Breaking Free From Insurance-Gated Healthcare: Reimagining Longevity Medicine Through the Lens of Wealth Management

If you have an account with Fidelity, Schwab, Vanguard, or another financial institution, you likely chose them because of their easy-to-use digital tools for managing stocks and ETFs. What is somewhat more mysterious to many users is their marketplace of financial advisors and wealth management services. I have spoken to such financial advisors before and always left wondering how they managed to have a job when I consistently outperformed them with my extremely simplistic strategy: “buy index funds as much and as early as possible, and hold for decades.”

What I have more recently discovered is that you can only get so far with diversified stocks and ETFs. It’s still a great foundational strategy for people wondering what to do with their excess savings, but it turns out that to reach egregious levels of wealth, like eight- or nine-figure USD, one probably needs to lean on some savvy experts (or spend a lot of time becoming one themselves).

Healthcare is similar. Much of the conversation about what healthcare “should” be, what insurance “should” cover, or what type of healthcare is a “right” ends up hotly debated, simply because the overall concept is oversimplified. As a physician who has worked in diverse settings—from free clinics to cash-pay concierge clinics—I believe we need a more nuanced understanding of each type of healthcare in order to fix the entire broken, confused system.

Safety Net Healthcare - What We All Deserve

When people state that healthcare is a right, I think of safety net healthcare. This is the kind of healthcare that should be available to anyone, no matter their means or situation. Whether one is homeless or a billionaire, incarcerated or a doctor, this is the healthcare that we typically think of as “life-saving.”

This is the principle behind EMTALA—the Emergency Medical Treatment and Labor Act. This federal law was enacted in the 1980s in the United States to provide emergency medical treatment to anyone, regardless of their ability to pay or legal status. To me, this seems like an appropriate basic human right. However, even this minimal standard is a point of debate for some health centers located among largely uninsured populations. Before this law was in place, many hospitals, under financial or staffing strain, would dump patients on the streets without providing even basic screening and stabilization.

This topic becomes more mired in controversy the farther we get from emergency care. The Affordable Care Act (ACA), community health centers, the Hill-Burton Act, the Children’s Health Insurance Program (CHIP), the Ryan White HIV/AIDS Program, the 340B drug pricing program, Medicaid, and Medicare are all laws and services that provide some level of safety net healthcare.

Whatever our political beliefs about subsidizing such programs, we can agree that all the above are largely inadequate for optimal healthcare, much less longevity-focused medicine. Like basic financial services and protections, these are in place to prevent immediate demise and disaster.

Insurance-Gated Healthcare - What We All Despise

According to the CDC, we hit a record low rate of uninsured Americans in Q1 of 2023 [1]. A full 92.3% of Americans had health insurance during that time period, and more than half of those people likely experienced feelings ranging from anger to frustration toward their insurance. It might surprise some, but physicians don’t love insurance plans either. Because of the need for diagnosis and billing codes, we have largely become documentation monkeys, with over 50% of a primary care doctor’s time dedicated to “desktop medicine” [2].

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Not to mention the arms race in play between health systems and insurance plans around fee-for-service reimbursement schemes. Because preventive care, counseling, and other “vague” doctoring tasks can only be billed per unit of time, health systems have figured out that procedures can generate more cash more quickly. Thus, doctors who conduct procedures, particularly low-cost ones (to the health system), are most financially rewarded for their efforts.

Insurance companies have also been trying to squeeze more juice out of the proverbial healthcare orange. Reimbursement rates are opaque and negotiated with every single health system separately. You likely won’t get a straight answer from anyone about how much your surgery, physical therapy, or lab test might cost out-of-pocket until billing codes have been submitted into the ether. Not to mention, premiums have been increasing by up to 10% each year [3].

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Finally, the American public has only recently discovered how additional middlemen, like pharmacy benefit managers (PBMs), add to the costly mix of the U.S. healthcare system. That’s not taking into account, of course, the poorly negotiated prices of drugs for Americans compared to citizens of other countries. Without going off on a full tangent, we can all agree that there’s something terribly wrong if we’re spending $4.5 trillion a year on healthcare and deeply underperforming compared to similarly wealthy countries [4, 5]. We quite literally have the highest rates of infant and maternal deaths as well as deaths from assault [6].

