In 12/01/11 Reader's Comment to: "Advocates Raise Concerns Over Shift to Medi-Cal HMO Coverage" I stated: [.. any "managed" model, especially those with financial incentives, assume consumers' choices will be limited within set parameters to achieve clinical and incentivized savings. Hence, there is an inherent built-in policy conflict in advocates' free choice position (opt in/out-of-plan & from networks) and the incentives offered to providers/plans.]

All individual needs are real and important to acknowledge when designing a program. Public policy by its very nature focuses on the larger public welfare. By all rational empirical clinical/cost data, "well managed" care programs/plans have proven to be superior to any alternative self-coordinated care.

Posturing aside, there are trade-offs. Patients have to give some of their "free" choice in voluntary opt-in/out to receive more comprehensive and coordinated coverage/care. It behooves advocates and the state to find common groun