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The introduction of compulsory health insurance (assurance maladie obligatoire, AMO) in France has been a major political issue, fueled by philosophical and political controversies about its legitimacy and by struggles to defend professional interests. We retrace the path of this principle of obligation, which is a constituent of our contemporary social democracies and a pillar of protection policy, across three periods and within the general scheme alone. The early days of the first social insurance law (1920–1930) show the founding contradiction of the system: that between the socialization of a risk based on the obligation of affiliation of the beneficiaries on the one hand, and the refusal of the tariff obligation by doctors on the other. The principle of a “vast national organization of compulsory mutual aid,” which had been forcefully put forward at the time of the Liberation, was however hindered by the private strand of the medical profession, which continuously tried to obtain a relaxation of the obligation. Finally, from the 1980s onwards, in a context where the neo-liberal model was gaining ground, the compulsory solidarity base was eroded to the benefit of a private actor who was very far removed from these principles.