When government provides or arranges for health care, it is held to lower legal standards than private parties are, especially when liability is barred by "sovereign immunity." This paper examines sovereign immunity and its implications for health care quality by comparing private-sector and government accountability in several legal contexts. It then considers whether the law should be changed; the possible relationship between limited government accountability and public mistrust of a larger government role in health care; and the potential role of disparate legal standards if a lower tier of care evolves in government programs.