How Health Became a Luxury Commodity

The Atlantic

29-05-2025

For many Americans, health care is something to be dreaded and deferred—a source of pain, wasted time, or financial hardship. For luckier Americans, it could mean curling up on an exam table in a med spa and receiving a 'gravity' colonic. Amy Larocca's new book about the wellness industry, How to Be Well: Navigating Our Self-Care Epidemic, One Dubious Cure at a Time, opens with the author undergoing exactly this procedure, against doctor's orders. The water forced into her colon will, she writes, discharge toxins, and the result will 'change my life, provide perspective and purpose and a near-ecstatic lightness of being.'
Larocca, a reporter who spent two decades covering fashion for New York magazine, is being somewhat facetious. But only somewhat. She can't deny being a willing participant as well as a skeptic, and she's far from the only woman who has chased the idea of being not just healthy but well —a state she describes as the new 'feminine ideal.' Wellness is a $6.3 trillion industry, according to a 2024 report from the Global Wellness Institute, an industry trade group. That's bigger than the GDP of Germany, and nearly four times the size of the global pharmaceutical industry. The real growth has been within the past 10 years—the GWI's report calls it the 'wellness decade.' And women represent most of its consumers.
In a nation known for its relatively poor health, nearly everybody seems to be thinking about how to be healthy: According to a 2024 report from McKinsey, 82 percent of U.S. consumers consider wellness to be a 'top or important priority in their everyday lives,' and 58 percent said they were prioritizing wellness more than they had the previous year.
Another year on, even more has changed. With Donald Trump's appointment of Robert F. Kennedy Jr. as the secretary of Health and Human Services, the ethos of wellness has been incorporated into the 'Make America healthy again' movement, a cause marked by extreme skepticism about conventional medicine (including vaccines) and extreme openness to purported alternative cures. MAHA reached a new apotheosis this month with Trump's nomination of the wellness influencer Casey Means for surgeon general. Means graduated from medical school but does not have an active medical license, having dropped out of her surgical residency because she 'saw how broken and exploitative the healthcare system is,' as she wrote on her website. Although she's expressed skepticism about the national vaccine schedule for children, some MAHA adherents are worried that she's not anti-vax enough. If confirmed, she will join Mehmet Oz within the broader ranks of HHS; before being tapped to lead the Medicare and Medicaid programs, he was a celebrity physician and daytime TV host with a history of espousing unreliable medical advice. Mainstream medicine may have good reason to frown on these government officials, but their rise to power is explicable: Americans are exhausted from navigating a health-care system so costly and inconvenient that it has sent many of them scrambling for alternatives.
MAHA is such a young movement that Larocca's book couldn't be expected to account for it. But the author deftly transcribes the writing on the wall. Wellness culture spread 'like a rash,' she writes, showing up in the places you might expect— The White Lotus, the influencers selling detoxes to Los Angeles wildfire victims —and the places you wouldn't. The Financial Times, for example, recently published an article on the scientifically challenged practice of somatic 'tapping,' under a vertical titled ' Adventures in Woo-Woo.' Art in America 's recent ' Spring Wellness Issue ' features a story about Marina Abramović's rebirth as an alternative healer. (The 78-year-old artist hawks 'longevity drops' for roughly $130.) And good luck attending a wedding free of woo-woo this summer: An event planner told The New York Times last month that about 75 percent of the weddings she organizes contain a 'wellness element'—sound baths, beach yoga, or 'spiritual-growth sessions,' for example. The well women overtook the fashion world long ago: While researching this article, I received an invitation from the designer Maria Cornejo for a gathering at her downtown boutique. She was promoting not her latest collection but a new book on longevity. 'Ayurvedic mocktails' were promised.
How to Be Well sets out to capture the depth and breadth of the wellness invasion—its fads, its legitimate practices, and its so-called cures. Larocca details the impressive variety of forms wellness can take: ingesting supposedly magical super-ingredients (ashwagandha, matcha, hyperlocal honey), chasing spiritual highs from fitness classes (SoulCycle, Peloton), or attending a $1,000 wellness-focused 'traveling road show' from Goop, Gwyneth Paltrow's health company, valued several years ago at $250 million.
There is something old and something new in this welter of products and practices. Even as the movement repackages traditional practices from China and India, it also promises better health through data collection, biohacking, and at its most extreme end, the Silicon Valley cult of longevity advanced by Peter Thiel and others. Larocca homes in on the often-caricatured type of the Lululemon-wearing, Pilates-toned girlie—'hopped up on her plant-based diet and elaborate adaptogen regimen'—whom she got to know well during her years writing about the fashion world. But she also devotes space to its advocates on the far right, including the conspiracist news site Infowars, which shills some supplements containing the same on-trend ingredient—ashwagandha root—that features in products sold by many mainstream wellness companies, including the Los Angeles hippie-chic brand Moon Juice.
