The Inside Scoop on Longevity

The ACA architect spent his Aspen interview explaining, case by case, why the cheapest health fixes go undone — because the savings land in someone else's pocket.

• A longevity book from a man who hopes to die at 75.

• The strongest predictor of a long life is the one no one sells.

• You already get enough protein. You’re short on fiber.

• The food system makes disease cheaper than health.

• The savings are real. They just go to someone else.

• Where the power actually sits.

• The cheapest medicine is the one no one can sell you.

• A personal note.

A longevity book from a man who hopes to die at 75.

The 68-year-old bioethicist who once argued he hopes to die at 75 has written a book about living a long, healthy life. After our conversation, ice cream was served at his book signing. He would like you to know it is good for you.

Dr. Zeke Emanuel hasn’t changed his mind about 75. What scares him is dementia, not death, and no drug moves that line much. The book, Eat Your Ice Cream, is about the years before the mind slips: what you can really do, and what the wellness industry sells you instead.

Here’s the story he’s writing against. Wellness, as sold, is a personal optimization project. Track your sleep. Max your protein. Buy the stack of supplements. The former surgeon general nominee he criticizes, Casey Means, built a following on gummies and immunity blends. The promise is simple: your health is a set of choices, and the right purchases will fix it.

The strongest predictor of a long life is the one no one sells.

Start with his most surprising claim: the best sign of a long, healthy life is the quality of your relationship, ahead of diet, exercise, and sleep. He’s pointing to the Harvard Study of Adult Development, which has followed the same people for more than 80 years. It keeps finding that close ties beat cholesterol.

I asked him why Big Wellness skips this. His answer? You can’t sell a friendship. There’s no product, no subscription, no $500 test. So the influencers ignore it. And so do most doctors, he says, because a visit isn’t built or paid to ask how often you see the people you love.

You already get enough protein. You’re short on fiber.

Everyone in the room, he says, already gets enough protein. The average American eats about 12 ounces of meat a day. About 12 ounces a week is closer to the mark. The Dunkin’ sign promising protein, protein, protein is selling you more of what you’ve already got. The thing most Americans actually lack is fiber. We just don’t build meals around the beans, nuts, fruit, and vegetables that carry it.

The deeper mistake he names is “maxxing,” the idea that if a little is good, ten times more is better. The body runs on balance, not on more. Too much of one thing usually throws something else off. The supplement aisle is built on the opposite belief.

The same goes for GLP-1 weight loss drugs. More than half of people who start a GLP-1 like Ozempic or Mounjaro stop within a year, and the weight tends to come back. Losing and regaining over and over can cost you muscle while it adds back fat. Real wellness, he argues, is built from habits you can keep for decades.

The food system makes disease cheaper than health.

Ultra-processed foods now make up more than half the calories American adults eat. Emanuel blames a policy choice, not weak character. In the 1970s, Nixon’s farm chief, Earl Butz, told farmers to “get big or get out.” He rebuilt the rules to back corn, soy, wheat, and rice with tax money — the cheap building blocks of processed food. The cheapest calories became the most processed ones. For people on a tight budget, they were also the most filling per dollar.

So the system makes disease cheap up front. Then, he says, it acts shocked by the obesity, diabetes, and heart disease later, and pays the price. He calls it doing everything “ass backwards.” We pay to grow the problem, then pay to treat it.

The savings are real. They just go to someone else.

This is where the pattern earns a name. Call it “orphan savings:” money the system could save by preventing illness or cutting waste, except the savings go to someone else.

Dr. Emanuel’s own work supplies a good example. He wrote a “billing simplification” rule into the Affordable Care Act. It went nowhere. Part of the reason, he says, is that the government doesn’t keep most of the savings from simpler billing; insurers and hospitals do. So the agency with the power to act had little reason to push.

Dr. Emanuel puts U.S. health spending near $5.6 trillion (federal number-crunchers count $5.3 trillion for 2024) and paperwork costs at $1.25 trillion. Estimates vary a lot by how you count, and McKinsey puts the part you could easily save at about a quarter-trillion. Either way, processing a hospital bill costs far more than processing a credit-card charge. The gap is “orphaned savings” no one is paid to close.

The same thing explains why insurers won’t pay for prevention. People switch plans most years. So the insurer that pays today to keep you healthy watches a rival collect the reward next year. Prevention becomes a gift to whoever insures you next. So it doesn’t get funded.

It also explains a missed chance during the pandemic. Schools got tens of billions in relief money. Better indoor air would have meant fewer infections, fewer asthma attacks, and higher test scores. But very few districts spent the money on air systems. The payoff was spread out and years away.

Where the power actually sits.

Once you see “orphan savings,” the wellness story looks different. We’re told to fix ourselves because the individual is the one person with a clear payor attached. Habits matter. And someone can sell you a supplement, and no one can sell you a farm bill.

So the better question is who holds the lever. Some fixes just need a person with power to use it: the farm chief who sets the subsidies, the hospital buyer, the drug list committee, the employer Dr. Emanuel calls “AWOL and idiotic” on cost, the lawmaker who could make billing the same everywhere. Other fixes work by giving people more room to act: better defaults, lower prices, better buildings, real food close by. Telling a shift worker with a long commute to cook from scratch asks willpower to fix a supply problem. Cheaper produce and a school lunch program change what’s actually within reach.

The cheapest medicine is the one no one can sell you.

When I ask him for the single thing anyone could do today, Dr. Emanuel says: throw a dinner party. You cook, so you eat real food and learn a recipe. You invite people, so you get social connection. Good conversations exercise your brain. Afterward you take a walk. He calls it “wellness stacking.” It’s also the rare health move where the savings aren’t orphaned. You pay for it, and you’re the one who reaps the benefits.

A personal note.

I had to leave Aspen Health early. On Tuesday, my 15-year-old toy poodle, Zizou, gave me a scare. I flew home first thing Wednesday and handed my remaining three panels to my friends Dr. Jeremy Faust and Blythe Adamson. While I traveled, my dog-sitter and her mom took Zizou to the vet. An x-ray showed a dislocated hip.

He was up and moving overnight. By morning he was putting a little weight on the leg. Yesterday, we saw a veterinary orthopedic surgeon, who took another x-ray. Zizou had popped the hip back into place on his own. The leg is still weak and splays out, so he’ll wear a brace for two weeks to let it heal and to keep the hip from slipping again. We’re both relieved.