Colombia's health system is at a crossroads following the current government's reforms. The system has provided one of the highest health care coverage in Latin America with the lowest out-of-pocket expenses, although it is among the least funded. Success is attributed to a model of "ordered competition", based on insurance with a tightly regulated private sector partnership and profit controls. Care for the poor is fully subsidized. The model is similar to the Dutch one. The once functioning system is now in crisis. The article examines which ideological approach is best for managing the health system.