My wife, Haley, and I celebrated our fifth wedding anniversary last month. However, we have yet to officially sign a marriage license. We simply didn’t feel it was right for us to reap the benefits and privileges of legal marriage when some of our friends and family members weren’t offered that same right. In June, all that changed for the estimated 12 million Americans who openly identify as lesbian, gay, bisexual, or transgender.
The recent Supreme Court decision is a culminating policy event that is the result of a decades-long movement for marriage equality. This movement involved the determination and leadership of thousands of individuals, community-based organizations, and policymakers. As I reflect on this landmark moment in our country’s history, I can’t help but think about the lessons of this movement and what it can teach those of us working to improve the health care system.
Sociology teaches us that social movements—like the Civil Rights Movement—go through natural stages of maturation. Recently, I read an article exploring the role of philanthropy in supporting movements, which summarizes this phenomenon well:
Movements are fluid and evolve differently based on political, economic, and social circumstances. After they emerge, movements generally coalesce around an identity and vision, and then sometimes they are formalized through public awareness campaigns and network development. Over time, movements achieve successes and suffer setbacks, might face counter-movements or generate new movements, and produce a variety of outcomes.
In the world of health care, it’s been over a century since Teddy Roosevelt became the first president to push for expanded health coverage options. In the decades since, a cadre of concerned citizens, community-based organizations, and political leaders built a movement around the collective aspiration that all people in the United States have access to health insurance coverage. In many respects, the Affordable Care Act can be seen as a culminating achievement of this movement, as it cemented in policy the desire to insure all Americans, and made available new coverage options that get us closer to that goal.
To be clear, there is still much work to be done to ensure all people living in this country have access to the health care they need, let alone thrive as healthy, productive members of our society. In a couple of health care issue areas—specifically, health equity and consumer-oriented health systems transformation—nascent change efforts are showing promise of developing into full-blown movements in the coming years and decades.
Being clear about which stage of a movement we’re operating in is essential, because different stages of movement-building require different skills and tactics. At CCMU, our advanced stage health insurance coverage work entails policy implementation and advocacy, assessing progress toward long-term goals, and refreshing our leadership approaches in this sphere. On the other hand, our early stage consumer-oriented transformation and health equity work entails research, developing messaging frames, organizing a base of constituents and allies, strategically assessing power, and building public will.
Building the capacities of community-based organizations and pairing the right tactics within these change efforts will be essential to ensuring forward progress. We’re committed to this learning and growing and to being active leaders in working to create a better health care system in Colorado and beyond. And, I’ll keep looking for lessons from other great movements and how they reach important milestones—just as soon as I finish signing this marriage license!