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.

They may have grown 35 percent in the past year, but the fact is that health savings account (HSA) plans—which are high-deductible health plans that can be linked to tax-advantaged health savings accounts—are still pretty thin on the ground. In 2007, the number of Americans covered by these plans grew to 6.1 million, up from 4.5 million the year before, according to a new survey by America's Health Insurance Plans, a trade group. With total private insurance coverage topping 170 million, however, that's small potatoes indeed.

In case you haven't come across them, these plans (also sometimes described as consumer-driven health plans, though that phrase can also refer to other plans) must have a deductible of at least $2,200 for families and $1,100 for individuals in 2008, among other criteria. An HSA that links to the plan allows people to accumulate money tax free to pay for medical expenses.

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."

Money can't buy you love or happiness, but it may protect you from having a stroke. That's the takeaway from a new study in the journal Stroke, released today. Researchers found that the least wealthy were three times more likely to have a stroke between ages 50 and 64 compared with those who were in the top 75th to 89th percentile in wealth (the very wealthiest outliers were excluded). Once people hit 65, however, all bets were off, and wealth no longer afforded them protection.

The study examined the effect of education, income (annual earnings), and wealth (all housing and financial assets) on nearly 20,000 participants in the ongoing University of Michigan Health and Retirement Study. It's the first study to find that wealth predicts stroke incidence independently of income and education, according to Mauricio Avendano, a research fellow in public health at the Erasmus Medical Center in Rotterdam and coauthor of the study, in a press release announcing the findings.

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.

Chalk one up for sickly patients. California regulators have ordered insurers there to reinstate the health insurance policies of 26 people who lost their coverage after the insurers claimed they had lied on their applications, according to news reports. The 26 cases represent the most egregious examples of insurers wrongly "rescinding" policies, typically for inadvertent errors. The person gets sick and starts making expensive claims, and the insurer cries "fraud!" The patient says "forgot!" or sometimes "say what?" For example, one woman I spoke with on this topic had answered "no" when asked if she'd been treated for cancer in the past 10 years. Later her policy was yanked because the insurer claimed that regular blood work she had to ensure her earlier cancer hadn't returned constituted cancer treatment.

Now California begins a case-by-case review of thousands of rescissions in the past four years, and it may be that these 26 are the tip of a fairly hefty iceberg. And consumer advocates say there's no reason to believe this issue is confined to California. They expect similar cases to begin emerging elsewhere.

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.