the compassion I mention means simply realizing that people funding IRA's and agreeing to pay the taxes later, had no idea a) health insurance would get so costly b) the government would step in set an arbitrary income ceiling and heavily subsidize people below it and expect people even one dollar above the number to pay full freight.
As far as boldly proclaiming they dodged taxes, due to less pensions being offered these people were simply trying to provide for some income in their later years. When you take 70K living expenses out of an IRA in your early 60's and a couple pays close to 20K in HI that's is not a lower tax rate.
I never trust the government.... lol And not that I was "smarter", but I planned for my early retirement by putting $$ into 401K and also a reasonable nest egg in after tax investment as in back of my mind it seemed like government would do something that wouldn't be advantageous to be all in 401K/IRA's. If I were truly smarter I'd have done an even better job
I actually expect to see more manipulation by the government as 401K/IRA balances remain a huge target. Time will tell.
However, if it were me and I needed $70K for living expenses, I'd lower the IRA W/D to $64K and then figure out how I'd cover the $6K difference for the next few years until I could get Medicare. One example, get a HEL, pull $6K from that. Cost you about $200 in interest the first year, then $400 a year each subsequent year.
For example, get a HEL, pull $6K from that each year. For 4 years you'd pull out $24K and pay about $4K in interest, much less expensive than forgoing the subsidy. And if subsidy rules change then you just unwind that transaction.
Heck, I'd even consider borrowing against my credit card. Even at 21% interest you'd pay $10K in interest over the 4 years, but save much more than that in subsidies.
Or look to sell a car or some other assets. Maybe sell house and downsize and pocket enough from sale of house that doesn't count in your AGI/MAGI.
Or even plan to pull a large sum from IRA now ($24K) and then put that into after tax investments and pull from there each subsequent year. You then only take hit in current year but gain benefits in subsequent years with subsidy. But if subsidy goes away then that works against you.
Just need to figure out what works for you.