While the Democrats and the Republicans debate the Health Care Reform Bill and how we are going to pay for universal coverage, a revolution in healthcare delivery already is taking place right under our eyes. Even if the federal government doesn't pass legislation on healthcare this term, the healthcare delivery system will have been changed so dramatically that it will be unrecognizable from what we knew just a couple of years ago. Consolidation of hospitals, cost reduction, and the quality of care are themes that will be evident in medical delivery for the next few years. Among these three, cost reduction is and will be the engine of change.