Americans were health ‘‘haves’’ rather than have-nots. They had something to lose,
and reasonably enough, they weighed the prospective advantages of government
action against its possible costs. By contrast, the health have-nots tended to be those
who lacked resources in other areas as well. Their political voice was even more
muted than their numbers would have dictated. In contemporary circumstances,
unless a majority of the middle and professional classes in the United States believe
that their interests coincide with those of the working class and the poor, the basic
structure of power and interest groups will tilt strongly against redistributive reform.
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