The first is demographic change, which, to me, is going to be the most important force. The second is consumerism, followed by the fight over managed care. Next are a number of volatile financing issues. Then there is the politics of health policy, and, finally, the relationship of our health care system to society. These trends are interrelated.
Consumerism affects health policy.
If you're talking managed care, you're talking about financing. If you have an aging nation, that gets mixed up with health policy and finance. It's difficult for Americans to understand that there are usually intermingled forces at work, when you try to solve a problem. But most of the time, it doesn't happen that way. The first factor with serious implications for the future is demographic change.