As the Health Care debate continues in Congress it makes all of us involved in the delivery of health care to stop and question how do we pay for new technology? Evolutionary changes seem to be absorbed into the system with incremental cost increases. As we develop more cutting edge changes, who should bear the brunt of that cost? Should it be in the research and development cost of companies, passed on to insurers, or the government, or paid for by patients taking advantage of new and improved technology? The answer to this and other questions will become clearer after Congress makes its final recommendations and a Bill is signed. With implant technology, it is often years before we realize the benefits of new devices and/or techniques. With survivorship of approximately 90% at 10 to 15 years for total hip and knee replacement, incremental improvements will need a large number of patients and long follow-up to determine if they are beneficial. We can use various laboratory tests and experimental models to get a reasonable idea if new technology will be better technology, but in the end it is how these implants respond in humans. All of us should be prepared to tighten our belts and shoulder a portion of health care costs so that we may continue to develop new and better techniques and equipment.