The United States health care system is undergoing rapid change. This is happening at a time of breathtaking scientific breakthroughs around the human genome, applications in cell and gene therapy, and the use of big data and artificial intelligence (AI). The cost of health care as a proportion of the US economy has increased dramatically. The cost of cancer care is a major contributor to these cost trends. Predictions made in 2013 about how public and private payers would interact to build future models of cancer care and reimbursement were off the mark. A clear-eyed review of where those predictions went awry and where the health care industry has changed over the past 10 years can inform as to how to best move forward.

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