Corporate health reform comes to our house

While most attention remains focused on Washington and the health reform debate, it's also the season where corporations sign their workers to next year's health plans.

This is where the real reform is happening. (The blog Bombing Science found this on a wall in Toronto. We'll discuss its importance.)

My wife's employer has offered us insurance for many years now, but she pushed this year's brochure on me last night because, instead of offering the usual option of a PPO (Preferred Provider Organization) or HMO (Health Maintenance Organization), it's now focused on three different choices:

1. A plan offering low deductibles.
2. A plan offering low premiums.
3. A Health Savings Account (HSA).

Having read a lot of brochures in the past, it seems clear that my wife's employer wants me to take Option Three.

Health Savings Accounts have been around for years, mainly as part of a high deductible plan. This year our employer, in conjunction with its insurer, is pushing it as something else. Health reform.

Under the plan preventive care is covered 100%. No deductibles, no copays, nothing. Checkups are free, get yours today. Care outside the provider's network only gets 60% coverage, but inside the network it's the same 80% as always.

These lower rates on out-of-network care are drawing serious political heat. The HSA is a bridge between this reality and a new set of market incentives.

The idea is here is a pile of money for health care. It's yours to spend. Use it, but if you don't then you don't lose it. It rolls over. It lets people save for things like cosmetic procedures. It creates an incentive for them to shop and get the best deal on costs covered by the HSA.

This will be great for people who don't get terribly sick. For those who do, just stay in-network and you get the same deal you got before.

But giving employees free preventive care and an incentive to restrict their other use of the resource is the heart of the plan. It's not just what Republicans have been calling for. It's what corporate and insurance reformers have been looking toward, a way to turn consumer choice into a weapon against costs.

When people talk about having 80% agreement on what needs to be done to control health care costs, this is the kind of thing they're talking about.

I don't know if it will work. I don't even know whether we'll sign up for it. But it is a reform, in that it's a completely different plan than anything our family has been offered before. It's market-driven, but it also meets the Administration's goals of having people covered at work.

Change has come.