» Humphrey Taylor Chairman of the Harris Poll, Harris Interactive
I have an IQ test for forecasters. If they are brilliant like the late Herman Kahn, they never make forecasts that can be proved wrong in their lifetime. If, like me, you conduct political polls, you make a forecast on Election Day morning that may be proved wrong that evening. That obviously indicates a very low IQ. So I am happy to raise my IQ level by offering 20 forecasts regarding the next few years:
1. President Bush will make good on some of his campaign promises for making healthcare more accessible and affordable, but they will not substantially reduce the number of people without insurance.2. The number of uninsured and underinsured will continue to increase.
3. Congress will start work on ways to "fix" or "improve" the Medicare Modernization Act—especially its pharmaceutical benefit plan.
4. Washington will do little to reduce the rapidly increasing long-term costs of Medicare.
5. Medicare Advantage plans will increase their share of Medicare beneficiaries, but most beneficiaries will remain in traditional fee-for-service Medicare.
6. The ideological debate about roles of government and "the market" will continue. On the left: the proponents of universal coverage, single-payer systems, and healthcare as an entitlement. On the right: proponents of competition, choice, personal responsibility, and market forces. Bismarck, Beveridge, and FDR vs. Adam Smith and Milton Friedman. Neither side will land a knockout punch, but advocates of market forces will win some battles.
7. There will be better metrics to evaluate the quality of care provided by hospitals, physicians, and health plans, but they will not be good enough to persuade those being evaluated that they are fair.
8. The "pay for performance" movement will grow, led by third-party payers (e.g., Leapfrog and Bridges to Excellence), the Institute of Medicine, academics, and policy wonks. Many doctors and hospitals will complain.
9. Pressure will grow to create a new federal government agency to evaluate the cost-effectiveness of diagnostics, drugs, procedures, and other treatments, influenced by those in the United Kingdom, Australia, Germany, and other countries.
10. High deductible and "consumer-driven" health plans will grow rapidly—but from a small base—and will be described as "consumer empowerment" or "consumer choice" plans.
11. Out-of-pocket costs will rise even faster than total healthcare spending. This trend will be described as increased "personal responsibility." As a consequence, nonadherence/compliance will increase substantially.
12. The IT revolution will move forward (slower in the United States than abroad), but it will be too soon to know if it can deliver on its promise of improved quality, fewer medical errors, increased efficiency, and lower costs.
13. The insured public will respond positively to "choice" and negatively to higher out-of-pocket costs.
14. Healthcare costs will continue to grow much faster than the GDP (but more slowly than in the early 2000s). The main drivers: new technology, increased utilization, and hospital price inflation.
15. The "Vioxx effect" will cause more drug companies to fund clinical trials of approved drugs, following the example of Pfizer's new trial of Celebrex.
16. All major drug companies will list clinical trials of their new drugs in a register, whether this is mandatory or voluntary, and release the results, both positive and negative.
17. A drug importation (or "reimportation") bill will pass and be signed into law, but it will fall short of what many advocates are asking for.