This paper presents the conditions underlying the current economic crisis and the increasing efforts to reform the U.S. health care system. The Western industrialized nations, other than the United States, provide universal access to health care. And these nations monitor, incentivize, and, in some instances, control use of care and manage the administrative costs attendant with care in a much more effective manner than the U.S. health care system. Although there is no certainty with respect to the final structure that health care reform will take in the United States, organizational efficiency, information, and evidence-based utilization are three areas in which breast centers should prepare for the future.