The nomination of Means represents a merger between these anti-establishment forces on the left and the right. MAHA is generally associated with its own version of health and wellness—downvoting vaccines, seed oils, and hormonal birth control while promoting ideas ranging from the basic or commonsense (wholesome school lunches and preventive medicine, good; pesticides and microplastics, bad) to the dubious or risky (raw-dairy consumption, skipping shots, eschewing fluoride). Under Trump, MAHA's big tent draws in snake-oil salespeople alongside skeptics, paranoiacs, and ideologues. Uniting them is a deep disdain for the health-care industry. After critics pointed out that Means never finished her medical residency, Kennedy replied on X, 'Casey is the perfect choice for Surgeon General precisely because she left the traditional medical system—not in spite of it.' Larocca asks: 'Is wellness just consumerism, or is it a new politics, a new religion?' Perhaps it is all three.
If MAHA is a religion, it represents a kind of prosperity gospel in a country where access to health care is often determined by wealth. 'Good health in America has been elevated as a luxury commodity as opposed to a fundamental right,' Larocca writes. The average American, she notes, spends just 19 minutes a year talking with a primary-care physician. Meanwhile, the average member of Parsley Health—a 'direct primary care' health-and-wellness clinic whose standard membership costs $225 a month without insurance—spends at least 200 minutes a year being listened to. In short: To get that kind of attention from a doctor, you'll have to pay dearly for it.
Nearly a third of Americans don't have adequate access to primary-care services, including regular checkups, a 2023 PBS News report found. And 40 percent of adults reported that they were delaying or forgoing doctor visits because of high costs. More than a third of all U.S. counties are ' maternity care deserts,' lacking a single obstetrician or birthing facility. The country spends more than twice as much money on health care as other high-income nations, with worse outcomes: 40 percent of Americans are obese, and six in 10 adults have a chronic illness.
For both the affluent and the aspirational customer, wellness seems to hold the promise of bridging a gap in medical care. The cost of wellness products and services has a very high ceiling, but the barrier to entry is low—almost anyone can purchase a $38 jar of adaptogenic 'dust' that claims to improve your mood, and that option is much easier than bushwhacking your way toward finding a therapist who takes insurance. But most alternative cures are no more affordable than conventional medicine. Neither are members-only urgent-care practices that come with wellness bells and whistles. Sollis Health, for example, promises an average wait time of three and a half minutes or less—if you can pay its annual fee of at least $4,000.
The wellness industry and the MAHA movement may draw from different political cultures, but they both operate from a place of fear: We can't control skyrocketing infections or health costs, but we can try to manage—or at least tinker with—how we feel inside our bodies. At the height of the coronavirus pandemic, 'taking care of yourself was going to be the only way to get through our terrifying new world,' Larocca writes.
Particularly attracted to wellness's promises are women and people with chronic illnesses (also often women), Larocca writes, in part because the concerns of both groups have historically been played down by doctors. I find much truth in this argument, as many of my own forays into wellness have followed unsuccessful attempts to treat various ailments through the modern medical system. After years of visits with doctors to manage my migraines (none would prescribe one of the many available migraine medications; one suggested that I visit the ER if things 'got really bad'), I found the solution in acupuncture and an individualized prescription for herbs. This successfully treated both the headaches and the joint pain roundly waved off by my rheumatologist. But the cure was costly: The herbs set me back $200 a month, the acupuncture $175 an hour—and you can imagine how much of this was covered by insurance.
Larocca does a good job of both explaining the wellness industry and ferreting out its scammier corners—the way that, for example, a variety of cleanses, clean-eating programs, and fasts are almost indecipherable from disordered eating. But she doesn't quite answer the bigger question: What are we owed in terms of our health? How much of it is our responsibility, as consumers, and how much can be laid at the feet of a government that has failed to create wide-scale solutions?
Read: How did healing ourselves get so exhausting?
That depends on whom you ask. The wellness industry views health as an individual pursuit, one that requires us to be model consumers and do the work necessary to recognize which goods and services to pay for. MAHA, meanwhile, seems to want to use the top-down power of legislation to mandate nutrition-labeling reform, limit the use of pesticides in our food system, create stricter rules for vaccine development, and call for the removal of toxins (however the government defines them) from the environment. (So far in his tenure, RFK Jr. has focused on redundancies at HHS, slashing thousands of jobs.)
But other messaging suggests that MAHA prefers to shift the burden onto the individual, too. 'Once Americans are getting good science and allowed to make their own choices, they're going to get a lot healthier,' RFK Jr. said in a November interview with NBC. So maybe we're on our own, either way, when it comes to curing what ails us.
Finally, you might be wondering: Does any of the stuff detailed in the book actually work? In her conclusion, Larocca, who has subjected herself to more wellness treatments than can be listed here, points to the solutions we already know: hydrate, sleep, exercise, eat plants instead of processed foods, seek out 'the best medical care you can manage.' (Hah.) She doesn't recommend a single product, practice, or service, although she does name one tip that helped her. Spoiler alert: It's a simple breathing exercise. And it's free.