The Missing Middle

On September 25, at Moonshots LIVE in Los Angeles, our founder sat in the room for a day about the long future. Peter Diamandis asked how much people would give for twenty or thirty more healthy years. Cathie Wood called health care the most profound application of AI. And a $101 million XPRIZE is racing to "restore muscle, cognitive, and immune function by a minimum of 10 years."

Across more than ten hours of the livestream, the word caregiver never came up.

Two days earlier, on the sidelines of the UN General Assembly, the McKinsey Health Institute and Abu Dhabi's Future Health released a report putting the prize at $16.4 trillion a year in 2050, with 12 more years of healthy life expectancy at birth. It is serious work. It mentions caregivers once, in a methodology note, as "caregiver productivity."

That is not a complaint. It is the gap. Both rooms described longer, healthier life as a science race and a market. Between the breakthrough and the birthday cake sits a family, sorting out the pills, the appointments and who drives on Tuesday. The report itself finds that 19 of the 23 drivers of health sit outside the formal healthcare system. Most of them sit at a kitchen table.

About 63 million Americans do that work today, and the WHO projects 2.1 billion people over sixty worldwide by 2050. If the moonshot is more healthy years, the ground crew is already here, and it deserves the same attention.