Last month, Davis' 77-year-old wife underwent triple-bypass surgery. Kaiser Permanente's cardiologist conducted all the necessary tests and sent her to an outside team of heart surgeons--among the best-known in the state--for the surgery. She was transferred back to a Kaiser hospital four days after the operation and was later discharged. She paid nothing.
"You can imagine, that would have been thousands and thousands of dollars if we would've had to pay it," Davis said.
Taylor of Secure Horizons said that any system would have perverse incentives--to spend either too much or too little. "The solution is to have a system to monitor good care and make sure it happens," he said.
"Medicare HMOs can and do provide high-quality care," said Dallek of the patient-rights group in Los Angeles. But she said she wants reforms to require an easier and speedier appeals process if HMOs reject treatment or refuse referrals to a specialist. And she warns of widespread abuses by some commission salespeople who enroll new HMO members without explaining that the customers must stay within the HMO medical network for their care.