The meaning of the line is pretty clear? It is a rhetorical flourish not to be meant taken literally. The author obviously just means "now they are widespread".

The meaning of the line is pretty clear? It is a rhetorical flourish not to be meant taken literally. The author obviously just means "now they are widespread". "Back in the day HMOs were basically non-existent but promised cost containment, among other benefits. Now they are widespread but they didn't deliver on any of their promises."