successful social movements are so interesting to scholars. We study them because they are the exception to the rule, big coalitions promoting big ideas that can become the foundations of major social change. As of 2008, supporters of substantial healthcare reform have been trying once again to do what they have failed to do so often: overcome the fragmentation of the U.S. political system and pass universal healthcare reform.
The problem for healthcare advocates is the “paradox of purity”: groups with influence among policymakers have a better chance of getting their ideas implemented, but are incentivized to adopt narrower policy goals or accept smaller reforms. Less influential groups are free to think big, but have a greatly reduced chance of getting their goals implemented. Given these constraints, we ask how a social movement for health reform might be built. How can proponents of big ideas build a big enough support base to overcome fragmented U.S. politics and get their ideas implemented?
Fragmentation of some sort has long been cited as a reason for the American failure to pass universal healthcare coverage. Different authors note different key variables: as distinct as race, the federal system, the tax code, the weakness of unions, path dependency since the New Deal, and the power of the medical lobby (Gordon 2003; Hacker 2002; Hoffman 2006a; Mayes 2004; Morone and Jacobs 2005; Quadagno 2005; Skocpol 1997; Starr 1982). Much of the literature is occupied with efforts to create a hierarchy of the different variables: is racism more or less important than the American Medical Association (AMA), or are the courts more of an obstacle