Why America’s Health Crisis Is an Incentive Problem

0:00You look at our food system today, the majority of what people are eating is ultra-processed crap. The average child spends less time outside than like a maximum security prison that people are spending, he plus hours on phone. We are in the midst of one of the biggest problems in the country. If we don't fix this, like America is going to have even more serious problems. The environment that we exist in is just structurally just hard to be healthy, which is why you see the default health outcomes in the U.S. being so poor. Why not just universal basic ozempic? Why doesn't that solve the problem?

0:25I think now the problem is we're feeding our kids poison and like all of them are sick. I think many of our problems are downstream of the fact that the majority of the country is just sick. No matter if we get richer or whatever, if most of the country is sick, it's kind of like, what is the point?

0:39Erik Torenberg:What if the chronic disease crisis isn't a health care problem, but an environmental one? Justin Maris has spent 15 years building companies around a single idea. That what you eat, how you move, and where you live matter more than the pills you take. His great-grandmother lived to 95 without ever shopping organic or asking for no seed oils. She didn't have to. She grew up in an environment that wasn't actively making her sick. Today, the average American child spends less time outside than a maximum security prisoner. 70 % of their diet is ultra processed food. Almost 80 % of adults are overweight or obese.

1:12Erik Torenberg:And the healthcare system will pay hundreds of thousands or millions of dollars to manage a heart attack, but nothing to prevent one. TrueMed is trying to change that math. The company allows people to spend tax-free HSA and FSA dollars on lifestyle interventions. Gym memberships, better food, sleep aids, that treat, reverse, or prevent chronic disease. The idea is simple. If we're going to fix American healthcare, we have to make prevention as easy to pay for us treatment. I speak with TruMed founder and CEO Justin about why the 1970s were the turning point for American health, how crop subsidies created a poisonous food system, and why peptides might be the most disruptive thing to hit healthcare in decades.

1:52Erik Torenberg:you've been on a quest for the last few years to uncover and make a dent in solving our food crisis our health crisis our disease crisis why don't you trace your journey a little bit to how you became obsessed with this and then we'll get into what we're up to yeah so peter steel has this idea of like a secret and i feel like the idea that what you eat your lifestyle all these things they impact your health outcomes, they impact your energy, they impact how you feel. I kind of came across that idea when I was 20. And it felt like this secret where if you look at any data in the U.S., U.S. healthcare outcomes are horrible.

2:28They're bad. They're getting worse, like obesity, heart disease, all of these conditions are basically at record levels and continue to go up. And as I started to read more about our food system, about environmental toxins, about all these sorts of things, I just became more and more convinced that everyone's like, what's going on with our obesity crisis? Why are we so sick? And the answer is just simply that we exist in an environment that systematically outputs unhealthy people. And that this idea that you could just change your food, change your diet, change your exercise, change your environment, and that would lead to much better health outcomes naturally, feels to me like this secret that, you know, I've believed and invested behind and started companies behind for 15 years, that still the average person does not totally fully internalize.

3:11And so I just became obsessed with this idea the first time I came across it when I was like 20 or so.

3:16Erik Torenberg:And you yourself have gone out of your way to go against the grain in terms of your own personal life and trying to be healthy, but it's very difficult to be healthy today. It's almost like people used to say when they were canceling people on Twitter all the time, hey, just build your own Twitter. Like, you want your own information, you can just build your own. And similarly, like you have to build your own like food. Totally. Yeah, I mean, in so many ways, I feel like health used to just be an output of the environment that we exist in. Like my great-grandmother, she lived till she was 95, very healthy until the day that she died.

3:45And she never shopped organic. She never like avoided and asked for no seed oils at the grocery store. She never did like any of the insanity that I've kind of had to learn, figure out and do. That's because primarily she lived and grew up in an environment that was not sickness promoting. She was not exposed to 40 ,000 novel chemical compounds that exist in the U.S. or eating foods that were like addictive and made her feel shitty and like impacted her health. And so I think that the environment that we exist in is just structurally just hard to be healthy, which is why you see the default health outcomes in the U.S.

