Structurally Australia’s health care system is surprisingly similar to that of the US. Despite this Australia maintains one of the world’s highest performing health care systems in terms of efficiency and outcomes, according to a suite of metrics compiled by the OECD and others. This standing is ever-fragile, however, as the ripple effects from health policies past can have long-lasting ramifications, and while some policies can be incrementally steered in a new direction to increase fitness-for-purpose, others require a paradigm shift. The former can be difficult on technical grounds, let alone where partisan political ideology is at play; the latter is only rarely achieved for the same reasons. This presentation will canvas some key Australian health policy structural elements, and select initiatives, which have enabled ‘the system’ to deliver on its social contract in delivering high quality, affordable, universal health care despite (or in spite of) political and other head winds. Some could be of interest to US change makers.