One of the most important changes is the advent of consumerism. The consumer is increasingly involved in health purchasing. They are interested in better clinical information. They also want more economic information on how they're spending their money. Employers are increasingly interested in seeing their employees and beneficiaries take more responsibility for their health care.
Some people talk about defined contribution.
We don't see sweeping changes involving vouchers but perhaps creeping contribution where employers and members shift the amount of money from the employer to the member's wallet, and the member becomes increasingly involved in the purchasing decision. We also expect incremental changes in the types of regulatory requirements that are placed on us. This is an increasingly sophisticated business and we expect there will be regulatory change, but we'll be able to manage that. Finally, we expect rational competition. We really have seen the marketplace become much more rational about pricing products above costs over the last couple of years.