Neoliberal reforms in health care are an accumulation by dispossession. In examining this in Romania, we show that neoliberal reforms led to an uneven landscape of public and private care. We document how patients variously situated in Romanian society respond to this situation, and demonstrate the instability of their strategies—restraining from formal care, lifting-off from public care and hooking-up to private care. Public– private biomedical pluralism proves to be detrimental to vulnerable and better-off patients alike.