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Contemporary events illustrate both the opportunities and the obstacles to democratic nation-building through military occupation. In addition to international influences or prewar legacies, domestic political forces within the occupying nation also set limits on the capacity for social and political change. We illustrate this dynamic by examining the effects of U.S. interest group politics on Japanese health policy during the American occupation after World War II. These struggles over health policy in postwar Japan illustrate that military occupations do not operate in a political vacuum but are shaped by the push and pull of domestic interest group politics back home.