The Preamble and the Directive Principles of Indias Constitution provide for state intervention for assuring every citizens health and well-being. Yet India has wide disparities and inequalities in the standard of living, with two-thirds of the people without access to tap water and a clean toilet, a third malnourished, over a million children dying before reaching the age of five, and millions dying due to communicable diseases that are treatable at an incredibly low cost. Despite insuring schemes, every year over 60 million are impoverished due to the high cost of care. This is due to abysmal spending on health, weak governance, and poor leadership. Clearly, India has failed to forge a political system founded on the principle of a social contract where ensuring universal access to fundamental public goods-clean air, safe water, sanitation, hygiene, nutritious food and basic healthcare, and security against health-expenditure shocks-is visualized as its primary obligation, not an option. In deeply stratified societies like ours where gender, caste, religion, and residence create barriers that cannot be overcome by individual effort, the negotiating presence of a strong and assertive state becomes necessary. This book discusses the evolution of Indias health policy, followed by a comprehensive discussion on financing and governance in health, and contains two stories about Indias struggle to reverse the HIV/AIDS epidemic and revitalizing the primary healthcare system in rural areas under the National Rural Health Mission (NRHM). Finally, it assesses what the future focus should be. It is based on the authors understanding of the health sector acquired over two decades of engagement in various capacities.