American journal of public health
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Historical Article
Health care reform and social movements in the United States.
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.
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Members of the Rekindling Reform Steering Committee collaborated over a period of several months in early 2002 to develop a set of principles and goals to help guide and define the group's efforts for comprehensive health care reform in the United States. The next step is to circulate this document to the sponsoring organizations for their approval. This document is, then, a work in progress, subject to revision as the process of discussion and review continues. These principles provide a sense of the lessons members of the Rekindling Reform Steering Committee have learned from their study of other countries' universal health care systems, and how those lessons have informed their thinking about the nature of the health care reform needed in United States.
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South Korea is one of the world's most rapidly industrializing countries. Along with industrialization has come universal health insurance. ⋯ Since 1997, with the intervention of the International Monetary Fund, Korean national health insurance (NHI) has experienced deficits and disruption. However, there are lessons to be drawn for the United States from the Korean NHI experience.
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Britain's National Health Service (NHS) was established in the wake of World War II amid a broad consensus that health care should be made available to all. Yet the British only barely succeeded in overcoming professional opposition to form the NHS out of the prewar mixture of limited national insurance, various voluntary insurance schemes, charity care, and public health services. Success stemmed from extraordinary leadership, a parliamentary system of government that gives the winning party great control, and a willingness to make major concessions to key stakeholders. As one of the basic models emulated worldwide, the NHS-in both its original form and its current restructuring-offers a number of relevant lessons for health reform in the United States.
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The Rekindling Reform initiative examined the health systems of 4 countries: Canada, France, Germany, and Great Britain (United Kingdom). From the 4 country reports published in this issue of the American Journal of Public Health, 10 crosscutting themes emerge: (1) coverage, (2) funding, (3) costs, (4) providers, (5) integration, (6) markets, (7) analysis, (8) supply, (9) satisfaction, and (10) leadership. Lessons for the United States are presented under each point.