It is a difficult thing to acknowledge failures and try to learn from them. Having made some trend predictions last year, it is only fair to evaluate them honestly. But why must I feel impelled to try again for 2016? Here is a quick review of some 2015 issues I identified in early January. I said health spending growth would be muted, but it rose more quickly than I expected, but it was more than personal income growth, as I suggested it would be. I said exchange enrollments would be less than projected–that was accurate. I said providers were suffering initative fatigue and CMS would provide no relief–that was accurate and research does suggest many providers are not even trying to avoid penalties or get incentives. Specialty drug prices continue to be an issue and despite the wailing, no real action has been taken. Provider risk-taking has spread faster than I anticipated, but many providers are dropping out of some of these programs. I said too much capital was available for startups and while exits would be strong in the first half of the year, the “bubble” would begin to pop in latter 2015. This was basically correct and both venture fundings and exits have slowed in the fall and early winter of 2015. I said there might be a significant economic slowdown, but the economy sputtered along at its usual pathetic 2% or so growth rate. And I was wrong that the Supreme Court might invalidate subsidies on the federal exchanges (although it kept them alive only by laughable legal logic) but right that no action was taken by Congress either that might threaten the core of the reform law.
So what do I think for 2016? I suspect that health care spending will rise at the same 5%-6% we are seeing in 2015. I think people will continue to complain about drug prices, but do little. 2016 may be the year that we see providers begin to demand higher reimbursements. The mega-health plan mergers will be blocked. Regulators will not lighten up on providers or health plans. The exchange plans will get more and more expensive and fewer insurers will offer plans on them. One of these years there will be an economic slowdown. And maybe I will stop making predictions!!