Why America’s Health Crisis Is an Incentive Problem - a16z Podcast Recap

Podcast: a16z Podcast

Published: 2026-02-04

Duration: 42 minutes

Guests: Justin Mares

Summary

American health outcomes are poor due to systemic issues like crop subsidies and processed foods. Justin Mares suggests financial incentives for healthier lifestyles could shift focus from treatment to prevention.

What Happened

Justin Mares, founder and CEO of TrueMed, argues that the poor health outcomes in the United States are largely due to an environment that promotes unhealthy living. He highlights that the average American child spends less time outdoors than a maximum-security prisoner, with 70% of their diet consisting of ultra-processed foods, contributing to the staggering statistic that nearly 80% of adults in the U.S. are overweight or obese.

Mares discusses how the U.S. healthcare system is reactive rather than preventive, spending large sums on managing diseases like heart attacks instead of preventing them. TrueMed aims to address this by allowing individuals to use tax-free HSA and FSA dollars on lifestyle interventions such as gym memberships and healthier food options, potentially redirecting hundreds of billions towards prevention.

The conversation delves into the historical roots of the current health crisis, tracing back to the 1970s when childhood obesity and heart disease rates began to rise. Mares attributes this to a shift in the food industry, where natural ingredients were replaced by cheaper processed alternatives like high fructose corn syrup, and government subsidies made unhealthy ingredients like corn and soybean oil artificially cheap.

Despite the introduction of a new food pyramid that promotes whole foods and vegetables, the impact of these changes is limited by the pervasive influence of big food companies. Mares points out that nutrition science in the U.S. is heavily funded by these companies, outspending the NIH 11 to 1, which skews public health recommendations.

Additionally, Mares explores the potential of psychedelics as mental health therapy and how peptides could disrupt the pharmaceutical industry. He argues that traditional mental health treatments neglect the biological aspects of health, and interventions like metabolic psychiatry could offer solutions through dietary changes.

Finally, Mares makes a case for treating the chronic disease crisis as a national security issue, given its widespread impact on the population's health. By shifting focus from treatment to prevention, he believes the U.S. could significantly improve health outcomes and reduce healthcare costs in the long term.

Key Insights