I am a psychologist. In the 1990's I had a practice in Bay City, Texas. I took private insurance. The HMO's and the PPO's began to move in to our area. I was offered a plan from the local physician-owned hospital where I would get paid $5,000. per month and I was to see patients for a MAXIMUM of 6 visits. Also I was required to hospitalize 5 patients per month. (For a psychologist, this means everyone with a slight substance abuse problem.) If I did not send them 5 patients per month, I had to pay back $1500. per month that I did not reach that goal. I did not sign the deal and eventually quit the practice and began teaching in the local university. This is the provider's side of the problem--the medical doctors are not levelling with people.