4:19being so poor. And how are the Amish exempt from this? Just as an example, what do they do differently? I mean, they do a lot differently. You should go to one of the communities. There's a lot of things they do very differently than you and I. But basically, they're eating food that is grown locally, seasonally all the time. They're outside all the time, working with their hands. They're existing in a tight-knit community. And there's like a whole host of environmental and lifestyle differences that the Amish have. So you can argue, do you have to live like the Amish to have better health outcomes?

4:48But certainly, they have much better health outcomes, and they live very differently than you or I. But they're not doom-scrolling like us, so how do they make it?

4:55Erik Torenberg:It's like they might live longer. They're uninformed, I know. They might live longer, but at what cost? So when did things start to get really bad? Or has it just been monotonically for the last century? Or was there sort of a moment where things started to escalate? And what happened? Yeah, things started to get much worse in the 1970s. My view is that that is around the time when you started to see childhood obesity tick up. You started to see obesity, heart disease, things like this kind of start to move. And in my view, a big reason for that is there was a lot of shareholder and other pressure, specifically geared towards big food companies around that time where basically these companies are today like 150 years old.

5:33Almost every big food company is shareholder owned. They are not run, controlled or anything by CEOs. They're basically just like these lumbering corporations that the market is just having them optimize for like earnings per share. And what that means is these companies for the last 50 years have consistently decided to trade a real ingredient for something that's like kind of a fake version of that. Like they've moved from strawberries to strawberry flavoring, or they've moved from sugar to high fructose quart syrup. And you kind of roll this out over a 50-year period and you look at our food system today and the majority of what people are eating is ultra-processed crap that is like addictive, is not nutrient-dense, and is full of like environmental toxins, chemical compounds, things like this that the human body has in our entire millions of years of evolution never encountered many of these compounds.

6:21And so I think that that shift started in the 70s. It's compounded generationally. It certainly doesn't help today that the average child spends less time outside than like a maximum security prisoner. Like most kids today are eating like 70 % of their diet is ultra processed foods. People are spending eight plus hours on phones. Like all these sorts of things are factors. But I really think that our food system started to become uniquely poisonous in the 70s. And especially in the U.S., that's why you started to see many health care and health outcomes trend in such a negative direction, especially relative to the rest of the world.

6:53Erik Torenberg:What are the levers that could make a dent in reversing some of these trends as it relates to the food system? Yeah, from a food system standpoint, I think the biggest single lever that we could pull, which would be extraordinarily politically challenging to pull, is fixing our crop subsidy system. So if you look, the U.S. government, I think it's the last decade, has spent close to$100 billion on crop subsidies. They're basically subsidizing corn, soy, and wheat so that American farmers can grow corn, soy, and wheat. Because it's subsidized, it's artificially cheap, So we grow a lot of it because it's subsidized.

7:23It's artificially cheap. And so these big food companies use it in everything. And so these big food companies have basically gone on like a 30-year journey to replace sugar with high fructose corn syrup or to replace olive oil or something like that with soybean oil, which is highly processed and inflammatory, causes obesity and all sorts of like rat and human models. And I think that this sort of wholesale swapping of let's take the worst ingredients in their most highly processed form and replace them with an ingredient that humans traditionally ate is one of the root causes of chronic disease.

7:53Like today, the average American gets almost 20 % of their caloric intake from soybean oil. This is historically anomalous. And it's not because anyone wants soybean oil. Like you're probably not like a big consumer of soybean oil or anything like this. It's just because it's artificially cheap. And because it's artificially cheap, it ends up in everything. And I think that that is one of the core kind of root causes of what is going wrong in our food system today. And is that a uniquely U.S. problem? Yeah, it's a uniquely U.S. problem. I mean, the U.S., our food system, relative to like Europe or something like that.

