HIMS is spending millions on a Super Bowl ad this Sunday with a provocative claim that “rich people live longer.” The ad, narrated by Common, features parodies of Jeff Bezos in a spacesuit and Bryan Johnson under a red-light therapy lamp. The message is that elite healthcare is a luxury, and HIMS wants to change that with affordable lab testing.

It’s a bold claim. But is it actually true? If so, what can you do about it? The rest of this post will cover the ad itself, the evidence behind it, and some potential alternatives.

The HIMS Super Bowl ad

HIMS Super Bowl Ad: “Rich People Live Longer”

HIMS’ Chief Design Officer Dan Kenger says “the ad shines a light on the uncomfortable truth that America’s wealth gap has turned into a health gap.” Their solution is affordable blood testing for $349/year, along with various treatments.

We broadly agree with the thesis. Empirical Health offers 100 biomarkers for $190, so we’re clearly in the camp that affordable preventive testing matters. But let’s look at what the data actually shows.

Do rich people actually live longer?

Rich people do live longer, but there are caveats as to why.

A famous 2016 study by Dave Cutler, published in JAMA, analyzed the association between income and life expectancy across the entire United States from 2001 to 2014. They found rich men live 14.6 years longer than than poor men. For women, the gap is 10.1 years.

Life expectancy vs. household income percentile. The richest men live nearly 15 years longer than the poorest. Source: Chetty et al., JAMA 2016.

That’s not a small effect. Fifteen years could be the difference between meeting your grandchildren and not.

Caveat: the gap is partly driven by location

For people in the bottom income quartile, where you live changes life expectancy by about 4.5 years.

Geography of life expectancy in the bottom income quartile. Poor people in New York and San Francisco live years longer than poor people in the Rust Belt. Source: Chetty et al., JAMA 2016.

Low-income men in New York City live about 5 years longer than men with comparable incomes in Gary, Indiana. The cities with the longest life expectancy for low-income people tend to be places like New York, San Francisco, and Santa Barbara.

What’s particularly interesting is that this geographic effect is strongly correlated with health behaviors like smoking (r = -0.69), but not significantly correlated with access to medical care. In other words, it’s not just about whether you can see a doctor.

So why the rich-poor gap of life expectancy? And what can you actually do?

There are a few reasons wealthier people tend to live longer. Not all of them require being wealthy to fix.

The insurance problem is real

HIMS is right that the American health system has gaps. Here is how it breaks down:

• 27 million Americans have no insurance at all—about 8.2% of the population. And this number is expected to rise significantly if enhanced ACA subsidies expire.
• Nearly half of workers with employer coverage are on high-deductible plans with minimum deductibles of $1,650 for individuals. That means even “insured” people are paying out of pocket for most routine care.
• Insurance usually doesn’t cover advanced biomarkers like inflammation, ApoB, or Lp(a) included in Hims’ panel. So often people with good insurance may still choose to cash pay for labs.

Medical practice lags research by 17 years

The healthcare system has substantial intertia. Your annual physical typically includes a basic lipid panel: total cholesterol, LDL, HDL, and triglycerides. These are fine, but were based on foundational evidence discovered by the Framingham Heart Study in the 1950’s-1970’s.

Modern lipidology has discovered biomarkers that are more accurate, and are now recommended by organizations like the American College of Cardiology:

• ApoB: A more accurate version of LDL cholesterol. ApoB directly counts artery-clogging particles, while LDL estimates the cholesterol mass inside them. About 20% of people have “normal” LDL but dangerously high ApoB. The European Society of Cardiology now recommends ApoB over LDL as the primary lipid measurement.
• Lp(a): The strongest hereditary risk factor for heart disease. It’s genetically determined, stays stable your whole life, and one test tells you your inherited risk forever. The AHA and NLA recommend everyone get Lp(a) measured at least once.
• hs-CRP: A marker of chronic inflammation. Recent research shows inflammation is an even larger risk factor than cholesterol for predicting heart attacks. The ACC recommends hs-CRP as a risk-enhancing factor when making treatment decisions.

Most insurance plans don’t cover these unless you already have a diagnosis, but they’re not exhorbitantly expensive. Hims’ blood test program costs $365. Empirical’s is an alternative to Hims that costs $190.

What HIMS is offering

HIMS now offers a lab bundle for $365 which includes 100 biomarkers. Hims lab panel is similar to Function Health, Empirical Health, or Whoop Advanced labs.

HIMS describes their philosophy as: “annual physicals measure a handful of basic markers. Our Advanced plan goes 10x further to give you a detailed picture of your health.” That’s a fair point. The standard annual physical is genuinely limited. It’s worth noting, though, that HIMS has faced some controversy around their Super Bowl messaging, with medical organizations questioning claims about their compounded drug offerings. The FDA is also restricting them. But the lab testing piece is a straightforward, valuable service.

The bottom line: proactive testing shouldn’t be a luxury

We agree with the core message of HIMS’ ad. Rich people do live longer, and part of the reason is access to better, more proactive health information. The good news is that the most important biomarkers—ApoB, Lp(a), hs-CRP, HbA1c, eGFR, and more—are available without insurance and without spending thousands of dollars.