In 2007, those behind the 2006 coup drafted a new constitution specifically aimed at turning back the political and policymaking clock to the pre-1997 era. However, in the preceding decade a significant transformation of Thai politics had taken place. Specifically, social cleavages had become politicized and particized in ways we have not seen before, and policy-focused, popular party programs had become part and parcel of serious party campaign strategies. Focusing on health policy, we thus argue in this article that institutional reforms have had predictable and observable implications for policymaking in Thailand, but only when considered in the context of changes to the broader social structure and other political conditions. While the 1997 reforms brought about a well-documented shift toward a more centralized, coordinated, and nationally focused policymaking environment, the 2007 reforms have been less successful at reversing that impact. In short, the coup makers are finding it harder than they supposed to force the genie back into the bottle.