Why do resource-constrained countries make costly commitments to universal health coverage and AIDS treatment after transitioning to democracy? At a time when the world’s wealthiest nations struggle to make healthcare and medicine available to everyone, this book explores the dynamics that made landmark policies possible in Thailand and Brazil but which have led to prolonged struggle and contestation in South Africa. While conventional wisdom suggests that democratization empowers the masses, this book draws attention to an underappreciated dynamic: that democratization empowers elites from esteemed professions – frequently doctors and lawyers – who forge progressive change on behalf of those in need in the face of broader opposition at home and from abroad. The relative success of professional movements in Thailand and Brazil and failure in South Africa highlights critical differences in the character of political competition. Whereas fierce political competition provided opportunities for professional movements to have surprising influence on the policymaking process in Thailand and Brazil, the unrivaled dominance of the African National Congress allowed the ruling party the luxury of entertaining only limited healthcare reform and charlatan AIDS policy in South Africa. The book offers lessons for the United States and other countries seeking to embark on expansive health reforms.