8:23Europe, many of their countries are smaller. They tend to lean much more into a local food agriculture system. They also don't have as much of a federal intervention on their food system. The U.S., like in many ways, this sort of subsidy of corn, soy, wheat, things like that, it had good intent. I mean, a lot of the crop subsidy stuff started with a farm bill in the 80s where basically like farmers were exposed to inclement weather, bad weather that was like impacting their crop yields. The US government stepped in and was like, okay, we're gonna try and keep these farmers solvent. I think that the intent was good, but now here we are, like years later, we have billions a year going towards these crop subsidies that are making Americans sick.

9:02And I think that we used to say, okay, we just need to make sure that we're growing enough calories and make sure that Americans are not dying of starvation. They're not like, you know, make sure our kids have enough to eat. I think now the problem is like we're feeding our kids poison and all of them are sick. Why not just universal basic ozempic? I mean, why doesn't that solve the problem? Yeah, well, so I think there's two things. One, I think that GLP-1s are potentially an incredibly interesting technology. Like I think that we are in the midst of the worst chronic disease crisis, one of the biggest problems in the country.

9:34And if we don't fix this, like America is going to have even more serious problems like 20 years from now. So given that the average American is overweight, we're looking at almost 80 % obesity overweight rates. I think that it does make sense to put a bunch of these people on a GLP-1 to try and jumpstart them in a direction where they are moving towards health. That said, I don't at all think that giving universal GLP-1s to everyone is like necessarily a universal solve. There's just a very poor history of saying, here is an intervention that like is going to solve all of our problems as a species.

10:10You know, and I just think that it is quite unlikely that Ozempic is the one thing that is going to be a cure-all. Like just to use one example, what is, you know, how does Ozempic work? Is it basically, it turns down someone's appetite. So you're just eating less. If you're still eating the same crap that the average American is eating today, but you're on Ozempic and eating less of it, like you are almost certainly going to be deficient in protein and micronutrients and a bunch of things that will have like long-term health implications if you like under eat or get exposed to not enough of those nutrients for a very long period of time.

10:44So I think we fundamentally like have to solve the food issue if we want to have a healthy country.

10:49Erik Torenberg:By the way, have we yet updated our food pyramid in the sense that we have an accurate understanding of what we should be getting at a country level in terms of nutrients? Yeah, I mean, the new food pyramid is a tremendous improvement over the old guidelines. I mean, not only is the site super sexy, you know, Joe Gebbia did a great job on that. But finally, for the first time, people are saying like, eat whole foods, eat more vegetables, eat, you know, meats and like other well-sourced sources of protein, vegetables, fruits. It's crazy that it took until now to say maybe we shouldn't be giving kids, you know, 15 servings of whole grain and saying that like sugar is totally fine for kids under two.

11:27Like we recommend some amount of sugar for kids on the age of two, which was the past, you know, past administration sort of guidelines. So I think there are tremendous, tremendously positive stuff.

11:37Erik Torenberg:And so for people who want to make a difference in the food system, you mentioned that policy recommendation. What about people want to do something direct that you obviously, you know, before TrueMed, you started a bone broth company. What are other big companies that could be built in the space or opportunities to make a difference? Yeah, I think there's a ton of opportunities. I mean, within the space that I, like I think the core problem is that a bunch of these lifestyle interventions, like eating a healthier diet, exercising, taking certain supplements, taking like peptides, if that makes sense for your sort of individual person and risk profile, all of these things can be considered healthcare interventions.

12:14And yet, if you look at our healthcare system, nothing in the healthcare system thinks about someone who is at risk of heart disease exercising as a healthcare intervention. No payer pays for it. No one incentivizes you to do that. It's just sort of like a doctor is like, yeah, you should like clean up your diet and exercise. And so I think that there is a tremendous, tremendous opportunity for people that want to make a dent on this problem, figuring out how to make these sorts of lifestyle interventions part of the healthcare system is what we're doing at TrueMed and incentivizing people to actually invest in their health, to invest in prevention, to invest in things that like move the needle from a chronic disease standpoint.

