In 2006, the Netherlands passed the Health Insurance Act requiring all legal residents to obtain health insurance from private insurance companies. The reform created a national health insurance system guaranteed to all citizens regardless of income or labor force status and introduced a market orientation that makes private insurance companies the sole providers of health insurance. How does the new policy compare to the US model of private health insurance provision? Is this reform evidence of a shift toward the American model? We use a comparative case study method to distinguish the new Dutch system from the private insurance system in the United States. We find that although the Dutch system includes market solutions similar to the US model, it still provides a universal guarantee of coverage to all of its citizens and should be viewed as 'privatization' within the Dutch context rather than a cooptation of American health policy.