On the Third Hand: Concierge medicine

Rep. Pete Sessions, R-Texas, and Sen. Bill Cassidy, R-La., have introduced a Patient Protection and Affordable Care Act (PPACA) change bill that is full of interesting ideas for modifying the PPACA commercial health insurance provisions.

See also: Sessions-Cassidy PPACA overhaul bill, dissected

Some of the ideas in the Sessions-Cassidy proposal might be worth considering even if the current PPACA commercial health insurance framework stays more or less as is.

One section, for example, would beef up insurers’ defenses against healthy consumers who intentionally go without health coverage. Consumers in that situation could still sign up for major medical coverage during an open enrollment period, without going through medical underwriting. But they would have to pay more for their premiums.

Another provision would let some low-income, low-asset consumers buy limited-benefit health insurance rather than full-fledged medical coverage. The provision would protect the holders of that coverage by limiting health care providers’ ability to sue the limited-benefit coverage insureds for re-payment.

One drawback is that the major medical-limited-benefit divide might push some health care providers to discriminate against the patients with the limited-benefit coverage. One advantage is that the provision might do something about the reality that PPACA coverage seems to be a much better deal for hospitals than it is for moderate-income, poorly subsidized exchange plan buyers.

Still other proposal provisions would encourage doctors to start and consumers to use concierge medical practices.

A typical concierge medical practice charges a consumer a flat annual fee in exchange for a year of access to primary care services.

The proposal would let a health savings account (HSA) user tap HSA funds to pay the fee for a concierge practice.

Another provision states that a concierge practice service package “shall not be treated as offering health insurance coverage and shall not be subject to regulations as such coverage” under the federal Public Health Service Act and the Employee Retirement and Income Security Act (ERISA).

I think the provision raises a really important point: It’s very easy for professionals of all kinds to turn themselves into accidental equivalent of a bad, 1980s-style HMO: an organization that’s promised to provide all the services a customer needs, for a flat annual fee, without either the seller or buyer understanding why that cute little promise is actually absurd.