I usually comment on business and then provide an additional comment on insurance. Over the past month, so much has happened on the business side of insurance that I'm going to go out on a limb and make some predictions based on what I see as an agent, business coach, patient, plan member and tax payer.

Insurance companies are merginging to gain marketshare and reduce operating cost. This trend will continue, but premiums will continie to rise because of the increasing use of technology and the increasing focus on managing care to improve outcomes.

Both caregivers and hospitals will join larger organizations to achieve economies of scale, gain market share, and be able to hold their own when negotiating rates with the insurance companies.

Medicare, Medicaid, and Obamacare will remain virtually unchanged apart from pressure to control cost. As a result, employers will find that their group plans will continue to see large increases in premiums, or they will opt for plans that have higher deductibles in exchange for maintining a comparable premium. This will result in employers with fewer employees moving their employees back to the private market and providing increased wages instead of the health insurance benefits.

Because of the increasing tax penalties for failing to obtain health insurance, more people will enroll and, since they are paying the premiums, get the free preventive care. While this will begin to reduce the cost of providing care and premium increases over time, it will increase the demand on the healthcare system and excerbate a shortage of trained professionals. Waiting for treatment will be the political driver that leads to a focus on the cost of training healthcare professionals in this country.

Insurance products will continue to evolve to respond to these changes. Insurance is about sharing risk among a lot of policyholders to compensate a few in tragic circumstances. We've already seen a movement to include living benefits like disability and long term care riders on life insurance policies. With the higher health insurance deductibles we'll see increased use of accident, dread disease, and hospital indemnity policies. These are policies that have smaller premiums and provide large cash payouts for those somewhat rare events. By combining large deductible health plans with supplemental insurance people can still have health and financial protection with manageable monthly premiums.