Profit Prophets

Wonks Predict Stormy Health Care Ahead

Flash forward. It's 2010 and you've developed diabetes, maybe from all the Mr. Softee you sucked down during the heat wave of 1999. Not to worry. A little sensor—the same kind that used to tell the toaster when your bread was ready—can now be implanted in your hand to monitor your glucose level. Or perhaps you've developed a brain tumor. Relax! The surgeons can use lasers to remove it, without having to crack open your skull. You can even take a vaccine to ward off cancer in 2010. Or, at least, a team of Silicon Valley prognosticators thinks so.

The Institute for the Future, a California-based think tank that provides health care prophecies to insurers, pharmaceutical companies, the World Bank, and huge companies such as Coca-Cola, Xerox, and IBM, is looking into its crystal ball to divine the shape of the health industry a decade hence. Basing many of its predictions on trends already beginning to take root (the toaster sensor has already been put to medical use by the army, and a vaccine for skin cancer is now in clinical trials), IFF offers a vision that is either soothing or anxiety-provoking, depending on the size of your bank account.

For those who land in the next century employed and insured, the future may indeed be dreamy. If the institute is right (the 10-year forecast IFF put out in 1989, it should be noted, was 82 percent correct, according to an independent review), market forces will have their way with health care and the patient will become the ultimate consumer. Doctors, hospitals, and drug companies are going to put even more effort into wooing the well-insured patient. That means that, rather than sitting around reading People in the waiting room, future patients might be given a beeper so they can run errands and receive a courteous page when the doctor is ready. They're likely to spend more time with the doctor once they get into the office. And, if the report is correct, an imminent burst of patient power will "pop the God bubble that once surrounded doctors," so eager-to-please doctors might even listen to you.

Perhaps inevitably, health care is expected to become a world of brand names. "It's like my kids have Levi's and Nikes," explains the institute's resident health care expert, Wendy Everett. (Reached for comment through her futuristic "phone nanny" in Hawaii, Washington, D.C., Oregon, and California, Everett is perhaps anything but resident.) "Brands can be used as a proxy for quality," she says, noting that patients have few other ways of figuring out what health care is worthwhile.

But isn't the prospect of visiting the Nabisco professor of oncology at Microsoft Hospital just a wee bit disturbing? A hazy discomfort with the idea of treating health care like running shoes comes into sharper relief when commercialization is considered alongside another IFF prophecy: that a good deal of the population won't be able to afford the "quality" product. (As with other products, that fact alone will no doubt boost its reputation.) Indeed, Everett predicts that, even as the country ups its health care spending, there will be 6.5 percent more uninsured people each year.

For these futurelings, the forecast is bleak. At the bottom of what Everett describes as a three-tiered system, the mounting pile of uninsured would, not unlike today, be relying on a "tattered safety net." (At the top of this hierarchy, the wealthiest people would have old-style insurance, the kind where you go to the doctor and just submit the bills. In the middle layer, there's a cheaper, more limited setup, something closer to today's managed care.) In Everett's worst-case scenario, a recession would cause the number of these non-consumers to jump from today's roughly 44 million to 60 million.

Whatever financial fate lies in store, the possibility of major reform fixing the underlying inequity seems slim. "I just don't see anything coming down the pike," says Everett. (IFF also correctly predicted in its 1989 report that there would be no significant health reform.) "There's just no social will." On this point, a number of prognosticators seem to agree.

In the wake of Hillary's collapsed effort, Victor Fuchs has suggested that it would take a 1930s-scale depression or another world war to generate enough interest in health care reform. David Blumenthal, writing in the New England Journal of Medicine, speculates that a pandemic "dwarfing AIDS" might get voters interested in national health care. Or, Blumenthal thinks, having 85 million people uninsured might stir up the political will sufficiently for that kind of change.

Unfortunately—or is it fortunately?—it would take more than 25 years for the uninsured to reach those kinds of numbers. In the meantime, at least some of us consumers, sensors in hand, can look forward to basking in a little medical attention.

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