The concern regarding the future of the National Health System (SNS) is evident, and the discussion is quite heated. A first necessary reflection addresses the complexity of the institutional architecture of the SNS when establishing a reformist project. Because, as is well known, we are not talking about a “National Health Service” model like the British NHS, but about a “System” that integrates the seventeen “Regional Services” plus a small addition, the so-called INGESA, for the management of the health services of the two autonomous cities of Ceuta and Melilla.