If you do otherwise, you have to pay for that cost yourself. HMOs' existence is based on their financial profit, the difference between the money that rolls in and the money that rolls out. As you may have noticed in financial papers and other news, they have made plenty of profits recent years. This has been accomplished at a cost to those who buy into their agenda, which are the people who are on HMOs and physicians and other providers of healthcare services. Since heir appetite for profit is unlimited, they try to cut cost and increase their demand for premiums.
Cost cutting comes with reduction in quality.
Same is true with HMOs. They put you in the lower end of buying power. HMOs pay your physicians significantly less than their actual fees. I drop an example here. As you know, I am a cancer specialist.