U.S. Healthcare is not a system but a fragmentation of care delivery mechanisms. Healthcare Reform drives at reducing costs through access, quality, and efficiency. The U.S. economy contracted in 2007 and healthcare spending increased consuming an even greater and potentially unsustainable share of the economic wealth. Affordable care means "shared risk." The Patient Protection and Accountable Care Act (PPACA) was signed into law on March 23, 2010. The bill outlines the next ten years for new policies and pilot programs. More profound for us are the many provisions that promote fundamental delivery system reform. At this time, the burden of leadership is immense. Our profession needs a large cadre of qualified leaders to shape the future.