Kaiser is primarily a California HMO (they have a few other plans). It has been around for decade. People either hate it or love it because it is quite rigid in how it works (and you have to go specifically to their facilities). For the majority it seems like it's a cheap but very rigid option (especially compared to PPOs).<p>I feel like, at least in California, the majority of HMOs got usurped by HSAs which became popular after Obama-care kicked in. Many many companies used the threat of the never implemented "cadillac plan" tax to rework the benefits they offered. It wasn't unusual to have a couple both have different PPOs and effectively get improved coverage through "double coverage". It's still possible, but not with HSAs.
HMOs are so much better than PPOs, but they're rare these days. They are significantly cheaper than PPOs. Most HMOs don't have deductibles, and all of them have lower premiums than PPOs. The "out of network" coverage of PPOs is an irrelevant scam. Your insurer covering 10% of a $200,000 out of network surgery is still going to bankrupt 99% of people in America.<p>HMOs require you to get a referral from your primary care doctor to see a specialist, which has the added benefit of making sure people actually <i>have</i> a PCP. Primary care is one of the few types of care where the more you apply it, the better a patient's health outcome.<p>No one gets an HMO because they're scared of having less choice of which doctors they can see. They pay more to have a choice that's ultimately irrelevant to their health. Most people choose doctors based on friend/family referrals and Yelp reviews, meaning they don't know how to choose a doctor. Reviews/referrals have no relation to health outcomes.<p>The end of the article refers to the "medical loss ratio" enforced by the ACA, which did indeed incentivize insurance carriers to tolerate higher healthcare bills. This affects PPOs much worse than HMOs. It should all be burnt down.<p>Further reading, one of the best books on the subject: "An American Sickness"
Years ago I was in a DC bar and struck up a convo with the man next to me. He was a physician and after a few drinks he opened up to me and said, "The main problem with the healthcare system is that we don't let old people die." It was one of those transgressive things you hear and take note of. It does seem like a foolish use of resources to extend the life of someone in their 80's for a few months of more misery for the cost of several million dollars, when that same money spent on younger people could change their whole life for the better. But yeah, "Let old people die" is probably not going to win elections.
> The short story as I understand it is that HMOs actually worked early on, but realized people got really really upset when told that their personal doctor sucked and the treatment recommended sucked. They’d bail for whatever insurer covered every damn thing. So insurers realized better to just jack prices rather than control costs.<p>I don't know how true this is for the HMO story, but I do know that many patients absolutely hate being told "no" after they've convinced themselves that they <i>need</i> a certain treatment.<p>We've all heard the stories about the patient who was right about their own diagnosis but was denied care by their doctor, but these are the rare stories. Providers get bombarded daily by demands for antibiotics for colds, for example. If you're well educated about antibiotics you probably wouldn't believe the number of people who think antibiotics treat every infection and doctors are just meanies for refusing to hand them out. Many doctors get tired of fighting these battles and just write prescription after prescription for antibiotics on demand, which creates a loyal customer base of patients who are happy because they get whatever they ask for.<p>The situation is even scarier for controlled substances. The internet and sites like Reddit have a weird way of convincing people that they <i>need</i> Adderall and/or Xanax, and that doctors are evil if they won't prescribe them no questions asked. I've heard too many horror stories from my psychiatrist friends who get patients showing up demanding Adderall, but on closer examination will describe classic depression symptoms (e.g. having trouble focusing after a recent breakup, but no problems for the first 2-3 decades of life). Some of them have been convinced by Reddit (it's always Reddit) that ADHD is the explanation to their mental health problems and a high dose of Adderall will solve all of their problems.<p>Then when they say "no", they get pinged a few weeks later by the psychiatrist down the hall because the patient is back with a different doctor trying the same story. The sad part is that they often continue this rotation until someone shrugs and writes the prescription. A disappointing number of providers don't mind having a lot of controlled substance patients because it's a steady stream of easy appointments to write new prescriptions every few months.
FTFA:<p>> But something happened between 1978 and today. Now we all have HMOs<p>No, we don’t.<p>“Forty-nine percent of covered workers are enrolled in PPOs, followed by HDHP/SOs (29%), HMOs (12%), POS plans (9%), and conventional plans (1%)” [0]<p>And part of this is government policy actively promoting the HDHP/SO, and starting before that private market blowback of the provider choice issue in public healthcare policy debates as far back as the debates over the Clinton healthcare plan effecting marketplace decisions.<p>[0] <a href="https://www.kff.org/report-section/ehbs-2022-section-5-market-shares-of-health-plans" rel="nofollow noreferrer">https://www.kff.org/report-section/ehbs-2022-section-5-marke...</a>
I miss my HMO dearly. It was the last time I felt like I got good healthcare.<p>I now have a high deductible healthcare plan with like a $3000 deductible and the plan is “don’t get sick.” It’s disgusting and I work for a major university.
> 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.<p>At that point it's not an HMO anymore and basically becomes a single-provider PPO with an added subscription fee.<p>> 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).<p>Pretty much.
Question for HN - For those not self employed and in the US, does your employer provided health insurance offer a HMO option? I've always heard that some companies do, but I've never seen a company offer one.
related, this is a think tank's history of negotiating power in health care<p><a href="https://www.nihcr.org/wp-content/uploads/2015/03/Congressional_Testimony-_Health_Care_Provider_Market_Power.pdf" rel="nofollow noreferrer">https://www.nihcr.org/wp-content/uploads/2015/03/Congression...</a><p>its claim is that there's a shifting balance of power driven by the business cycle. employers expand coverage in random directions in boom times, someone gets squeezed in bust times<p>'who is the villain' in this mess changes faces from cycle to cycle
Listen. No matter how you cut it, the system doesn't want you to be healthy. It starts with the fact that there's no - or at least significantly less - profit in prevention, and then it's all down hill from there.<p>Put another way, health of the masses is down. Yet profits of the "health care" system is up. If you can get your arse up off the sofa...just follow the money. Anything else is a distraction.
At my last job, we never had employer-supplied care; it was too small a firm to get into anything unless he bought into a cooperative, which I think was a word with about three too many syllables for the CEO to grasp.<p>I ended up buying marketplace plans, and the first two or three years, you had a choice between HMO and PPO plans; after that, it's obvious the local insurers (who also dwindled to one or two) decided all the market wanted was "it's the minimum that counts as coverage" Silver-tier HMO plans, all with the exact same (highest legal) copay/out-of-pocket limits, and either removed anything else or priced it stratospherically. I guess the health-care marketplace ended up much like the airlines after Expedia; they had to jettison anything appealing to look good on a price-comparison engine.<p>Once we had a guy visit the office trying to sell a HSA/HDHP plan; after three minutes discussing it after his visit, we all decoded that the basic premise of the plan was that it disincentivizes you from getting the care you actually need. It's sold on the concept of "you're an above average driver" (you won't ever be sick enough to actually need to tap the HSA) and promises of being able to stick the IRS with a tax-exempt savings scheme.<p>My current position offers a PPO or HSA/HDHP scheme and pays like 90% of the costs for your choice. I wouldn't touch the HSA option with a 10-metre pole.