The current health care system continues to be an out-of-control mess. Among the biggest concerns any of us should have looking ahead for 2016 is the fundamental problem of being unable to control costs and produce efficiencies. This has not been addressed; it has only been bandaged over.

In my opinion, 2016 will be the year in which Obamacare’s financial underpinnings start to unravel. The cost shifting that has occurred already has — like a game of musical chairs— fewer participants. The Supreme Court will continue to uphold challenges to the Affordable Care Act, and lobbyists will continue to stymie any meaningful budgetary or legislative reforms.

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It almost doesn’t matter. Just as “Herbert Stein’s Law” states — “If something cannot go on forever, it will stop” — Obamacare is starting to grind to a halt of its own accord.

We should watch for the following issues in the new year.

Expect large-scale identity thefts into large hospital systems and insurance providers by sophisticated attackers.
These data breeches will be financially costly and will compromise the reputation of the relevant hospitals as well. Don’t be surprised if a presidential candidate or his or her family is targeted. This will fuel the rising opposition among some to the sharing of private information.

Hospitals will face $155 billion in Medicare reimbursement cuts through 2020.
Too many of them operate on razor-thin margins already. But it doesn’t end there. The recently passed extension of the payroll tax cuts call for further reductions in payments for patients who default on their bills. In addition, there are proposals to reduce Medicare payments to teaching hospitals. With such financial stressors (among others), look to see hospitals close, use alternative providers (e.g., nurse anesthetists instead of anesthesiologists) or even divest themselves of some employed physicians. The latter occurred in the 1990s as hospital systems closed money-losing practices. The recent budget deal now prevents hospitals from buying offsite locations as a way to increase pricier outpatient services that are covered by Medicare. Some are grandfathered in … for now.

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Out-of-pockets costs to consumers will rise.
Generic drug makers are now required to pay an additional rebate under Medicaid if drug “costs” exceed inflation. Brand name drugs already do. Consumers who don’t have Medicaid will see their drug expenses increase. Expect deductibles and premiums also to rise.

States that used “free federal money” to expand Medicaid will start feeling the pinch soon.
Federal subsidies will not cover the full cost after 2016. When some states embraced Obamacare by expanding Medicaid by using federal dollars or creating their own exchanges, the deal was too good to be true. The rising costs have states worried and they may see, as Missouri did, their own credit ratings impacted. It probably won’t stop there. As Congress continues to look to cut its budget, the reimbursement rates to states may well drop even further than now expected. This will lead to bigger state budget deficits in the billions of dollars going forward.

Consolidation of insurers is going to be bad news for everyone else.
With increased bargaining power with drug companies, hospitals and other providers (including doctors), consumers will see higher prices and less choice. We’ll see the wringing of hands by politicians but no real change.

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Related: Insurance’s Urge to Merge

All of this sounds pretty daunting. But if, like any intelligent patient, you’re not willing to accept a disturbing diagnosis without understanding the underlying data, here are some specifics supporting these conclusions.

All cost control measures fail, or are delayed.
Prevention and Electronic Medical Records are a financial bust. Switching people from free emergency room care covered by direct subsidies to emergency room services covered by Medicaid does nothing to the cost or quality of the actual service being provided.

How does this impact any of us? Where are we seeing this materialize as health care consumers? Check out the cost of Medicare and Medicaid, and look at your state and federal budgets. All are still increasing (your tax dollars). If you need a more personal example, look at your paycheck and see what’s coming out now in health insurance premiums.

One way to control costs, of course, would be to put a lid on medical progress, the same way a lid on economic growth might reduce carbon emissions. If we set a goal for 2060 of giving everyone free and unlimited access to the quality of medicine that exists today on the first day of 2016, that would be very doable.

Of course, it would be like giving everyone today free and unlimited access to the quality of medical care available in 1970. Maybe no one would notice? That was part of the idea behind imposing a tax on medical devices. Indeed, if Congress were clever, it would have imposed a much higher tax but only on devices not approved yet by the FDA.

Related: The Winners and Losers in Health Care

Eventually, the cost of today’s luxury pacemaker or miracle drug would come down through economies of scale or the expiration of patents. We could then have “free health care for all” and no one would notice that we have no new cures or treatments.

Think about this, though: While Obamacare has not been repealed, the tax on medical devices it imposed to help pay for the goodies has been waived for two years. The consequences of this are expanded Medicaid coverage and ongoing dysfunctional bureaucracy. We’ve disrupted health care for 300 million people to enroll 30 million.

Another idea for reducing costs is to ban, or tax heavily, the tax-favored medical insurance that costs above a certain amount. Those so-called “Cadillac” plans were set to bear such a burden, both to raise taxes to pay for more Obamacare goodies and to increase the prices of certain health care procedures or health insurance policies, reducing the demand and thus lowering costs. That, too, was just deferred for two years.

Increasing capitalist competition, ironically, was another idea that was supposed to work. Surprise: Insurers are leaving low-profit markets and the industry is consolidating. The idea, of course, that there is any competition in the insurance industry is laughable. In most states, regulators specify the prices and terms of coverage. How could there be competition in any meaningful sense of the word?

Related: Obamacare Co-op Collapse

That used to be the way airline tickets were priced and routes assigned — by the FAA — until that hard-hearted capitalist Jimmy Carter had his way and deregulated air travel. Long distance phone service was another victim of deregulation, to the everlasting benefit of consumers.

But health insurance is not only becoming more consolidated as an industry, it is subject to strict price and quality controls that must be applied industry wide. Instead of price-fixing illegally, industry players get to fix prices legally, by getting the federal government to tell everyone what must be covered and the state governments to set the prices. We consumers are coerced into buying this insurance with higher deductibles and copays — and we’re being given fewer choices while doing so.

Dr. Ramin Oskoui, a cardiologist in the D.C. metropolitan area, is CEO of Foxhall Cardiology PC. This is the second of a two-part look at the state of health care in America. Read the first part here.