We have successfully navigated through multiple economic events and multiple iterations of healthcare delivery. When we started, national health expenditures were 6.9% of GDP and Senator Ted Kennedy proposed a single-payer plan that would be funded through taxes. The 80’s provided us with HMO’s, 20% interest rates, DRG’s, COBRA, Stark Law, HIPPAA and CHIP. Working through the 90’s and early 2000’s we experienced the dot-com crash, HSA‘s, Medicare Part D and the first FDA approved genetically targeted cancer therapies.