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The National Health Service in England is on the verge of sweeping changes that would apply free-market methods to the state-financed health care system. The government proposal, WORKING FOR PATIENTS, would bring about the most far-reaching changes in the NHS since it was founded following World War II. This paper examines a number of important issues and questions raised by the White Paper on the NHS. One cannot understand the proposed changes in the NHS in abstraction from the broader context of the basic principles upon which the NHS was originally established: universalism, equality, accessibility, and continuity of care. The so-called reforms contained in the White Paper potentially threaten an internationally unique national health care system.