Purchasing Power in Health: Business, the State, and Health Care Politics

David J. Shulkin, MD
JAMA. 1990;264(10):1329-1330. doi:10.1001/jama.1990.03450100121040.
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For the past two decades, Business has been at war with Medicine. Medicine has lost crucial battles and is still retreating. This book recounts the underlying causes of the conflict and adds an understanding of past and present strategies of the warfare.

In what reads more like a doctoral dissertation than a flowing narrative, the author examines the impact of corporate America on medical care between 1969 and 1988. With extensive interviews requiring 30 pages of footnotes, she recounts the events leading to business' entrance into the health policy forum. The myriad of facts makes for slow reading. Nonetheless, it's an interesting story.

Dwindling corporate profits in the late 1960s set the stage for change in health policy. While the general economy faltered, the health care industry was undergoing a growth spurt. With declining revenues and rising medical care benefits, industrial leaders felt compelled to act. By the early 1970s,


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