The ultimate purpose of medical insurance (HMO, PPO, etc...) is to make money for the shareholders, and their performance is measured in quarterly profits. Not in the improved health of the policyholders and their 12 month policies, especially when there is a yearly renewal of their contract that allows any improvement in their current policyholders health to lower the risks of a competing insurance company if the policyholder switches companies. Chronic diseases cost the most to treat, and by doing the least they can until the policyholders get old enough to qualify for Medicare, the insurance companies focus on short term profits at the expense of the long term health of the policyholders and increased government costs to treat these chronic conditions that developed during the years the policyholder was insured by the for profit insurance companies is rewarded. Which is a long way of saying anytime there is a choice between short term profit for the insurance company and long term health of the patient, the odds favor the short term profits insurance companies.