In the United States, the national and state levels of healthcare politics and policy have been extensively researched, but the metropolitan/local level has been neglected. In "Healthcare Politics: Louisville's Growth Machine 1947-2007," David Houvenagle reviews past local healthcare politics research and offers fresh insight into local health policy and politics. Working from a urban political economy perspective, Houvenagle explored both the local power structure of healthcare and its policy agenda at salient times of history when there was significant city-wide healthcare decision-making. Then using social network analysis and field interviews Houvenagle explored who recently was in charge, their policy agenda and their decision-making processes. He articulates how the urban political economy theory called the "Growth Machine Thesis" is a substantial, theoretical explanation for both Louisville Kentucky's local healthcare political power structure and local health policy agenda over the time span of six decades.