>>Now if someone would kindly explain how is what HMO are doing is different from rationing, that would clear the waters of this discussion.

LOL. HMOs are all about rationing.

Interestingly, while the Japanese model drives costs down by limiting technology costs, Obamacare focuses elsewhere. It creates an IPAB that applies cost limits not to technology but to doctors, hospitals, and health care providers. The law says that the IPAB can't require rationing, but that just transfers responsibility to those whose costs are being constrained who may have few available responses apart from rationing. Next is the ACO that "rewards" doctors for keeping costs under control. People need to think that one through- once there was an expectation that your physician would be on your team when trying to access expensive care, not subject to financial disadvantage if you succeed which is the new idea. Then you've got the PCORI that will identify and create templates/protocols to identify the best "dollars per quality adjusted life year" care modalities. QALYs are not new but this is very different from NICE, Cochrane and others in the first world.

Not sure who thought all this up, but is it better than the simple Japanese approach? I guess time will tell.