The Italian National Health Care System was created in 1978 on a strong govern-mental basis and, a long series of reforms nothwistanding, it still bears that kind of bias. Health services and policies in Italy continue to refer to a centralistic and wel-farist culture, largely dependent upon state intervention. The first part of the essay describes the main features of the Italian National Health System as it has been de-veloped in the last few years, showing that its shortcomings are due to the limits of its structural configuration. In the second part of the essay, the author claims that these limits emerge from an overarching political orientation which he calls "lib-lab policies". In the concluding remarks, the author proposes to reorganize the health sevices and policies in the light of what he calls "welfare pluralism", i.e. building the health system upon three autonomous, interlinked and interchanging sectors (state, market, third sector organizations). This new model, called "societal welfare mix" based upon a societal (not nation-state) citizenship, is seen in oppo-sition to the lib-lab mainstream model.