Johnathan Clements, an incisive writer, recently noted retirement should be like a long vacation in Vegas. Have fun, but don’t run out of money. Non-Medicare eligible boomers and early wave Gen Xers face another retirement hurdle — unaffordable health insurance before retirement. In 2003, Congress tweaked tax laws to allow deductible contributions to health saving accounts (HSAs). Withdrawals from HSAs could be used tax-free for qualified medical expenses. In a libertarian pipedream world, HSAs coupled with high-deductible health insurance policies would force people to choose the least expensive healthcare option. Patients would shop around for cheaper options, thus lowering expenses. In the real world, unfortunately, high deductible policies cause higher out of pocket costs over time.

High deductible plans can initially lower costs but inefficiently. Economists at the University of California, Berkley, and Harvard found employers could reduce medical spending, but employees simply avoided preventative care. In Doctoring 101, you learn that strategy causes worse problems down the road. As another example, the Journal of Clinical Oncology reported women delayed follow up exams or biopsies after mammograms when using high deductible insurance plans.

In the last 10 years, the number of high deductible employer-sponsored health insurance plans has quadrupled. Currently, almost 40 percent of large employers offer high deductible plans with half of all workers in the United States with $1,000 deductibles. According to the Federal Reserve, four in 10 workers can’t afford an unexpected $400 bill without selling something or using a credit card.

Some companies look for better ways to manage costs. CVS discovered employees stopped taking prescriptions when enrolled in a high deductible plan. To improve employee health, next year CVS will roll out a prescription plan using discounted, non-generic drugs. CVS has enough influence to demand lower prices from drug manufacturers. Medicare should follow suit for Medicare Part D. Give J.P. Morgan CEO Jamie Damon some love. J.P. Morgan ended all high deductible plans for all employees making less than $60,000. Employees couldn’t afford necessary procedures with high out of pocket costs.

On a personal note, our daughter has a chronic health condition. After months of hospital visits, she found a medicine that worked. There was only one problem. Her insurance company didn’t want to cover it without trying another medicine. Stop taking the medication that is working, and if the new one doesn’t work, then we’ll think about covering the first one. It’s like Alice in Medical Wonderland.

The Affordable Care Act limited premium costs for middle-aged individuals by forcing everyone to buy insurance. The end of the individual mandate for health insurance ends these restrictions. For most people working until age 65 when Medicare kicks in is the only practical option. Sadly, America is the only developed country where people can face medical bankruptcy even with health insurance.

You can’t always get what you want, but Buz Livingston, CFP can help figure out what you need. For specific recommendations, visit livingstonfinancial.net or come by the office in Redfish Village, 2050 Scenic 30A, M-1 Suite 230.