Both of you make very good points. The problem is that, as the HMOs have become more powerful, they have modified the rules so that, in primary care, even by accepting HMOs you can't survive.
I believe Paul has mentioned that one insurer has most of the market share where he lives--so they use their near-monopoly power to drive down physician re-imbursement. As the Blues do in so many areas when they control the market.