12:50Erik Torenberg:Yeah. So let's get to TruMed. First, trace the idea maze a little bit in terms of, you know, you've been obsessed with this problem, sort of meta problem, this series of problems. And it's kind of like, where do you even start? I'm sure you, you know, picked over every nook and cranny. How did you settle that? Hey, this was the opportunity. What were maybe some other things you would consider? Yeah. So in growing Kettle and Fire, basically, when we launched, it was like$16 a carton for 16 ounces of bone broth. And everyone was like, this is good, but this is like very expensive. And now, nine years in, we're in every grocery store in the country and the average price per box is like$7.

13:26Way more people buy it, but they're also like, this is very expensive. I kind of like had that experience and then looked at things like Costco and Walmart are the two largest sellers of organic products in the country. To me, that is a signal that like people want to invest in products that are good for them. They want to buy products that leave them off better, healthier and like but it's just cost prohibitive. And then if you look at the healthcare system, we have this weird dynamic where if I am at risk of cardiovascular disease or heart disease, like I basically can exercise, I can eat well, I can do all of these things that will prevent an acute heart attack or something like that.

14:04And I'm basically not, that's all like cash pay. I'm paying out of pocket. I'm doing all of that kind of stuff totally on my own. Whereas if you take someone that doesn't do any of those things, basically they have a heart attack early and then the healthcare system will pay hundreds of thousands or millions of dollars to manage that person's condition basically for the rest of their lives. And so I think that fundamentally, like we need to incentivize people to invest in prevention, to invest in, you know, leveraging lifestyle interventions that can make a dent on chronic conditions. And that was kind of the lens through which I was looking at what's the company that I want to start after Kettle and Fire.

14:40When I met Dr. Mark Hyman, who is basically, you know, he's a functional medicine doctor, or co-founder function, he mentioned that something he was doing with a bunch of his patients was for patients that would come in, he would recommend lifestyle interventions and he would write them something called a letter of medical necessity, which is basically a letter that the IRS has said for certain people where an intervention matches, matches like a lifestyle intervention, matches a condition someone's working to treat, reverse, or prevent, they can spend, they can get that letter and use tax-free HSA, FSA dollars on sleep aids, healthy, you know, better diet, supplements, exercise, things like that.

15:19And so when Mark Hyman told us kind of about that idea, I was like, this is a really interesting thing. Like we could basically try and build infrastructure that allows the average person to get one of these elements, if they qualify, and use like the telemedicine rails that HIMSS, Rho, and other companies have spent the last several years building. But rather than prescribing Ozempic or prescribing TRT, we can actually prescribe food interventions, exercise, things like that. So that was kind of the idea and like where it started from. I looked at a whole host of other things like thought about starting a grocery store, thought about starting like a life insurance company that would be aggressive in terms of like helping you live longer and making lifestyle interventions.

16:03But ultimately felt like this was the type of thing that had the potential to direct hundreds of billions of dollars towards lifestyle interventions over the next couple of years. And so it felt like it was the right thing to do.

16:16Erik Torenberg:Yeah, everyone knows we need to shift more, you know, from chronic to preventive care. And this is basically a way to financially incentivize people to do that. Exactly, yeah, exactly. One of your ideas is that the root cause of a lot of issues is this mismatch between our genes and our environment. Why don't you flesh that out a little bit more? Yeah, so if you look, like, think of an animal in the zoo. Like, an animal in the wild with few exceptions. Like they can get, break their leg, get an infection, whatever. But when an animal is like, exists in a species appropriate environment, that animal tends to be healthy.

