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A characteristic of the German health care market is the high complexity, amongst others due to the plurality of actors and interest groups. With so many players involved, health care reforms necessarily are the outcome of a quest for influence reflecting the relative power of interest groups. However, in much of the health economics literature, this fact is neglected, with the consequence that public regulation fails to have the intended effect. The treatment of social (interest) groups is central to understand political economic processes. Basic models in this area are the models of Olson (1965), Peltzman (1976) and Becker (1983). The objective of such model considerations in the health care market is to maximize efficiency and quality of care and thereby reduce expenditures. The section “The German health care market and its players: An overview from an economic perspective” analyses the structure of the health care market in Germany together with selected health challenges of the last decade. It questions to which extent the new political economy in contrast to welfare economy is able to explain health economic aspects. The section “Drug Prices and Pressure Group Activities in the German Health Care Market: An Application of the Becker Model” analyses the shift of power and influence among the pharmaceutical industry, the pharmacies and the social health insurers (SHI). Since the health care reform in 2004, these interest groups have been negotiating the structure of surcharges and discounts among each other without any intervention from the government. This reflects the assumption of a passive government in the Becker (1983) model and makes this model to a good choice for application. The negotiations and the resulting amendments of this ordinance express the shift of power and influence among the involved interest groups in the German health care market after 2004. The first assumption is a closed system based on the theoretical work by Becker. The amount of total budget and the amount of total influence is constant and defined as 10. In such a standardized system, the influence by producers and pharmacies decreases about 0.007 units of political pressure to the value 9.989, whereas the influence by SHI increases about 0.007 units to the value 0.011 between 2008 and 2010. More realistic is the second assumption, the assumption of an open system where the amount of total budget and the amount of total influence can change over the years. With this assumption a trend becomes apparent which shows an increase in political pressure by SHI about 0.015 units to the value 0.036 and a decrease of political pressure by pharmacies and producers about 18.326 units to the value 34.022 between 2008 and 2010. This reflects the cost control trend in combination with the empowerment incentives for SHI. Noteworthy is the high pressure level of producers compared to the other interest groups. As a conclusion one can say that the last years show a movement to more competition between the interest groups. This leads to more balanced power relations. But nevertheless, the most powerful group is still the producer group and the influence of the SHI is still very low. However, the government does not always behave passively. On sensitive issues for voters such as co-payments, the government tries to maximize votes. So, in the section “Drug Prices, Rents, and Votes in the German Health Care Market: An Application of the Peltzman Model”, the reaction of consumers (insured persons) and producers (pharmaceutical industry) based on electoral behavior and relating to drug prices and co-payments imposed on drugs is analyzed, using the health care reform of 2004 as an experience. The changes in prices and medications after this reform make it to a natural choice. For the analysis, the interest group model by Peltzman (1976) is applied to the German health care market. The vote-maximizing government has to find the optimal combination of rent and price of regulation. For the optimum solution, the variation of votes on the part of pharmaceutical industry has to equal the variation of votes on the part of consumers. Reflecting different power structures leads to drug prices ranging from 5 to 50 Euros, associated with a co-payment of 5 Euros. Prices between 50 and 100 Euros are possible as well, reflecting a balance of power facing the pharmaceutical industry. These prices are associated with a co-payment of 10% of the selling price. Concerning the transition from 1989 reference price regime to the 2004 reform one can say that producers who had accepted the reference price had an incentive to increase their price while lowering their sales volume.