The German healthcare system has developed into a political construction site over the past years and decades: one reform follows another, health policymakers come and go. However, if one looks for lasting successes in health policy actions, disappointment comes quickly. Financial bottlenecks, heavy contribution burdens, supply gaps, inadequate quality, and income losses for service providers are on the agenda. The responsible health policymakers have repeatedly tried to stop and reverse this downward trend with ambitious and hopeful reform projects. Yet, no one has managed to achieve a significant breakthrough so far. Well-intentioned reform approaches are regularly undermined by the conflicting interests of the actors in the healthcare system. What is obviously lacking is a long-term sustainable reform perspective.