Δαφνη Ευτυχια Αρθουρος

"does he even realize that they exist?"

Maybe not; I didn't, until you pointed them out. (Uh, I'm not seeing anything about being non-profit on the web sites of the ones I've clicked on so far -- I presume your info about their non-profit status is from elsewhere? Or am I just having a bad findstuffontheweb day?)

When I was covered by Kaiser Permanente, after they bought the HMO that had bought the HMO my former employer had used, I got a definite "we used to be about prevention and still see ourselves that way but act like we're all about short-term cost-containment only" vibe from them, they were skilled at nickle-and-diming their patients, and neither I nor my doctors were happy about their budgeting only five minutes per visit of doctor-patient face time (and no, that's not an exaggeration, at least not on my part -- five minutes was the number a doctor complaining about them (and about to take a job elsewhere) told me, and fit my observations).

Between that and the business of having rates go up and benefits decrease each year at policy-renewal time -- which yes, could just as well have been a non-profit just trying not to lose money in the face of increasing costs as it could be greed -- from a patient's point of view there wasn't a whole lot to distinguish them from a for-profit company.

Some of the changes made sense to me -- when they stopped covering prescriptions filled at convenient neighbourhood drug stores and made us go to the pharmacies in their facilities, I grumbled, but I didn't get angry at that (I did get upset at their letter about it describing the change as being "for your convenience" when there was no plausible way to spin it as being more convenient). When they started disallowing various drugs where there was a similar but not identical drug available (e.g., trying to tell me different antihistamines were interchangeable when I knew from experience the one they wanted to switch me to did not work for me, or switching me from a more effective proton pump inhibitor to a less effective one), then I got more than a little bit annoyed.

So in the context of Saariko's argument that the 'house' skims its profit off the top without adding any benefit in return, an organization like Kaiser must(?) be skimming less (i.e. just its administrative costs, including executive salaries, but not womdigious corporate profits -- in theory possibly adding enough organizational efficiency compared to a non-HMO approach to make that a good value (but not, AFAICT, in practice)), and thus a valid counterexample to the analogy I quoted, the HMOs I've dealt with (four, I think) have still been broken in much the same way as health care in the US overall is broken.

Thing is, if I understand the history right, HMOs started off as a promising-sounding attempt to fix (or at least patch) that brokenness, and may have actually functioned that way for a while, by the time I became a patient of one they had started turning into an example of how such an attempt can go awry. *sigh*

Which illustrates how important it is that we choose/design a new system carefully, and not just assume that anything else will be better than what we have ... as well as how important it is that we do find something better than what we have.