Blood collection centers in the United States have been providing a safe, reliable, and stable source of blood to hospitals for nearly a century. Unlike most countries, in the U.S., independent, non-profit suppliers compete with each other to supply hospitals and medical centers with blood, essentially treating it like a commodity in a free market. Since 2008, there has been about a 25% decrease in blood units collected, distributed and transfused; while at the same time, the cost of collection and preparation of blood continues to increase due to more selective donor criteria, leukocyte reduction, and increased testing for infectious agents including bacteria and/or emerging infections (e.g., Zika). The median price blood centers are reimbursed for a unit of RBCs, however, has decreased since 2013; and some estimate that 90% of RBC units are sold below cost. If large blood collection agencies are not financially sound, the effects could reverberate throughout the health care system threatening a safe blood supply for patients and national emergencies. The U.S. may need to rethink the method for financing the national blood supply.