The a16z Show: "Why America’s Health Crisis Is an Incentive Problem"

Date: February 4, 2026
Host: Andreessen Horowitz
Guest: Justin Mares (Founder & CEO, TruMed)

Overview

This episode dives deep into America’s chronic health crisis, framing it as the result of structural incentives rather than a purely medical or personal willpower issue. Andreessen Horowitz and guest Justin Mares explore how environmental, regulatory, and economic incentives have shaped a food system and lifestyle that defaults to poor health outcomes for most Americans. The discussion also covers possibilities for startups, policy changes, and novel healthcare models that could realign incentives toward prevention and wellness.

Key Discussion Points & Insights

1. America’s Health Crisis: An Environmental, Structural Problem

• Processed Food and Sedentary Living:
  • Americans’ diets are dominated by ultra-processed foods, and children now spend less time outdoors than maximum-security prisoners.
    • Quote: “The environment that we exist in is just structurally just hard to be healthy.” – Justin (00:00)
• Nature of the Problem:
  • Poor health outcomes are the default; the system itself is making people sick.
  • "If most of the country is sick, it's kind of like what is the point?" – Justin (00:25)
• Historical Perspective:
  • The turning point was the 1970s when big food companies, driven by profit and shareholder pressure, began replacing real ingredients with artificial and cheaper substitutes (e.g., high fructose corn syrup, seed oils).
    • “Our food system started to become uniquely poisonous in the 70s.” – Justin (05:08)

2. Crop Subsidies and Economic Incentives

• Government Subsidies:
  • Over $100B spent in the past decade primarily supporting corn, soy, and wheat, making unhealthy food ingredients artificially cheap and ubiquitous.
    • "The average American gets almost 20% of their caloric intake from soybean oil. This is historically anomalous." – Justin (06:59)
• Uniquely American:
  • Comparisons to Europe, which lacks such large-scale federal interventions and leans more on local agriculture (08:17).

3. Prevention vs. Treatment

• Healthcare Spending Misalignment:
  • Preventive and lifestyle approaches are cash-pay and under-incentivized, while expensive treatments are covered.
    • "The healthcare system will pay hundreds of thousands or millions of dollars to manage a heart attack, but nothing to prevent one." – Narrator (00:39)
• TruMed’s Solution:
  • Enabling tax-free HSA/FSA dollars to be spent on lifestyle interventions—like gym memberships, nutrition, and sleep—as healthcare expenses (00:39; 11:53; 34:59).

4. The Mismatch Between Genes and Modern Environment

• Zoo Animal Analogy:
  • Animals in their natural environments thrive; taken out, they develop chronic problems—just like people in America today (16:26).
    • “The health of an animal is basically a reflection of the health of an animal's environment.” – Justin (16:37)
• Discipline vs. Environment:
  • Rather than framing health as personal discipline, consider how to make healthy choices easier by design (17:00–18:30).

5. Policy Levers and Political Obstacles

• Fixing Subsidies and Regulations:
  • Crop and food subsidies need overhaul, but this is politically challenging due to powerful lobbies (06:59; 22:39).
• Regulation of Chemicals:
  • US allows tens of thousands more chemicals in food and environment compared to Europe, due to weaker regulation (19:26).

6. The Role and Limits of Technology and Pharmaceuticals

• Ozempic/GLP-1 Drugs Debate:
  • These appetite suppressants could help some, but don’t fix the fundamental issues in diet quality and environment (09:21).
    • “If you're still eating the same crap... you're almost certainly going to be deficient in protein and micronutrients...” – Justin (09:21)
• Peptides:
  • Emerging class of compounds may be disruptive for wellness and enhancement, but more research is required (36:20).
    • “Peptides are going to be so disruptive to our current healthcare system.” – Justin (36:20)

7. Corporate Capture and Public Health Guidelines

• Soda Contracts in Schools:
  • 80% of schools have vending machine deals with soda companies—example of harmful incentives in action (25:53).
• Industry Funding Skewing Science:
  • Nutrition science is heavily funded by industry, outweighing public interests (37:51).

