Are you in an area where Kaiser Permenente operates? It has been, on the whole, a great healthcare provider. The level of integration of their centers is great--I can walk downstairs for an MRI or Xray or lab test (no waiting for one doctor's office to phone in authorization/orders). Electronic records are fully and usefully integrated. Costs are relatively low, and there are several options of locations in my area--small, neighborhood office; a larger, integrated facility; and a 24-hour hostpital-like facility. They also have partnerships with other hospitals in my area, so I can go to other hospitals and be treated fully under KP insurance. There are so many advantages, I've kept my KP plan over several employers (including a stint on the Healthcare marketplace).

I'm using the KP health system. Its pretty awesome. Everything in integrated. I can use the website or phone app to check any of my test results. I can message my doctor for a e-consult at no extra cost. They usually reply within half day. I can book most appointments online. If I went to a specialist, I can continue messaging them in the future. And since the doctor is gate keeper, you just need them to approve a procedure and it will happen.

I had Kaiser years ago and while the quality of care was high I remember eight- to ten-week waits to see certain specialists for non-critical issues.

The HMO approach concerns me more as someone with special medical needs -- I would strongly prefer the flexibility to see a specialist that is experienced with my specific condition as I've had problems with doctors whose only experience with my condition is in a textbook

HMOs are great if you're healthy and plan to remain that way for a while. I have the same deductible and co-pays as a PPO but pay about $200 less per month. The level of care is adequate for my needs, and I actually go to the doctor now because the HMO is integrated with the provider network, so I can book appointments online. Since the HMO also owns the lab and other facilities at the clinic everything that they do to me is covered. They even have an optometrist in case I need an eye exam. Their pharmacy is also really quick compared to most places.

HMOs fail most often on mental health from anecdotes of friends on them. They force you through only one provider who may be qualified or not, and you get a "permanent record" which can actually really hurt your care in the future. If Jill the ARNP says you were awful and maybe faking a sympton, and she has lunch with a bunch of other doctors in the cafeteria, you're gonna get treated like crap.

Yeah, I can see how that would be an issue. The HMO I'm on actually specifically covers private practitioners because their in-house practitioners are totally full for months. And it was pretty damn easy to get an appointment. I just had to call in and get a preapproval.

People don't plan to remain healthy?

Based on most people's actions, it would appear not.

Excessive eating, drinking, smoking, and insufficient exercise and sleep seem to apply to most people.

I'm in kidney failures (due to an auto-immune disease.) I have to do dialysis every day. I'm super careful with diet and lifestyle. But many people are not. My dietitian tells me stories of dialysis patients that go out for massive fast food meals before coming in for dialysis. Dialysis functions maybe at 10-20% of a normal kidney. Its meant to keep you alive not pull out wastes products from your excesses. It doesn't do a perfect job. These people are slowly just killing themselves.