Can HMOs Be Fixed?

In part one of this essay (“The HMO Revolution: How It Happened, What It Means,” Dissent, Spring 1998) I explored the rapid growth of HMOs, noted potential advantages that prepaid group practices held over traditional fee-for-service arrangements, and considered a number of important shortcomings of HMO/managed-care organizations. I concluded that the greatest difficulty and danger for patients and caregivers lay with the expansion of for-profit health maintenance organizations. Profit is...