This article addresses the potential role of business leadership in diverse efforts to reform health care financing: exploring managers efforts to alter health care markets in their role as large purchasers of health insurance,their potential contributions to future national policy proposals, and their involvement with community-level activities to control local health costs and quality. I argue that managers' leadership in market restructuring and community health initiatives will be difficult to reproduce in the realm of major national health policy initiatives due to constraints related to ideas,interests, and organization.

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