The subject of this article is the impact of the political participation of business on the substance, process, and power of State policymaking about medical care in the 1980s. The article focuses on organized business coalitions, how and why they emerged to participate in the health policy debate, and the impact of these interests on health policy itself. It asks the question, How and to what extent has the emergence of business as an actor in health care politics changed both the process by which health policy is formulated at the state and federal level and the substance of health policy itself? It comes to the conclusion that business involvement has varied in impact and intensity from state to state, that business participation ultimately reinforces the control of the private sector over medical care resources, that business power can be used to decrease the autonomy and power of medical providers and is consistent with and reinforces current trends toward privatization and corporatization of the medical care system, and that the political participation of business has produced a degree of structural change in the medical care system. These changes have profound implications for unorganized consumer constituencies and their access to the policy process.
Get full access to this article
View all access options for this article.
References
1.
GoldbeckW.Executive Director of the Washington Business Group on Health. Interview with the author, Washington, D.C., April 1984.
2.
IglehartJ.Big business and health care in the heartland: An interview with Robert Burnett. Health Aff. 3 (1): 40–49, 1984.
3.
Adviser to the Massachusetts Business Roundtable. Interview with the author, Boston, Mass. June 1984.
4.
Committee for Economic Development. Building a National Health Care System. CED, New York, April 1973.
5.
CalifanoJ.Testimony to the Joint Economic Committee of the U.S. Congress, Washington, D.C., April 12, 1984.
6.
SheltonJ., Ford Motor Company. Testimony to the Joint Economic Committee of the U.S. Congress, Washington, D.C., April 2, 1984.
7.
Fringe benefits grow to 35 percent. Wall Street Journal, October 5, 1976.
8.
TellE.FalikM.FoxP.Private-sector health care initiatives: A comparative perspective in four communities. Milbank Mem. Fund Q. 62 (3): 357–379, 1984.
9.
SalmonJ.Corporate Attempts to Reorganize the American Health Care System. Doctoral dissertation, Cornell University, August 1978 (unpublished).
10.
NavarroV.The political economy of medical care. In Health and Medical Care in the U.S.: A Critical Analysis, edited by NavarroV., Chapter 6. Baywood Publishing Company, Farmingdale, N.Y., 1977.
Clearinghouse on Business Coalitions for Health Action. Directory of Business Coalitions for Health Action. U.S. Chamber of Commerce, Washington, D.C., March 1984.
14.
LoomisW., Dexter Corporation. Comments at National Governors' Association meeting, Denver, Colorado. January 16–17, 1984.
15.
Staff member of the Washington Business Group on Health. Interview with the author, Washington, D.C., June 1984.
16.
GoldbeckW.Interview with the author, Washington, D.C., June 1984.
17.
NolanJ.Political surfing when issues break. Harvard Business Review, January/February 1985, pp. 72–82.
18.
BanksL.Taking on the hostile media. Harvard Business Review, March/April 1978.
19.
FinnD.Public invisibility of corporate leaders. Harvard Business Review, November/December 1980.
20.
FennD.Finding where the power lies in government. Harvard Business Review, September/October 1979.
21.
DomhoffG. W.The Powers That Be: Processes of Ruling Class Domination in America. Random House, New York, 1978.
22.
AlfordR. R.FriedlandR.Political participation in public policy. Ann. Rev. Sociol.1: 429–479, 1975.
23.
KolkoG.The Triumph of Conservatism: A Reinterpretation of American History, 1900–1916. Free Press, New York, 1967.
24.
PanitchL.The development of corporatism in liberal democracies. Comp. Political Studies10 (1): 61–90, 1977.
25.
AlfordR. R.Health Care Politics: Ideological and Interest Group Barriers to Reform. University of Chicago Press, Chicago, 1975.
26.
SeidelmanR.Pluralism heaven's dissenting angels: Corporatism in the American political economy. In Political Economy of Public Policy, p. 59ff. Sage, Beverly Hills, 1982.
EstesC. L.Political Economy, Health and Aging. Little, Brown, Boston, 1984.
29.
O'ConnorJ.The Fiscal Crisis of the State. St. Martins Press, New York, 1973.
30.
FriedlandR.PivenF. F.AlfordR. R.Political conflict, urban structure and the fiscal crisis. Int. J. Urban Regional Res. 1 (3): 446, 1977.
31.
Massachusetts Health Care Coalition participant. Interview with the author, Boston, Mass., June 1984.
32.
BergtholdL.Business and the Politics of Health Policy Change. Doctoral dissertation, University of California, Santa Cruz, June 1985 (unpublished).
33.
Directory of Business Coalitions for Health Action. U.S. Chamber of Commerce, Washington, D.C., 1984.
34.
State by State Hospital Rate Regulation Survey. InterStudy, Excelsior, Minn., November 4, 1983.
35.
A special report on health issues in election year ‘84: State roundup. Review17(5), 1984.
36.
Lewin and Associates. Private sector initiatives—executive summary. As quoted in HillmanD.ChristiansonJ.Health care expenditure containment in the United States: Strategies at the state and local level. Soc. Sci. Med.20(12), 1985.
37.
SloanF.Rate regulation as a strategy for hospital cost control: Evidence from the last decade. Milbank Mem. Fund Q. 61: 195–222, 1983.
38.
StarrP.The Social Transformation of American Medicine. Basic Books, New York, 1982.
39.
BergtholdL.Crabs in a bucket: The politics of health care reform in California. J. Health Polit. Policy Law9 (2): 203–222, 1984.
40.
WolinS.The new public philosophy. Democracy, October 1981, pp. 23–26.
41.
RenaudM.Quebec: The adventures of a narcissistic state. In The End of An Illusion: The Future of Health Policy in Western Industrialized Nations, edited by de KervasdoueJ.KimberlyJ. R.RodwinV. G.University of California Press, Berkeley, 1984.
42.
MoroneJ.MarmorT. R.Representing consumer interests: The case of American health planning. In Political Analysis and American Medical Care, edited by MarmorT. R.Cambridge University Press, Cambridge, 1983.
43.
KleinfieldN. R.When the boss becomes your doctor. New York Times, January 5, 1986, p. 1.
