Survivor

When the host comes out at the end of the show, after all the contestants finish their game for this round and have thoroughly thumped one another, it's time to find out who get's voted off the island.

These days, healthcare reform, competition and policy is more similar to Survivor than to a thoughtful and well crafted incrementalistic approach we all expected. Sometimes it just doesn't work out that way.

For about the last 18 months or so, we've been wondering with more than passing speculation who will survive. Due to a confluence of completely unexpected events (credit debacles, major recession) and some expected results (sea change in Washington) change does appear imminent.

So, we asked a panel of experts who survives and who gets voted off the island.

First, the survivors. Our experts predict that Large Integrated Health Systems and the Federal Government will be the two surviving entities. These two organizations (if that is the correct term) were the #1 and #2 vote getters in our poll. A distant third place was single specialty group practices. What is even more interesting is that the younger experts (20's, 30's and 40's) tended to favor a government run system whereas the older (AARP eligible) experts anticipated the continued rise and dominance of integrated health care delivery systems.

No one thought that niche hospitals or large national managed care companies would carry the day. If you find yourself in one of 'these'...perhaps it's time to get your lifevest and consider paddling to the next island.