Government and market forces have fundamentally transformed the religious healthcare sector. Religious healthcare organizations are struggling to define their identities and determine what it is that makes them different and what implications the differences have for the delivery of social services and for public life. In response to these questions, the defenders of traditional Catholic healthcare make a variety of responses that first defend the continued relevance of the major institutions of Catholic healthcare, especially its hospitals, and second, specify reforms to make these institutions even more relevant to the new healthcare system. This essay argues that these defenses are inadequate to that challenge and that the reforms proposed are too timid. Catholic healthcare needs a better theoretical account of its mission and more creative institutional adaptations.