You know what happens.

The account slowly builds for the unexpected expense or long-term goal. The weight, cholesterol and blood pressure drop.

As I think about health care debates in the news, that principle comes to mind.

Should we radically restructure Medicare and Medicaid, the health care programs for the elderly and poor?

Such suggestions frighten people and polarize politicians. So nothing happens.

But to let the two programs continue on their current courses is even more frightening. Why? The trajectory of soaring costs means we're headed for a crash.

So why not make smaller changes - corrections in course that would affect, but not devastate, the budgets of future recipients?

Health care is a far bigger part of the economy than in generations past, and its costs are a rising percentage of most household budgets. Yes, prices for care have risen. But nearly everyone also is consuming more care.

Can we really consume more without paying more? 

The Kanawha County Commission is struggling with its own health care crisis. 

It recently discovered that employees hired after 1998 cannot count on cheap health insurance from the Public Employees Insurance Agency when they retire.

That's because the county is self-insured. Years ago it decided to stop participating in the PEIA plan, and the PEIA board eventually decided to stop letting the county's retirees pick up coverage.

The rule change applies to people hired after 1998 and affects those employed not only by Kanawha County government, but also by other government employers that don't participate in PEIA for current employees.

The PEIA board had a reason for the change. It is faced with $8 billion in uncovered costs for health coverage pledged to public workers in retirement.

So Kanawha County officials must decide whether to do nothing, return to the PEIA fold, or come up with their own plan for providing coverage to the affected employees when they retire.

The second and third options come with price tags for the county and, thus, its taxpayers.

While the PEIA premiums for both the county and its employees appear to be a little cheaper, returning to the state-run plan would bring the county an annual assessment for the cost of - you guessed it - retiree health care. It would have to carry that figure on its books and, presumably, spend less elsewhere.   

Of course, starting its own plan for retiree coverage also would be costly.

However, commissioners don't seem inclined to choose option one and do nothing.

They rightfully worry about certain categories of workers - emergency medical personnel and deputies, who tend to retire in their 50s because of the physically demanding nature of their work.

Should such employees feel forced to stay in difficult jobs until they qualify for Medicare at 65?

Fifty-somethings in the private sector might want to chime in at this point.

For example, early retirees of the Century Aluminum plant in Jackson County recently took up a collection and sent representatives to California to make a direct appeal to the company's stockholders. 

The company has dropped health coverage for its retirees - not just future ones, but also those already out of the work force.

The change has helped the company's bottom line.  

While that sounds cruel, healthy bottom lines keep companies providing jobs and, in this case, dealing with the volatility of the aluminum market.

Government also should worry about its bottom line.

Elected officials must answer to taxpayers, and like the Century retirees, many of them are dealing with their own health care crises.

Back to the concept of little changes.

Perhaps the county could find a middle ground - something other than elimination of retiree health coverage or continuation of coverage that is a great deal for retirees but not for taxpayers.

Here's an idea: Employee premiums, deductibles and co-pays could be set at higher rates.

Many law enforcement workers retire early and launch second careers. Some of the new jobs offer benefits; some don't.    

Higher health insurance costs would force more careful planning and saving on the part of those who want to retire early. But there still would be an alternative to struggling with car wreck victims or chasing crooks  into one's 60s.

Pay a little more. Work a little longer.

It has to happen in both the public and private sectors. Nothing else computes.

Friend is editor and publisher of the Daily Mail. She may be reached at 348-5124 or nan...@dailymail.com.