A better future for family medicine and the health of the public requires learning from history. Decades ago, the family physician visionary Gayle Stephens framed family medicine as a counter culture movement. The sociologist Paul Starr, in his seminal book The Social Transformation of American Medicine, wrote, “The dream of reason did not take power into account.” It is forty years later and despite earnest efforts, family medicine and primary care remain an under-resourced sector of US health care. I propose that we need to fundamentally rethink our strategies to assert power to transform health care on a strengthened and better resourced foundation of primary care. This will require strengthening allyship with patients and the public to build a broad-based social movement that demands a fundamental restructuring of the health system and democratization of health that takes power back from interests profiting from the status quo.