Sometimes it is hard to really understand the significance of events til years later, but we are going to do our best to identify what may have a lasting impact on health care from 2015. The reform law continues to spiral downward. Fewer people are being covered than projected, policies through the exchange cost more than promised, health spending overall has resumed an upward trend beyond personal income growth. For many Americans, health costs are as much of a burden now as they were before the law was passed. And at the end of the year, we saw Congress begin to nibble at the foundations of the law, deferring the tax on “Cadillac” plans and suspending the medical device tax, as well as refusing to fund the health insurer exchange plan bailouts. It is likely, regardless of the outcome of the 2016 elections, that we will see continued changes to the reform law. Another major event set in 2015 was consolidation in all health sectors–major health plan mergers proposed, substantial drug company acquisitions, continued consolidation by health systems. But the antitrust enforcers have begun to be a little bolder in rejecting some of these. Will 2015 mark the end of significant consolidation and a renewed commitment to the virtues of robust competition? We mentioned above that national health spending has re-accelerated, led by drug pricing. Will spending continue to grow at 5% plus, will it grow even faster, was 2015 an aberration driven by a temporary utilization spike from newly covered persons?
And finally from the world of the truly frightening, although potentially promising, the advance of new CRISPR gene-editing technologies opens the possibility of doing even more horrific things to human beings than we already do. Nuclear weapons are still pretty hard to make, biotechnology ends up being relatively cheap and easy and I think we have now seen that there are humans who will do anything, without limits, to other humans. The technology can be used, and likely will be, to cure some diseases and ameliorate others. It will also likely be used in other more questionable ways, to “improve” human functionality. And it almost certainly will be used by some truly evil people to cause death and harm in a widespread manner. Happy 2016!!