Longevity pioneer Peter Attia explains why the quest to live longer is constrained by the US healthcare system

• The ultra-wealthy are betting on tech and science breakthroughs to live longer.
• But the best bet for living longer is probably earlier detection of chronic disease.

The ultra wealthy have been shelling out to live longer for some time.

But creating more healthy years for more people isn't a matter of science fiction. It's a matter of preventing chronic diseases like cancer from taking hold. It's possible to do right now, for everyone. There's just no business case for it.

On March 20, Dr. Peter Attia, a leading expert on the science and art of longevity, sat down with podcaster Rich Roll to talk about what makes for a longer and healthier life.

In his view, there's a key obstacle standing in the way of your long-term health, ironically: the U.S. healthcare system.

The U.S. system is not designed to incentivize long-term health.

Attia's definition of longevity is a function of lifespan, the number of years you live, and healthspan, how well you can live them. Attia, who runs a private practice, tries to increase patients' longevity by delaying the onset of chronic disease.

Roll and Attia discussed cancer as an example. Treatment breakthroughs are not having a seismic impact on survival. Better survival requires better up-front detection, Attia said. Because stage-for-stage, you have a better shot at beating cancer if you have fewer cancer cells.

Attia's private practice is using fancy equipment and testing to try and spot cancer indications earlier. But a normal person trying to get testing with their general practitioner would run up against barriers.

Back when Attia wanted his first colonoscopy at age 40, instead of the recommended 50 (now it's age 45), he had to "fight like hell" to get it. Insurance wouldn't cover it, so he paid with his own money.

For Attia, it was well worth it because a good 5% of people who die of colon cancer are diagnosed with a cancer that occurs at or before the age of 40, he said.

"That's not a huge number, but it's not zero," Attia said.

You would think, Roll said, that there would be a lot of financial incentive to front-load patients with these types of tests and early detection scenarios to avoid these costs later down the line.

But the behemoth US healthcare system sees it differently.

Attia is from Canada, where the single-payer system has plenty of problems, he said. But it does two things well. First, everyone gets healthcare, Attia said. Nobody in Canada is on their way to bankruptcy court right now due to medical bills.

"But the second thing that a single payer system does very well — and this gets to the heart of what you're asking about, Rich — is the payer owns the risk for life, so there is an incentive to prevent," Attia said.

"Right now my health insurance is Aetna. Two years ago it was Blue Cross. Three years from now it's going to be United. What incentive does Aetna have today to care about spending a dollar on me when they are pretty much positive they will not own my risk in 20 years when the chickens come to roost," Attia continued. "That's the fundamental problem."

"Until you fix that problem, until there is true risk ownership between the patient and the payer and the provider, and that is carried out over the course of your life, there is no incentive for them to carry any of that risk," he added.

The rich get access to all sorts of cutting-edge treatments

With all of the buzz around "longevity," and much of that buzz generated by the world's most elite circles, conversations about living longer can get pretty unhinged pretty quickly. People are aspiring to live to 120 through shortcuts and technology breakthroughs.

In extreme cases, like software entrepreneur Bryan Johnson's, wealthy people are spending millions to study and fine-tune every measurable element of their biology.

Tech entrepreneurs Jeff Bezos, Peter Thiel, OpenAI's Sam Altman, and many more have allocated some of their extraordinary wealth towards backing biotech companies attempting to solve some piece of the aging puzzle.

"It's fun to kind of cast your gaze into the future. And imagine a world, like in that movie Elysium, where people get into pods and it diagnoses you and cures you immediately," Roll said. "And maybe at some point, who knows, we'll get there. But it's certainly not where we're at right now."

"And your work is very much a departure from that narrative," Roll told Attia.

Attia is just as excited as the next guy for scientific breakthroughs that could, for example, help older people's immune systems fight disease better. But he's not banking on them, he told Roll.

If you go back 120 years on paper, we've doubled lifespan from about 40 years old to 80, per Attia, but if you subtract out the top eight causes of infectious diseases, it hasn't budged at all.

On the one hand, it's pretty amazing that we've eradicated things like smallpox and infections with vaccines and antibiotics. But on the other, there's no real strategy for the other diseases that cut down on lifespan, which are chronic and require prevention.

Democratizing health knowledge

While fancy cancer testing and the like remains out of reach for many, knowledge about health can still help people make better choices.

Anti-aging trends — from cold plunges to fasting — have gathered steam.

Attia talks a lot about atherosclerosis, the deposition of lipids in the blood vessels of the heart, which is the underlying cause of most heart disease, the leading cause of death for men and women in the US.

It typically starts early in life, and it can be mitigated by things like a healthy diet.

"We have to be our own consumers of this," he told Roll.