Most developing countries have pursued formal health care system strategies which give primacy to government roles in financing and delivering health services. Despite decades of plans and investments based on this norm, the actual health care systems in many countries are quite different than what was intended or desired. Yet policies and plans continue to emphasize a statist approach. This paper argues that, given the current situation in many countries, this long-term strategy to develop a “national health service”—type model of health care provision is misguided and wasteful. The current and potential role of nongovernment health care providers in achieving high levels of access to basic services is highlighted, using data from an extensive analysis of health care financing and delivery in India. Major problems related to quality of care and the financial burden of unregulated fee-for-service medicine are also documented. India and many other countries need to rethink their health care system development strategies to acknowledge and build upon the opportunities offered by the already extensive nongovernment health care sector, rather than to view nongovernment services simply as a constraint to successful public programs. The paper provides specific recommendations as to how this might be done.