I don't understand why everyone insists on arguing about tiers and insurance and risk and whatnot. Any change from the way the AMA handles insurance now (i.e. a group plan where everyone pays the same), will be more expensive for EVERYONE than it is now. It can't help but be more expensive. Right now, you have a few people cashing checks and issuing cards. With any sort of system based on "risk," however you define risk, you have now made administering the program that much more complicated. Do you honestly believe that administering a more complicated system will not require additional staff? How do you think the AMA plans to pay for the additional staff? Hmm?