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But I digress. The point of this overview is to demonstrate how our healthcare system has become insurance-gated, subjecting each person’s health to the invisible whims of closed-door negotiations. Leaving our health up to this system is somewhat akin to storing one’s cash under a mattress or in a low-interest savings account. At the very least, invest in some index funds! Similarly, get a gym membership and start eating whole, unprocessed foods.

Wealth and Health Management - Is It Only For the Rich?

If you have enough money saved in a bank account to survive three months without going into debt, you’re doing better than about half of all Americans [7]. If you’re anything like my recently laid-off friends, three months is barely enough time to pull together a new job! So it can feel a bit unrealistic for most people to even conceive of one day requiring a wealth manager. And I’m not suggesting that it’s appropriate for most people.

Similarly, if you are currently hospitalized or undergoing intensive treatment for cancer or another serious illness, it’s probably not the right time to start thinking about longevity medicine. Get to “zero” first, when you can catch your breath to even schedule a virtual appointment or gather your health documents. Wealth management is only for people with some baseline of wealth. Longevity medicine is for people who aren’t currently bankrupt in health.

In fact, I wouldn’t even say that the very first step at this point is to see a longevity physician. You could first get your health “house” in order by doing the equivalent of budgeting, getting a high-interest savings account, and investing in index funds. Start by paying attention to how you feel, your quality and quantity of sleep, your menstrual cycles, and your nutritional intake. Once you hit a wall in your knowledge, then you can turn to experts. For the more independently minded out there, there is even a great deal of scientific content that practitioners like myself publish for free.

But once you reach a point where you have maximized your own knowledge and perhaps need a lab test or prescription, it is time to lean on folks like myself who have spent an ungodly amount of time in school for this purpose.

Not All Doctors are the Same

I might be stating the obvious, but not all doctors are the same. Doctors are very much like financial advisors and wealth managers; some are going to be at the top of their game, while others are just trying not to die under the burden of their administrative load (actually, I don’t know of any financial advisors dying under paperwork, strangely enough).

Like anything else in life, you need to understand your priorities before you seek out a physician. Sometimes, you just want a work note or a Paxlovid prescription. Just about any doctor will give you those things. If you want guideline-based cancer and heart disease screenings, most PCPs can take care of you well enough. But if you want your doctor to know the best liquid biopsy testing service for cancer screening, or which tests to include in your lipid panel (like ApoB and Lp(a)), you’ll need someone who speaks that language—a longevity physician.

Even among longevity physicians, you’ll find vast differences in practice. Some doctors lean more toward rejuvenation and performance enhancement. Others, like myself, seek to optimize healthspan while pushing the bounds of longevity with evidence-informed tools. Some longevity doctors are functional practitioners at heart, while others are evolved allopathic physicians. If you don’t understand what those terms mean, just know that they’re very different, and neither is equivalent to longevity medicine.

What is common among all longevity health practitioners is that most services are not accessible in an insurance-gated healthcare world. Even if many longevity blood tests and medications are covered by conventional insurance plans, the time spent with a longevity doctor is up to 10 times greater than that spent with your typical PCP. That level of attention requires membership or additional co-pay fees as a reality.

It’s All About Priorities and Personalization

Why do you even need a wealth or a health manager? Can’t a smart person do it all on their own?

A smart and very determined person could certainly get access to the best investment deals and even start a company and become a billionaire with enough luck and fortitude. Similarly, a person with the right aptitude could bully their insurance company and physicians into following a recommended longevity framework. Or, they could become a longevity doctor themselves (I don’t recommend it—it’s quite a lot of training that will put you in debt!).

Someone who wants to balance doing it on their own and not spend overly much on longevity care might turn to one of the latest platforms offering testing, supplements, or prescriptions at the low cost of $500-1000 a year (this is low cost, I’m afraid). But similar to gyms, you get what you pay for. With such longevity startups, you’ll still need to do a lot of the research yourself if you want to ensure you’re getting the best care for your unique situation. The panels you buy with a one-stop-shop and the supplements recommended are typically governed by the platform’s incentives (usually selling more tests and supplements).