8. Mental Health, Metabolism, and Functional Approaches

• Biological Underpinnings:
  • Strong connection between physical (e.g., gut inflammation, sleep) and mental health—functional health approaches can be highly effective (29:51).
    • “We massively underestimate the degree to which our mental health is tightly coupled to our physical health.” – Justin (29:51)
• Metabolic Psychiatry:
  • New research area viewing psychiatric conditions as rooted in metabolic dysfunction, e.g., ketogenic diets improving outcomes (29:51).

Noteworthy Quotes & Memorable Moments

• On generational decline:
  • “My great grandmother lived to 95... She didn't have to [shop organic or avoid seed oils]. She grew up in an environment that wasn't actively making her sick.” – Justin (03:35)
• On corporate lobbying:
  • “Monsanto specifically has done a lot of things that are incredibly, like, morally dubious... they spend a lot of money on lobbying and making sure they are immune from any of the harms.” – Justin (22:39)
• On the stakes:
  • “If, for example, China…deployed a bioweapon that made 75% of our population obese…everyone in America would be up in arms and trying to…solve this. This is an existential crisis.” – Justin (19:26)
• On soda subsidies and public health:
  • “80% of schools have contracts with soda companies… It helps fund schools, but it also comes with a cost of getting kids sick.” – Justin (25:53)
• On dietary experimentation:
  • “People should be just way more open to experimenting... I’m very bullish on people doing n of one dietary exploration and experimentation.” – Justin (37:51)
• On school nutrition:
  • “It’s crazy that it took until now to say, maybe we shouldn't be giving kids 15 servings of whole grain and saying that sugar is totally fine for kids under two.” – Justin (10:57)

Timestamps for Important Segments

• Intro & Setting the Stage: 00:00–01:52
• The Secret of Lifestyle & Health: 02:07–04:20
• Amish & Alternative Environments: 04:20–04:52
• Historical Shifts in Food System: 05:08–06:53
• The Politics of Crop Subsidies: 06:59–08:16
• Ozempic & Pharmacological Interventions: 09:17–10:49
• Consumer Health Startups & Opportunities: 11:53–13:10
• Gene-Environment Mismatch Analogy: 16:26–18:33
• National Security Analogy for Health: 19:26–22:13
• Corporate Capture Example – Monsanto: 22:13–24:28
• Re-thinking Grocery Stores as Healthcare: 24:28–25:39
• Guidelines, Regulations, School Food: 25:53–27:05
• Addictiveness of Processed Foods: 27:16–28:17
• Psychedelics in Mental Health: 28:17–29:43
• Metabolic Roots of Mental Health Disorders: 29:51–31:26
• Consciousness and Wellness Curiosity: 31:48–33:16
• Community Health and New Models: 33:16–34:44
• TruMed's Business Model & Future: 34:59–36:15
• Peptides as Disruptive Healthcare Innovation: 36:20–37:36
• Experimentation in Nutrition Science: 37:51–40:34

Further Exploration & Final Thoughts

• Approaching health as a community (not just individual) challenge
  • Potential for building health-oriented cities or group health insurance (33:37)
• TruMed’s vision:
  • A payment rails company incentivizing prevention and lifestyle interventions, possibly rechanneling hundreds of billions from sick care to health promotion (34:59)
• Nutrition science critique:
  • Field dominated by industry interests, leading to lack of consensus and need for personal experimentation (37:51)
• Exploring Contrarian Diets:
  • The “Ray Peat”/“Peters” camp vs. plant-based calorie restriction, and how everyone should find what uniquely works for their metabolism (39:12)

This episode makes the case that America’s health crisis is not a failure of willpower or lack of information, but a matter of incentives, environmental structure, and decades of policy stacking the deck against prevention and wellness. It’s a call for entrepreneurs, policymakers, and individuals alike to innovate, experiment, and advocate for systemic change that makes healthy choices the default.