This essay discusses important aspects of reforms in healthcare in Sweden at the beginning of the 1990s. Healthcare systems are marred by a set of basic dilemmas, without any final solution. The solution to one problem, like low productivity, tends to be followed by new problems arising from the solution. There is also a strong path dependency, given how important health care is in people's lives. Structural reforms are needed, but it is equally important to preserve and promote good cultures. A safe forecast is that health care systems will meet more self-assured patients. Informed patients, though, are mostly for the better.