But it seems to me that the review, while important and useful, has been focused on finding better ways for the existing institution to do what it already does. I want to approach this issue from a more basic level and ask what is required for the IMF to evolve into the best possible institution, designed for the global economy of the 21st century.
But because technology expands the set of treatment possibilities, it also has the potential to add to overall spending - in some cases, by a great deal. Other sources of uncertainty - for example, about how longer life expectancies among the elderly will affect medical spending - may also turn out to be important.