The HMOs make money by giving incentives for withholding care. They make money by coercing physicians to write preauthorizations for drugs that they don’t want to pay for, until it becomes so burdensome that we simply don’t prescribe them anymore. They make money by demanding exhaustive documentation to prove to their satisfaction that we are providing certain services, while knowing that we often have to forego the time-consuming extra documentation and accept lower payment so that we can use the time to ease the suffering of our patients.