On Health and Money

You'd expect to find a concierge medical practice in Palm Beach, Fla. These high-touch, personalized practices that give patients 24/7 access to doctors who keep close tabs on their care generally cost a few thousand dollars a year. That's more than many people who are already struggling just to cover their healthcare premiums and copayments can afford.

So I was surprised to learn of a Florida concierge practice that's offering its 24-karat care free to a select group of 25 people with incomes at 200 percent of the poverty level or less ($42,400 for a family of four). It's all happening under the auspices of the Palm Beach County Medical Society's Project Access, which provides nonemergency medical care to hundreds of residents in this mostly rural county, people who don't show up in the society pages and aren't well to do.

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After 12 years of unwedded bliss, two friends of mine recently got married. The reason: Her job offers health insurance benefits to married couples but not unhitched cohabiting ones. Now it turns out these two may have been at the leading edge of a trend. According to a new poll, 7 percent of respondents said they or someone they lived with decided to get married in the last year in order either to have access to health insurance benefits or to give their new spouse access.

And they say romance is dead. At a time when the typical family health plan costs upwards of $12,000 a year, sharing a group policy number is more than a token way to say "I love you." It's a hefty commitment, giving new meaning to "in sickness and in health."

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As anyone who's ever tried to decipher the Part D Medicare drug benefit knows, user friendly it's not. Seniors typically have dozens of plans to choose from, all with different moving parts—deductibles, copayments, coinsurance, covered drugs—not to mention that mother of all confounders, the so-called doughnut hole into which seniors fall after they've accrued a few thousand in drug costs. Until they reach a certain threshold and catastrophic coverage kicks in, they're responsible for paying the full freight.

Now the Journal of the American Medical Association has released a pair of studies that examine seniors' understanding of their costs under Part D, and how those costs affect "adherence" to their prescription drug regimens. One study found that—surprise!—60 percent of a random sample of seniors enrolled in a plan through Kaiser Permanente didn't know that it had a doughnut hole. Just over a third of these seniors reported that drug costs had affected their behavior, causing them to switch to a cheaper drug or not fill a prescription, for example. The other JAMA study found that seniors were less likely to report problems sticking to their drug regimens because of costs after the Medicare drug benefit began in 2006. But the sickest patients didn't see the same improvement.

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If there can be such a thing as buzz in health policy circles, for the past few years "consumer-driven healthcare" has been hot, hot, hot. Although only a little more than 1 in 10 adults is enrolled in one of these types of plans so far, it's the current big idea that everyone's focused on to reduce the number of uninsured and bring healthcare costs down.

Fundamentally, the idea is that if consumers have a bigger financial stake in their own healthcare—meaning they pay more for it, basically, because their plans have higher deductibles—this will lead them to make more fiscally prudent decisions and save the system money. (You know, you'll cut back on all those frivolous doctor visits that you schedule "for fun" because you like the gowns.) Since these high-deductible health plans have lower premiums than traditional plans, the thinking goes, coverage will become more affordable, and we'll make a dent in the 47 million people who are currently uninsured.

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