Policymaking and policy outcomes are not necessarily the result of a carefully designed process but can result from intertwined political and institutional dynamics that are often difficult to predict from the outset. This article examines such a policy process, the dramatic rise in the uptake of private health insurance (PHI) in Denmark. In a comprehensive welfare state, founded on the principle of universalism, its success is puzzling. The explanation suggested here is that the rise in PHI is an example of policymaking without policy choice. The article reviews the intended and unintended effects concerning equality in health care and public finance. It also notes that the introduction of a private alternative to the universal health care system has not weakened the support for the public services.
