Healthcare has historically been regarded as a local service. But national health systems are increasingly shaped by European integration. Since the 2010 establishment of the European Union’s new economic governance regime in response to the global financial crisis, the Council and the Commission are empowered to vertically intervene in the organization, and financing of member state health systems. The country-specific methodology of the new economic governance regime allowed these executive institutions to target the health systems of member states worst affected by the crisis, imposing pressure to curtail health budgets and marketize service provision. These supranational interventions created new grievances for both workers and users, as wages and material conditions in public health systems deteriorated and users experienced new barriers to access. The experiences of user- and worker-led campaigns in the health systems of Ireland and Madrid during the first decade of the regime demonstrate that these actors are cognisant of this re-scaling of power, and this has provoked some scaling upward of activities and new approaches to understanding grievances. While healthcare activism remains focused on domestic scales, this containment of protest reflects both resource limitations and strategic choice.