This feels all well and good but in reality it might work out differently. Your hmo argument feels like centering the lower quartile folks at the cost of the average middle class man that wants agency in his healthcare journey. the reason i chose a ppo instead of an hmo is with a ppo i can go visit a psyciatrist directly, tell them i had adhd symptoms, get diagnosed and get prescribed adderall pretty much immediately. With an hmo that would take at least months. Why pay full price for a canadian/uk style wait/referral system?