13d • General discussion
$100K Longevity Medicine vs No Dementia Diagnosis: Same Healthcare System
Peter Attia spends 6 figures annually on longevity medicine for 75 patients.
Meanwhile, 60% of people with dementia never get diagnosed.
Both are happening in the same healthcare system.
Something is deeply broken here.
Attia's patients get:
2-day comprehensive evaluations
VO2 max testing
Full-body MRI scans
DEXA scans
APOE genetic testing
Continuous biomarker monitoring
Dedicated physician team
Annual cost: $100,000+
The average Medicare patient with memory complaints gets:
15-minute primary care visit
Maybe a mini-cog if they're lucky
Referral to neurology (6+ month wait)
Often dies before diagnosis
Annual cost to diagnose: $0 (because they never get diagnosed)
I'm not criticizing Attia. His approach is scientifically sound. His patients get extraordinary care.
I'm criticizing a system where we've decided preventive longevity medicine is only for people who can pay 6 figures.
The tests Attia orders, ApoB, Lp(a), advanced lipid panels, inflammation markers, aren't covered by most insurance. Even when they predict disease decades early.
The tools we need for early dementia detection, computerized cognitive testing, blood biomarkers for Alzheimer's, advanced imaging, same story. Not covered. Not accessible. Not standard.
So we have two healthcare systems:
System 1: Ultra-wealthy get Medicine 3.0. Predict disease 20 years early. Prevent what's preventable. Optimize what's optimizable.
System 2: Everyone else gets Medicine 2.0. Wait for symptoms. Diagnose late. Treat reactively. Hope for the best.
The irony:
The interventions that work best for brain health aren't expensive. Exercise. Mediterranean diet. Sleep. Social engagement. Blood pressure control. These cost almost nothing.
But knowing you need them requires testing. Knowing is motivation. Motivation is behavior change. And testing costs money if insurance won't cover it.
My patients ask me: "Should I get an ApoB test? Should I check my APOE status? Should I get computerized cognitive testing?"
My answer: "Yes. And you'll probably have to pay for it yourself."
That shouldn't be the answer in a functional healthcare system.
We don't need to spend $100,000 per patient to improve population brain health.
But we do need to cover the $200 in tests that predict who needs intervention 20 years before symptoms appear.
Until insurance covers early detection the way they cover late-stage treatment, Medicine 3.0 will stay a luxury good.
And millions will develop preventable dementia while the ultra-wealthy optimize their NAD+ levels.
⁉️ Should insurance cover early detection testing even when patients are currently healthy?
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$100K Longevity Medicine vs No Dementia Diagnosis: Same Healthcare System
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