If doctors could act as gatekeepers, then patients would not run amok using the system in an irresponsible way, driving the costs ever upwards. The plan worked for a while especially for young, relatively healthy people. No matter how closely you think you are watching the Ace move around, they are still going to take your money. They do little in fact to manage care. What they manage are costs.
Care clearly suffers.
That is why on the national and state level, legislators are working on HMO accountability bills. Governor Shaheen will be signing one into law this month here in New Hampshire. But costs are rising despite the efforts of managed care companies to stem the tide. Cut services especially in the area of prescription drugs. Healthsource, the current carrier for state employees has consistantly thwarted the attempts of employees from getting the drugs that are prescribed by their doctors.