Business and the pushcart vendors in an age of supermarkets

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.