Can longevity transform America from a sick care system to a health care system?

Part I of a three-part series on the rise of longevity, AI & the future of primary care

It is widely understood that the U.S. is absolutely terrible at preventive healthcare. For far too long, we’ve apathetically accepted a sick care system built to treat disease, not prevent it. This is not due to a lack of science; we actually know quite a lot about how to keep people healthy. What we lack is a culture and economic model that rewards doing so. But the optimist in me believes that, finally, the times they are a-changin’.

Culturally, Americans are drawn to quick fixes: SSRIs for anxiety and depression, GLP-1s (off-label) for weight loss, Ambien for sleep. And structurally, our predominant fee-for-service insurance system pays a premium for procedures and prescriptions, while underpaying for prevention—especially the kind rooted in behavior, lifestyle, and longitudinal, relation-based care. You can see this incentive misalignment at every level of our healthcare system: from how preventive visits are reimbursed compared to “problem” ones, in the salary gaps between primary care providers and specialists, to the fact that insurance covers medication but not healthy food.

Enter longevity

Five years ago, longevity was a fringe concept championed by a niche group of Peter Attia and Andrew Huberman disciples—often male, affluent, and trying to live forever. There were few venture-backed companies in the space, no consumer brands bringing healthspan optimization to the masses, and certainly no politicians talking about wearables or advanced biomarker testing on Capitol Hill.

Flash forward to today: longevity has become a cultural force—and a catch-all umbrella for a new type of prevention-forward healthcare, encompassing everything from anti-aging gene therapy to hormone optimization, from full-body MRIs to cold plunges. Its breadth is both a bug and a feature: it’s hard to define (are we talking about wellness spas or primary care 3.0?), but also creates a big tent that invites mass-market adoption.

To get a sense for just how big and diverse this tent is, look at the atypical bedfellows at the formation of MAHA—longevity’s estranged cousin. At the forefront of this health-meets-politics movement, you’ll find crunchy granola progressives, biohacking libertarian techies, anti-vaxxers and even tradwives—united by a shared frustration with “the system” (Big Food, Big Pharma, insurance companies and doctors alike), and a desire to reclaim control over their health on their terms.

A cultural and psychological shift

Skeptics dismiss longevity as clever branding and a sleek UX. But if you do the work to unpack why people are actually using these offerings, you begin to see that it’s not just semantics; it’s psychological, cultural, and behavioral.

Critically, longevity is doing something primary care—the institutional home for preventive health—never could: it’s motivating people.

Traditional preventive care has long centered on population health style screening and avoiding bad outcomes in the future. Longevity, at its core, is about pursuing better ones. It reframes health as something to be optimized—not a system-defined obligation, but a self-directed opportunity.

This is the psychological unlock that primary care could never crack. And it helps explain why longevity is resonating, especially with younger consumers and men, who have historically opted out of traditional healthcare altogether.

If, like me, you believe cultural shifts are the first domino to ignite structural change, then the rise of longevity represents a rare opportunity to rethink how we define, deliver, and pay for preventive care in America.

And if we can smartly harness the momentum behind this movement—not just as a rebrand but as a fundamental redesign—it might finally give us the wedge we need to transform our sick care system into a true health care system.

AI: The other tailwind

Longevity’s rise isn’t happening in a vacuum. A second cultural and technological wave has emerged in parallel: AI. In healthcare circles, a lot of attention (and investment) has gone into automating the backoffice, where the opportunity is rather obvious—and in many ways, less controversial than automating doctors.

But, while payors and policymakers may be resistant to the bigger opportunity for AI in the actual delivery of care, the average consumer has already leapfrogged ahead—using ChatGPT, Claude and Gemini as a quasi-doctor in their pocket. With instant answers to medical questions, lab reports, and action-packed care plans that are more personalized, comprehensive, and even empathetic than most primary care visits, many are asking: why go to the doctor at all?

Together, these two tailwinds—longevity and AI-first care—are rapidly eroding primary care as we know it. They’re creating a new front door to the healthcare system and redefining how consumers conceive of and engage with preventive health more broadly.

And yet… for all the growth and hype, most longevity players are quick to say they’re a complement, not a replacement, for your primary care provider. That’s both a disclaimer, and an intentional marketing choice—few consumers are shopping for “primary care.” But it’s also a greenfield opportunity: someone is going to connect the dots!

My thesis

When paired with generative AI and meaningful payment reform, longevity has the potential to become what I call Primary Care 3.0: an aspirational, consumer-directed model for preventive health that people actually want.

Whereas traditional primary care is rooted in risk avoidance and system compliance, Primary Care 3.0 is poised to offer something different: living better, longer—as defined by what matters to you.

To achieve this, however, it must shed the medicalized, bureaucratic, and patriarchal baggage that has made primary care feel increasingly irrelevant—especially to a generation of consumers who don’t want to be “patients,” but health optimizers.

But we’re still in the early innings. To realize this vision, we need to move beyond longevity tools and build longevity care—an end-to-end system that’s clinically integrated, AI-augmented (not AI-only), sex- and hormone-aware, and financially accessible to all.

That’s the opportunity ahead for Primary Care 3.0.

Coming next

Over the next week, I’ll be publishing Part II and Part III of this series, available exclusively for paid subscribers.

Here’s a sneak preview:

• Part II: Why Longevity Is Eating Primary Care’s Lunch
  → How longevity platforms are flipping the traditional care model—and what today’s primary care players must learn from them to survive

• Part III: The Primary Care 3.0 Opportunity

  → In this deep dive, I’ll map out the opportunity to build a full-stack, AI-powered, prevention-first care system of the future—and share the biggest opportunities to evolve from longevity tools to longevity care.

  → For those of you specifically interested in longevity for women, payment model innovation, and the AI vs. human debate, this one’s for you.

Stay tuned!

xx. Carolyn

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If you’re new here, The XX Factor is a curated dose of insights, analysis and conversation shaping the future of women’s health, and the broader healthcare ecosystem. I bring my hard-won lessons as a founder in the space to spark questions, challenge assumptions, and foster connections that help us all build smarter, faster, and with greater impact.

To learn more about why I started this, check out my first post introducing The XX Factor here—along with some of my most popular deep dives: the menopause paradox, the growth-stage cliff plaguing women’s health, and why every company is becoming a “women’s health” company.

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