text: Rivera and the Greater New York Hospital Association (GNYHA), which represented 175 hospitals and nursing homes in the city, began working together almost as soon as he became president. The partnership took concrete form with the creation of the joint Healthcare Education Project, which now forms the cornerstone of New York's "medical industrial complex": the coalition of unions, providers, and advocates that keep health-care costs high by promoting "institution-focused care" over less expensive home- and community-based options.