SECTION THREE: Classical Health Savings Accounts: Many Surprises
One of the originators of Health Savings Accounts describes their advantages over existing health insurance. Improvements are suggested for the regular HSA. More dramatic cost improvement emerges from a lifetime HSA version, substituting whole-life approaches for pay-as-you-go. Most of this requires legislation, but could reduce health costs dramatically.
The cost of retirement living is probably already larger than the average lifetime cost of healthcare, or about $350,000. That's almost the same as saying nobody but a millionaire has a chance. But longevity is constantly lengthening, and healthcare will probably get cheaper eventually. So right now, retirement at $35,000 a year for 20 years is twice as expensive as healthcare, retirement at age 60 for 40 more years would cost four times as much as healthcare. Somewhere along the line, someone will suggest we make healthcare a minor component of retirement costs and roll the two together to save administrative costs. By that time, I expect healthcare to be largely an experience of retired people, anyway. With half the nation retired, the architects will have to design housing for that expectation. But the greatest challenge will be to find something for those people to do with their time. It might as well be -- it almost has to be -- something remunerative. Even assuming unlimited wealth, it's pretty hard to imagine people going on four ocean cruises a year, year after year. Or playing eighteen holes of golf, six days a week. I've known a few people who did things like that, but it's hard to imagine a whole nation doing it. And out of that synthesis will come some way to pay for retirement, including healthcare.
Buy and Hold. Don't pay high fees. 6% Returns or Know the Reason.
The alternative is to have no money. Alternatives to watching television aren't attractive, and in fact, they aren't much different from going to jail, except it is reported it costs more to be in Leavenworth than to go to Harvard. It's sixty or more years into the future, so it isn't my problem to re-design a civilization to fit its coming demography. All I can do is mention that having a regular check come in, won't be enough to occupy the time of half the country, so they better get started, developing something else. Meanwhile, here's how to arrange to get that check
For most of the past decade, saving for a rainy day has been in an interest-rate environment which made the usual saving process almost useless. Let's compare today with a generation ago. When my mother died at the age of 103, she had been living for decades on her savings account at the bank, with certificates of deposit and interest rates which were quite generous. She had a few stocks, but interest on fixed-income sources was the main thing, not just for her but for all the elderly folks in her generation. Well, for nearly a decade things have been entirely different for investors. The government has been trying to fight a recession with zero interest rates, and the Federal Reserve has accumulated trillions of dollars worth of bonds it will someday try to sell. Much of this has been financed artificially in ways most of us could not possibly understand, but we do understand two things:
1. A lot, if not most, of this maneuvering, has been at the expense of old folks. They were taught to depend on a fixed income, but interest rates right now are smaller than the rate of inflation, while the price of bonds has been driven high by the government owning trillions of them. They threaten to crash if things go back to normal, so somebody wants them to remain low. The Chairman of the Federal Reserve wants to be calm and reassuring, but essentially admits she isn't certain what to do.
2. When the Federal Reserve starts to raise interest rates back to normal, it will sell bonds, perhaps trillions of them. The bond market may not plummet immediately, but only if the Federal Reserve makes spelling mistakes. Cash may be king in this situation, but only if investors don't freeze, like deer in the headlights..
So, It's a little hard to imagine buying bonds, living on bank accounts, or doing most of the other things we watched our parents do with great success. That would include Health Savings Accounts, wouldn't it? No, it wouldn't. The HSA is a good place to buy common stocks, and the best of all places to park your spare cash. You can invest in anything you please with HSA, with or without coupons, because a tax-free account doesn't care about tax consequences. If your HSA has any limitations to what you can do, it must be caused by your broker or your advisor, not because the HSA program gets in the way. Overfunding the HSA account is always a good alternative, although mostly a passive investment in a low-cost index fund of the entire American market will work out better. Let's put it this way: if you start investing when you are fairly young, you will probably come out well enough. If you start investing when you are nearing retirement age, you had better be lucky, because you won't have time to ride it out.
1. The first weapon you will have is compound interest. It has great power because its secret is its effective interest rate rises at the far end. A small amount early in life is better than a big amount near the end, but any time is better than never. The tax-exempt feature is a treasure. Thirty years extra longevity this century extend it longer, and longevity continues to increase. But remember this: the net income must be larger than the rate of inflation. If you don't know the rate of inflation, just guess it is 3% a year.
2. The second weapon is passive investing. Don't try to beat the market, just try to equal the market, and you will eventually get where you are going. But don't pay high fees. Lots of brokers have great track records until you subtract their fees. In fact, it is probably impossible to have a great record unless you charge low fees. Instead, buy an index fund of the entire U.S. Stock market, and act like you forgot you have it. And don't establish a Health Savings Account with the first agent you happen to meet. I once overheard my mother advising my daughter, "Don't marry the first man who asks you."