Privatization is proceeding in all health care systems despite the fact that national health care is heralded as a triumph over the inequities of market forces and private incentives. There seems to be a widespread willingness, even among the social democracies of Western Europe, to see if privatization perhaps can work to increase efficiency and effectiveness, both economic and administrative. Although privatization is taking a number of different forms (see Stewart, Chapter 4 this volume), most focus on the mechanism of competition to achieve more optimal levels of supply and demand, price and quality. In this experimentation, a more nagging question than the specifics of privatization is the role of the state, and, ultimately, the integrity of public responsibility. By allowing an increase in private sector activities, the state, some claim, is spurning its obligation to promote the common good, a situation made worse when government regulation of the private sector appears to be weak. Every act of regulation, however, restricts the reasons for allowing privatization to occur in the first place. This quandary is testing the capacities of states to govern not only health care, but all areas where privatization is underway.