Many commissions have been formed to recommend changes in the health care system, and many reports and recommendations have been issued, but with little impact. This study seeks to understand the sources of this resistance to change and recommends measures based on this analysis. Contents: The Structure of Medical Care in Israel; The Ministry of Health; The KHC and the Histadrut; Structural Causes of the Crisis in the KHC; The History of Reform Efforts in the KHC; Reducing Surgical Queues; A Case Study; Alternatives to Public Medicine: The Private Sector; Conclusions and Recommendations. Co-published with the Jerusalem Center for Public Affairs.