I’m a financially sophisticated guy, and HSAs are just too much of a hassle. I know there are advantages there somewhere, somehow, but I just can’t bring myself to invest in fully understanding and leveraging.
What is the average Joe going to do?
Nothing.
It's like a ROTH IRA, tax free accumulation and withdrawals, for HSA's they need to be health expenses.
It's a loophole in a way. You fund it with tax deferred money, like a 401K (lowering your tax bill). Then you can either use the money for health care expenses OR invest it in options provided by the plan, again like a 401K. But unlike a 401K, if you ever use the money in the account for health expenses you don't pay tax on it. You do if you take it out for a vacation or something. But not for heathcare. I figure when I'm retired I'll need to spend money on healthcare so I'm funding my HSA now and investing the balance in some basic broad market stock and bond funds. When I'm retired, that's going to be where I pay my doctors from. And I have never paid and will never pay any tax on it if that's what I do.