On the other hand, the ultimate longevity care is in the hands of an experienced clinician who has access to all of the above testing and intervention partners. If you want a more guided, hand-held experience, even the low-end for longevity concierge has membership rates greater than that of Equinox (which is $350 a year in NYC).

But this is well worth it for someone who prioritizes their health and realizes it is the foundation upon which all else rests.

Actionable Takeaways for Longevity

This was one of my longer essays, so I want to leave you with some easy steps toward healthspan and longevity, free of mumbo jumbo.

Before reading on, take an honest look at yourself and decide whether health is in your top three priorities. If it is, follow these three steps.

A. Get your health and longevity house in order.
    a. Track how you feel in terms of energy, mood, and spirit.
    b. Monitor your sleep, nutrition, physical activity, and relationships.
    c. Find out what every biological relative you have suffers from health-wise (or died from). Focus on the biggest killers and threats to healthspan in older age: heart disease, dementia, cancer, and falls (often disguised as pneumonia, sepsis, or some other result of a hospitalization due to a fall).

B. Decide on your healthcare strategy.
    a. Evaluate your financial situation, time availability (you can replace a lot of handholding in healthcare by using your own time for navigation and advocacy), and urgency of your health priorities.
    b. Take a good hard look at what your health insurance covers and determine if your needs align to your covered health providers’ abilities.

C. Get started on your longevity plan.
    a. Focus first on eating, sleeping, and exercising well.
    b. Find a healthcare provider or platform (do the extra legwork to evaluate either option).
    c. Get screening tests appropriate for your personal situation, probably including screenings for lipid disorders, metabolic disorders, hormone imbalances, blood cell levels, micronutrients, specific vitamin deficiencies, cancer, and major organ function.
    d. Review findings with your physician and conduct follow-up testing or start necessary interventions.

With that, you’ll be well on your way toward living a long, healthy life!

References

1. U.S. uninsured rate hits record low in first quarter of 2023 | Blogs | CDC. Published August 3, 2023. https://blogs.cdc.gov/nchs/2023/08/03/7434/‌
2. Tai-Seale M, Olson CW, Li J, et al. Electronic Health Record Logs Indicate That Physicians Split Time Evenly Between Seeing Patients And Desktop Medicine. Health Aff (Millwood). 2017;36(4):655-662. doi:10.1377/hlthaff.2016.0811
3. Cox C, Fehr R, Levitt L, Claxton G. How Much and Why 2024 Premiums Are Expected to Grow in Affordable Care Act Marketplaces. Peterson-KFF Health System Tracker. Published July 25, 2024. Accessed August 26, 2024. Available at: https://www.healthsystemtracker.org/brief/how-much-and-why-2024-premiums-are-expected-to-grow-in-affordable-care-act-marketplaces/#Overall 2024 proposed rate change among ACA Marketplace plans, by insurer
4. American Medical Association. Trends in Health Care Spending. American Medical Association. Accessed August 26, 2024. Available at: https://www.ama-assn.org/about/research/trends-health-care-spending#:~:text=Although physician services is the,and 4.7%25 for prescription drugs.&text=The report discusses this breakdown,private businesses%2C etc.
5. McPhillips D. US health care spending vastly outpaces other high-income countries. CNN. Published January 31, 2023. Accessed August 26, 2024. Available at: https://www.cnn.com/2023/01/31/health/us-health-care-spending-global-perspective/index.html
6. Tikkanen R, Abrams MK, Djordjevic A, Schneider EC. U.S. Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes. The Commonwealth Fund. Published January 31, 2023. Accessed August 26, 2024. Available at: https://www.commonwealthfund.org/publications/issue-briefs/2023/jan/us-health-care-global-perspective-2022
7. Yochim D. Emergency Savings Report. Bankrate. Published January 2023. Accessed August 26, 2024. Available at: https://www.bankrate.com/banking/savings/emergency-savings-report/

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Until next time - Cheers to your health!

Hillary Lin, MD