I would agree. The irony is the much maligned HMO's now seem to beat PPOs, maybe because at least they have a more structured referral system and predictable r

I would agree. The irony is the much maligned HMO's now seem to beat PPOs, maybe because at least they have a more structured referral system and predictable rules, vs. PPOs always try and fight you. Double irony is the govt healthcare programs seem to be paying/performing better than the privates (Medicare is like the perfect PPO and no wait, managed medicaid/medical used to be sloooooow but now seem to be improving as the in-network provider availability is improving)