In reforming pension systems to assure sustainability and equity, conventional practice has called for a “three pillars” approach advocated in the 1990s. This chapter calls for significant revision in that approach. Three countries’ major pension surgeries in three countries – Chile, Singapore, and Sweden –are subjected to a post-operative appraisal. The main verdict is that a country can achieve sustainability plus insurance without the problematic second pillar built on payroll deductions in the formal workplace. The first and third pillars suffice, given political consensus. Chile’s famous pension reform has been emulated but misunderstood, for reasons detailed here. Singapore’s mandatory payroll-taxing system had succeeded in accelerating economic growth, but at the expense of reasonable returns to pensioners. Sweden’s notional defined contribution plan despite its name, is a sensible first-pillar approach, indexing pensions to demographic and economic movements.