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Ken, I guess that what I am trying to say is that it should be possible for a good HMO to exist. I have had my share of run ins with "health care organizations" and even socialized medicine (in the USAF and Canada). However, I have also been privileged to be associated with organizations of high levels of both efficiency and caring. GOOD PEOPLE WHO CARE ABOUT OUTCOME AS WELL AS THE BOTTOM LINE CAN (I BELIEVE) MAKE ALL THE DIFFERENCE. For the life of me I do not t understand why that type doesn’t predominate in this highly competitive business. One thing that may slew the curve is that many doctors I know (quite a few) can get all huffy front of a patient. That they may "blow up” at the slightest disagreement with their thoughts and/or if things do not go their way--even when their peers mention something. WHH PS : Ken I can't get this to come out quite right. So get a feel for what it is I am trying to say and please cut me some slack. For the heart of the matter, see the all caps sentence above.