Real Alpha
Watch mode

Sourcery · 4 min · Oct 14, 2026

The US spent $40 trillion in a decade with no life expectancy gain

Nworah Ayogu

Partner, Thrive Capital

Physician who ran Amazon Clinic, was Amazon Pharmacy's first chief medical officer and was on Cityblock Health's founding team.

  • Molly O'SheaHost · Founder, Sourcery

    Ex-Upfront Ventures investor; has interviewed Alex Karp and Palmer Luckey.

About this segment

Ayogu traces past US life expectancy gains to vaccines, antibiotics, statins and less smoking, then says the last decade bought no improvement. He argues the next decade should take Americans from 80 to 100.

From “Thrive Capital’s Dr. Nworah Ayogu on Why Neuralink Is More Interesting Than SpaceX”, Oct 14, 2026. Watch the full episode

“And then for the last 10 years, we've spent about 40 trillion on health care. We have not moved our life expectancy an inch.”
Nworah Ayoguat 50:20 · Sourcery50:20

Takeaways

  1. 1900 to 1950 added 20 years via child mortality, antibiotics and vaccines
  2. 1990 to 2010 added 10 years, half from less smoking, half from statins and BP drugs
  3. Cancer mortality gains were offset by overdoses; the rich-poor gap is about 15 years
Watch 3:36 from 48:08

In this episode

Full episode
  1. 40:00Early reasoning models solved hard diagnostic cases doctors often miss2:47
  2. 55:43How Cadence's remote monitoring saves Medicare $2.5M a week5:24

  3. 48:08The US spent $40 trillion in a decade with no life expectancy gain3:36

Up next · DecoderMeta can fund free agents with ads while OpenAI cannot4:59

Transcript

Transcribed by machine (Whisper) from the episode’s audio, so a word may be off here and there.

  1. 48:11

    But I think when you actually look at the outcomes as well, that's also fairly interesting. So I think a lot about like life expectancy because we always talk about how we spend all this on healthcare. I think a lot of ways we'd actually be fine spending on healthcare if we had better outcomes. I always say, look, I'm actually fine with the trade, and maybe this is just me. If someone told me, hey, we're going to spend a trillion more on health care this year, but everyone gets to live to 100, I'll take that trade any day of the week.

  2. 48:38

    Cut somewhere else. It doesn't matter. If you were giving everybody an extra 20 years of life, all day. All day, I will choose that for the nation. I will choose that for me. I will choose that for you. I'll choose that for my parents and your parents. But that's not the story we have. We're spending a ton for very bad outcomes, some of the worst outcomes in the developed world. And I was looking through the life expectancy trends because I think that's the outcome, right?

  3. 48:59

    You got to stay oriented on the outcome that matters. It's not just the spend, it's the outcome. You know, between, so right now, our life expectancy is about 80 years. That's where we are as a nation. Between 1900 and 1950, we went from a life expectancy of 50 years, which is wild, to a life expectancy of 70 years. And a lot of that was, you know, it was a mix, right? Some of that was, you know, increases in sanitation, increases in water.

  4. 49:22

    but a lot of it was that we improved our infant and child mortality so people weren't dying during childbirth, children weren't dying at an early age, and antibiotics. We got a bunch of really good antibiotics. We got a bunch of really good vaccines that were created, and people got them so then all of a sudden we as a nation lived 20 years longer. And then our next kind of big spur was between 1990 and 2010.

  5. 49:44

    We managed to go from living to about 70 to getting to about 80. And the big spur of that was cardiovascular disease. So half of that was reductions in smoking, but the other half was all good science. So it was statins to lowers people's cholesterol. We were talking about your cholesterol beforehand. Yep, which is good. It's good. It's good. Great cholesterol. And she authorized me to disclose her information, I hope, post hoc authorization.

  6. 50:10

    But it was also improvements in blood pressure control. So we reduced the number of strokes. So it was half medication, half just people smoking less. Right. And like that gave us the next kind of 10 years. And then for the last 10 years, we've spent about 40 trillion on health care. We have not moved our life expectancy an inch. And if that is not an indictment of the failure of the health care system, I don't know what is. 40 trillion for no change.

  7. 50:37

    Oh, my God. And it's interesting because if you break the numbers down, right, there are stories to be told within. I think in Hawaii, it's a tale of two cities as often. So in Hawaii, they live to be 80. In West Virginia, the average is 72. The richest man, the richest 1% versus the poorest 1% has a gap of about, if you're a man, about 15 years. So it is a tale of two cities. The other thing I think about for this past decade that we've had is that we've actually had huge decreases in cancer mortality.

  8. 51:08

    There are so many things that were death sentences that aren't anymore. Breast cancer, that used to be an almost fatal diagnosis. And we've seen that across a bunch of our cancers where we've had this huge uptick. And it's been amazing. Again, the frontier science has gotten there. It's just been balanced out by things like an increase in overdoses, et cetera. So we've had that kind of balance of two worlds.

  9. 51:28

    But I really think if you look at this next 10 years, this should be the period where, given where we're at with science and treatments now, that if we're doing our jobs right, we should look back at this next 10-year period is a period where we went from 80 to 100.