The Biggest Driver of Longevity Is Probably Sitting in Your Wallet

The biggest driver of longevity is…..

Not taking a stack of supplements

Not getting a full body MRI

Not having peptides injected regularly

Not taking cold plunges regularly

Not tracking your moment to moment glucose fluctuations

Not seeing an integrative or functional medicine specialist

The biggest driver of longevity is something that is likely sitting in your wallet or purse right now. It’s that thin piece of plastic or cardboard that has your Medicare, Medicaid, Tri-Care or private insurance information printed on it. 

We like to talk a lot about all the cutting edge technology, pharmaceuticals and supplements that people have access to on a daily basis. You can now go to a ‘longevity clinic’ and get your 250 metabolic markers, DEXA scan and full body MRI all in the same location for a mere $10,000 to $75,000 membership fee. That fee starts to rival some pretty exclusive country clubs. 

For many of us, having health insurance is not a concern. For a growing number of Americans it is something which is of great concern and often causes them to delay care. Ask any parent the anxiety they feel when their child has approached the magic age of 26 and can suddenly be faced with the loss of coverage due to an employment gap or working for a company as a 1099 contractor. 

In a landmark study by Wilper in 2009 his research showed a 40% higher rate of all causes of death for someone without insurance compared to those with insurance. Across multiple studies, uninsured patients are approximately 50% to 200% more likely to be diagnosed with advanced-stage cancer than privately insured patients, depending on the cancer type.

Now, I want to be fair to that 2009 number, because critics of universal coverage will rightly point out where it comes from. Wilper’s study was observational, which means it can’t fully untangle cause from effect. People without insurance also tend to be sicker and poorer for reasons that have nothing to do with the card in their wallet, and some of that gets baked into the comparison. 

When Oregon actually ran a randomized lottery for Medicaid back in 2008, about as close as we’ll ever get to a true experiment on this question, the two-year results didn’t show mortality or blood pressure improvements anywhere near that scale, though they did show a real drop in depression and in the kind of medical debt that keeps people up at night.

Meanwhile, the research that followed Oregon has still found a real effect on longevity markers, just a smaller and more defensible one. A study tracking 37 million low-income Americans found that gaining Medicaid cut the death rate among new enrollees by roughly 21%, working out to about $179,000 per life-year saved, the kind of number that would make almost any health economist call it a bargain. 

A similar study out of Massachusetts found a meaningful drop in deaths from conditions that are treatable with timely care after that state expanded coverage. So the impact of having health insurance on longevity is measurable, it’s real, and by the numbers, it’s one of the more cost-effective things we know how to do.

Among wealthy developed nations, the United States is the only country that does not guarantee universal health coverage for all citizens:

Currently close to 30 million American citizens do not have any form of health care coverage. The Urban Institute estimates that the expiration of enhanced ACA premium subsidies could leave approximately 4.8 million additional Americans uninsured, increasing the nation's uninsured population by nearly 20%. That total is larger than the population of Texas, our second largest state.  

These systems actually vary quite a bit as while some may tag it as socialized medicine (commonly referred to in the National Health Service model and Single Payer model) to argue against our ability to do it in the US. And yes every model has its own flaws. One of the flaws is not that it doesn’t cover all their citizens as opposed to the US where 1/11 are not covered.

National Health Service model

• United Kingdom

• Spain

• Italy

• Norway

• Sweden

• Denmark

• Single-payer model

• Canada

• Taiwan

Social insurance model

• Germany

• France

• Japan

• Belgium

• Austria

• Netherlands

Regulated private insurance model

• Switzerland

• Netherlands

This exceptional Substack post by Dr. Jessica Knurick explains the genesis of our system. In a very real sense this is a choice we make as a society. While the politics surrounding access to universal health care can be very interesting, the fact remains. The United States of America, the greatest country that has ever existed with the largest economy in the world, can’t figure out a way to demand that every man, woman and child has some degree of basic access to healthcare. It is appalling.

For 25 years I practiced emergency medicine. One of the foundational attractions for me of emergency medicine is the simple fact that we see every patient regardless of ability to pay. If you are sick, come through the door and we will take care of you. From the homeless veteran to the local CEO we will place you in a bed and do our best to determine what is the cause of your pain or concern. Of the tens of thousands of patients I have seen over my career I’ve had the unfortunate task of notifying some of them of what was found on the CT was likely cancer. I’ve seen plenty of patients who delayed care and allowed that elevated blood sugar to progress to diabetic ketoacidosis, a life threatening condition, for the simple lack of the ability to get insulin. Or the patient who had stopped taking their blood pressure medicine due to affordability who came in with a devastating stroke due to uncontrolled hypertension.

The funny thing is the US has a form of universal health care for its citizens. You just have to survive until 65 to get it. It’s called Medicare. Before 1960 almost half of older Americans were uninsured. Can you imagine! If you look at the data from people on Medicare that death difference in all causes of dying and being diagnosed with advanced stage cancer dramatically lowers. It does not disappear as the years of not having insurance, for some, can’t overcome the years of damage that have already been done. I saw a patient a while back and during his intake assessment he related his screening colonoscopy at 45 years of age had diagnosed an early cancer. It was a small adenomatous polyp that would have turned into cancer if left alone. He is the poster child for early screening. How many patients without insurance will take the time to get that screening colonoscopy as recommended at age 45 (recently down from 50) ?

And yes, now I practice a specialty where I do not accept insurance and operate outside the traditional healthcare system. While my fees are posted, I will clearly state they are a small fraction of the lower-end prices for those longevity clinics listed above.

So why write this post? I’ve listened to this debate about universal health care for my entire career. I’ve witnessed the ramifications of people not having insurance, as have most physicians, as we scramble to find the specialist this patient needs that would accept them or take them on as a charity case. We make multiple phone calls to university hospitals far away that are obligated to accept them. We rely on the kindness of physicians to make up for the lack of that simple fact of not having insurance. That is wrong.

In the midst of the movement towards non-traditional care, including wellness and longevity care, we are missing the forest for the trees. I talk to each of my patients, always, about nutrition, movement, getting enough sleep and managing stress. I recommend supplements and medications based on biomarkers I believe to be important. Many physicians in functional and integrative medicine do the same. But if we really want to make a dent in the population statistics where the US lags most of our peers, like life expectancy, maternal mortality and neonatal death rates, perhaps we should start with something much simpler, like providing basic health care for every one of our citizens.