> I guess this arises from the fact that much of the profit for HMOs is coming not from our monthly fees but from those extra charges. At that point it's not a

> I guess this arises from the fact that much of the profit for HMOs is coming not from our monthly fees but from those extra charges. At that point it's not an HMO anymore and basically becomes a single-provider PPO with an added subscription fee. > this incentivized insurers to increase dollar margins by growing revenue (and focusing less on costs) and to transfer profits from the regulated insurance side of the business to the unregulated provider side (see UNH and Optum). Pretty much.