Beginning in 1990, Mongolia, a former Client State of what was then the Soviet Union, undertook sweeping free market reforms under terms prescribed by Western development institutions. Principal among these were reforms to Mongolia’s Soviet-style health system. This paper reports the results of a research project designed to explore the consequences of these health sector reforms from the perspective of Mongolians living in urban and rural communities. Drawing upon interviews With householders, observations, medical records and illness histories (as reported by patients), I argue that the effective implementation of health reform has been compromised by the development of a private, primary care model in which physicians are largely unable to provide appropriate treatment for even the most common of ailments. Because of laws in the national health insurance system and the uncritical development of a private sector of health care, poor Mongolians have limited access to secondary and tertiary care. I conclude by arguing that the valorization of market mechanisms by international development institutions and NGOs results in a conflation of distributional efficiency With medical and public health efficacy. This has resulted in a system of attenuated primary health care for the poor and vulnerable. Even when modified by government concerns for justice and equity, the global/ Western push for privatization in Mongolia has primarily done what it has done elsewhere: produced poor medicine for poor people.