16:54Like there's a natural match between the health of the environment and the health of an animal. When you take an animal away from its natural habitat and put it in the zoo or something like that, like zoo animals exhibit all of these diseases that their counterparts in the wild just don't get. They have weird ticks, they get depressed. You know, in some notable cases, like animals have even killed themselves, which is just something you like don't see in the wild. And they get obese, they get all sorts of things. And so my take and what I think is very true is that the health of an animal is basically a reflection of the health of an animal's environment.

17:28If an animal is existing in an environment that is not health promoting, like you're in a season of drought or there's not a lot of food, that animal gets skinny and dies. Like you basically can kind of see that that animal is not existing in an environment that's health promoting. I think that over the last 100 years or so, we basically as humans have seen, you know, we've built an environment that is not considering or not underwriting, not thinking about what is the right thing to do for human health. Like how do we promote human health and flourishing? and so I think that so often when we think about health we think about like what is going on with you Eric with this specific condition as opposed to thinking about what is the environment that you exist in that leads to you not getting 8 ,000 steps a day that leads to you spending all day on your phone that leads to you like eating a terrible diet no not you know not you actually but I mean so so I think that that is like an important idea that people don't think about enough is just how do you shape your environment so that it's naturally health promoting as opposed to, you know, having to like discipline yourself and doing all the stuff that most people frankly fail at, myself included.

18:33Erik Torenberg:There's this, you know, there's this Twitter competition for a million dollars for who gets the best article. And there's this like, so people are doing kind of clickbait stuff. And there's one guy who's like, you know, how to change your life in a day, how to change your life in an hour, like these kinds of posts. And there was one that went super viral that was how to change your life in one minute. And it was a photo of smashing the phone. That's pretty good. Totally. The, um. Okay, so I'm curious for more, you know, you've talked about this idea of, hey, we should take this health crisis as serious as we take sort of our, you know, national security crisis.

19:06Erik Torenberg:Like, you know, we as a country have something of a NRA for health or something of a, you know, collective effort because it's a, you know, problem that, hey, the market might not solve, isn't solving on its own. And in fact, you know, exacerbates. What would, you know, you gave one example of, and the subsidies, what are some of the biggest levers you think? Yeah. So I'll answer that. But like just to frame how I think about the problem, you know, if, for example, like China or one of our adversaries deployed a bioweapon that made 75 percent of our population obese or overweight, 45 percent of kids obese or overweight, like and health care, like the largest cost in the country all of a sudden because everyone was sick.

19:48everyone in America would be up in arms and trying to figure out like, how do we solve this as an existential crisis? This is like a matter of national security that we make a dent on that. You know, no matter if we win the I-Race, get richer, whatever, if most of the country is sick, it's kind of like, what is the point? You know, we're not thriving as a nation. I think many of our political problems are downstream of the fact that many, the majority of the country is just sick. And so if I was like able to wave a magic wand and do anything, I think fixing the subsidies would be one thing for sure.

20:17that I would do. Secondly, I would have our healthcare system just invest far more in prevention. You look at other countries that have incredible health outcomes on a per capita basis. Singapore is a good example. They basically have these people that are not quite doctors, but are like coaches or something like that, that will check in with you and try and nudge you towards making better choices. Then I would take a much stronger stance, one much more similar to that that Europe takes when it comes to like certain environmental toxins, chemical regulation, things like that. Like in the US, we basically take the approach that if a company makes or manufactures a totally novel environmental chemical, that as long as they tell us under current regulations, something called grass generally recognized as safe, as long as they tell us, hey, this chemical is safe, we can introduce it into our food system.

21:10This is how like you've heard of the forever chemicals and stuff like this got into our food system and basically are all over the planet now because 3M invented them something like 60 years ago. And basically they just started using them. In the EU, these novel chemical compounds have to go through something that is much more like what it takes to unleash or get a pharmaceutical approved in the US today, where they have to do many years of safety testing. They have to show that it doesn't cause acute harm. And they basically have to approve it before it's allowed on the market. And the end result is we have between like 60 and 80 ,000 chemical compounds in the U.S.