Employers: Passive Purchasers or Provocateurs? Cathie Jo Martin Boston University Abstract 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 contribu- tions 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. Business and Health Care Financing in the Twenty-First Century At times it seems easy to forget what decade we are in, because in some rather odd ways the early twenty-first century resembles the early years of the 1990s. Once again we are veering toward war with an Islamic coun- try—once and again the overheated stock market has faltered. The pres- ident is named George Bush, and ten years after Bill Clinton ran for pres- ident promising national health reform, doomsayers are predicting calamity for the health system. As the incomparable Yogi Berra so suc- cinctly put it, “It’s like deja vu all over again.” At other times these easy comparisons with the past decade seem sanguine, as many conditions in our post–11 September world are far worse. Ten years ago airline pas- Journal of Health Politics, Policy and Law, Vol. 28, Nos. 2–3, April–June 2003. Copyright © 2003 by Duke University Press. The author wishes to thank Mark Peterson, Raymond Wertz, Mark Schlesinger, Kathy Dunham, and Miriam Laugesen for their thoughtful comments.