Belgium’s budgetary policy is again crumbling across the board. Marc De Vos and Brieuc Van Damme point out that healthcare policy has been dominated by budgetary concerns for years. Yet, the budget keeps on skyrocketing while the key challenge is increasingly to provide healthcare that is both affordable and accessible, while being of high quality. The authors indicate some directions with potential: increasing investments in ICT, improving coordination and integration between the stakeholders, and a real debate on a multi-pillar structure. Healthcare risks becoming unsustainable without pragmatic but fundamental reform.