This chapter provides an extended look at health politics and the health system in Portugal, characterized by overlapping tiers of coverage including a national health service. The chapter traces the historical development of the Portuguese healthcare system through a series of regime changes, particularly the transition from conservative dictatorship to democracy beginning in 1974. Since the 1979 foundation of the National Health Service, the main issues facing the health system have been the relationship between public and private provision of services and the system’s fiscal solvency. A 1989 constitutional revision, which redefined healthcare from being a constitutional right to universal free healthcare to one which “tended towards” no cost at the time of treatment and was based on individuals’ particular social and economic situation, shifted the system away from universalism, removed obstacles to privatization, and allowed the introduction of other forms of market mechanisms. As the chapter argues, though left and right political parties have differed in their approaches, actors in health politics seem to have largely agreed to move in the direction of a public–private mix of service providers.