The Health Fund

I just wanted to say a few words about the health plan I used to have at Adobe, and you can take those words for what they're worth. I'm saying my piece here because I never hear anyone talk about this sort of thing, and I think it's relevant to the debate.

I loved my plan. I'm sure there were problems with it—it probably had injunctions against pre-existing conditions and other gotchas that Obama and Congress are rightly trying to get rid of—but that I never ran up against. Here's the gist:

It was a health fund. I (or rather, my employer, who subsidized it to the point that it was either no-cost or very low-cost to me) paid money into this fund, and up to a set limit (which was something like $1K for me when I just covered myself, and $2K for my whole family the next year), all my bills were paid out of the fund at 100%. There were no co-pays. I went to the doctor, it was covered, done.

But here's the even better part (though the 100% coverage/no copay part was pretty damn good): I got to see the bills. The insurance company would send me statements showing what the doctor had charged, what they had negotiated to pay, and thus what had come out of my fund. I knew how much a visit to the allergist cost, how much a breathing test cost, etc. I could see for myself how much money was left in the fund, and *how* I'd spent what I'd spent so far. Because of this, I had a vested interest in questioning the reason for any tests that were ordered, how often I *really* needed to be seen, and whether that expensive drug was really effective. I loved having this kind of visibility into the cost of my care, and the incentive to try to lower that cost.

I also had an incentive to get routine preventative care in order to keep myself healthy, because using some funds to stay healthy meant there were funds left over at the end of the year that would roll over to the next year. So, for example, I had something like $440 left over from 2007, so for 2008 I would have had $1440 for myself or $2440 for my family (or maybe it was $3440, with $3K being the family baseline; I can't remember exactly). The cool thing about this was that it helped us save up for a bad health year. If we were going along great for a few years and then Al broke a leg or I got pregnant or the Beaner needed surgery, we'd have a pile of health fund money built up to help us cover costs before we had any out-of-pocket expenses.

If I exhausted my fund in any year, there was an out-of-pocket maximum of something, maybe $500 or $1000, and then the 80/20 coverage kicked in. So I was never out in the cold, never worse off than a relatively high-deductible plan, and often better off. I felt like the incentives were the right ones—staying healthy and saving money—and yet there was a safety net if I managed to fail at this mission.

I realize such a plan wouldn't be the best choice for everyone, but it seems like it should be a choice for more people. While I don't regret leaving Adobe for an opportunity to expand my skills and experience at a startup, I do regret leaving that health plan behind. I miss that health plan almost as much as I miss my former colleagues.

Posted by Lori in public policy and women's health at 9:04 PM on August 13, 2009