The United States is living through a crisis in longevity that can no longer hide behind statistical averages. After more than a century of steady progress, life expectancy has stagnated since 2010, with mortality now rising among the working class, while the most affluent enjoy the continued increases progress offers. Nowhere is this reversal more visible or damning than among the poor retired elderly.

A recent 2025 analysis by the National Council on Aging and the LeadingAge LTSS Center has provided the most precise measure yet of this divide between the rich and poor. Older adults in the lowest wealth decile (the poorest 10 percent) die, on average, nine years earlier than those at the top.

Drawing on Health and Retirement Study data from 2018 to 2022, the researchers found mortality rates of 17 to 21 percent among households who earned below $60,000, nearly twice those of the wealthiest quintile. Behind these numbers lies a simple truth—that poverty in old age maims and kills and at a much younger age.

The study’s authors, including Dr. Marc A. Cohen of the University of Massachusetts Boston, describe a society where wealth has become a more powerful predictor of survival than genetics, geography or medical innovation. Among the roughly 34 million older-adult households the team analyzed, four in five live with little or no financial cushion. They are one illness, one spouse’s death or one rent increase away from catastrophe. COVID-19 made that fragility unmistakable. As asset values soared for the top 20 percent, deaths mounted among older people of modest means, many confined to understaffed nursing homes or forced to delay medical care they could not afford.

The implications reach far beyond personal hardship. The United States spends nearly $4.9 trillion a year on healthcare (more than $14,000 per person) yet achieves the shortest lives and highest inequality among its peers. A quarter of that spending is lost to administrative waste and market complexity, while less than 3 percent goes to prevention or public health infrastructure. The result is a system optimized not for health but for the extraction of profits. Public health, once conceived as a collective good, has become the “poor relation of medicine,” funded only when a crisis makes neglect impossible to ignore.

Dr. Cohen’s research gives empirical weight to this structural indictment. A longtime analyst of long-term care financing and co-founder of the risk management firm LifePlans, he has spent decades studying how aging, health and economics interact. As co-director of the LeadingAge LTSS Center at UMass Boston, his work bridges academia and policy, quantifying what ideology obscures: that the premature deaths of millions of older Americans are not accidents of lifestyle but outcomes of design. His findings expose the moral arithmetic of a system in which physical survival itself is stratified by wealth.

In the following interview, Dr. Cohen reflected on what these data reveal about the nation’s priorities, the consequences of decades of privatization and what must change if longevity is to be treated as a social right rather than a financial privilege.

Benjamin Mateus (BM): Dr. Cohen, your work has long examined how economic resources shape the experience of aging. To begin, could you introduce yourself and explain what motivated this latest study? What does it reveal about the relationship between wealth, longevity and the conditions of retirement in America?

And, perhaps as part of that, could you describe what measures of wealth you relied on and what those variables tell us about material security—not just income but the ability to weather crises or afford care?

Marc Cohen (MC): My background is in economics, finance and public policy, and I’ve devoted my career to studying issues related to long-term care—both financing and service delivery. About eight years ago, I was invited to join the University of Massachusetts Boston’s Department of Gerontology to start a research center focused on aging: health, nursing homes, workforce, financing and consumer engagement. Together with my colleague Dr. Jane Tavares, we began working with the National Council on Aging (NCOA) on a series of studies they were interested in.