My two years spent working part time on health while at the Treasury convinced me that being a health economics policy guru was like being trapped in the 11th circle of Dante's hell. The problems are just too complex. The uncertainties just too great. And I do not have any of the answers.
Now that's honesty. There's been a recent jump in payor (insurance) company mergers recently, allegedly because the pool of insured people continues to shrink. As the pool shrinks, costs and risk sharing push mergers. Somewhere the train jumps the tracks, but I don't know what year it will be.
In a somewhat related vein, Dr. Lagace had this to say about a shortlived double residency in psychiatry and family practice: "It's like playing Russian Roulette with two bullets". Dr. Lagace is a family physician (so am I). As physicians respond to economic incentives by bailing out of both family practice and psychiatry, look for the next event to be a "crisis" of health care delivery in primary care and mental health. (Actually mental health services have been in the dumps for years, but Republicans figure the madhouses will handle those problems.)