Reform of the welfare sector is an important yet difficult challenge for countries in transition from socialist central planning to market-oriented democracies. Here a scholar of the economics of socialism and post-socialist transition, and a health economist take on this challenge. They offer health sector reform recommendations for ten countries of Eastern Europe, drawn from nine guiding principles. The authors conclude that policymakers need to achieve a balance, both assuring social solidarity through universal access to basic health services and expanding individual choice and responsibility through voluntary supplemental insurance.