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July 1, 2025

High Time Preference: The Cancer We’re Not Talking About

By Ismael Dainehine, Co-Founder & CEO @ EverGive

20 million people will die this year - not from war, famine, or disease, but from our inability to delay gratification.


That sounds dramatic. Good. It should.

Modern society is obsessed with now. Politicians scramble for quick fixes to please the next news cycle. Corporations chase quarterly profits at the expense of long-term resilience. We the people indulge in buy-now-pay-later lifestyles while our savings evaporate. All around us, symptoms of a deeper illness multiply: crumbling bridges, ballooning debt, overwhelmed hospitals. Yet we rarely name the root cause. It’s like an undiagnosed cancer eating away at our future: high time preference.

In plain English, time preference means how much we favor the present over the future. A high time preference mindset demands instant gratification - “I want it now!” - whereas a low time preference defers rewards to build something greater later. At the individual level, it’s the difference between spending now versus saving for a rainy day. At the civilisational level, it’s the difference between planting forests your grandchildren will walk through - versus paving over the last tree to widen a road today. Today, we suffer from a chronically high time preference. We prioritise immediate payoff and ignore long-term consequences. Our culture’s horizon has collapsed to the ephemeral present. Like a cancer, this short-termism quietly spreads through every system, undermining the foundations of progress until it breaks.

While “high time preference” isn’t a line item in WHO mortality tables, we can credibly estimate the annual death toll attributable to it by identifying the systems it undermines. High time preference - undermines healthcare, infrastructure, environmental sustainability, and public policy foresight. These are not abstract harms. Its effects are deeply embedded in the systemic failures that drive global mortality. A conservative synthesis of data from the World Health Organization [1], the Global Burden of Disease Study [2], and the Intergovernmental Panel on Climate Change [3] suggests that the annual death toll from preventable causes linked to underinvestment in these long-range systems may exceed 20 million lives per year. That’s more than the global death tolls from cancer, tobacco, armed conflict, and HIV/AIDS combined [4].

High time preference is a silent crisis. We talk plenty about climate change, pandemics, and other looming threats, but not about the mentality that hampers our response to all of them. Why do we repeatedly kick the can down the road on hard problems? Why do we consume and consume, as if tomorrow will never come? Because our collective time preference is sky-high - and it’s killing our ability to think and plan for the long run. Below, we’ll explore how this pathology manifests in key areas like healthcare, infrastructure, and debt. We’ll then look at the antidote: embracing a low time preference ethos, the kind of long-term thinking behind Bitcoin, cathedral-building, and patient investing. The stakes are nothing less than our civilisation’s future.

Healthcare: Short-Term Cures Over Long-Term Health

Our healthcare system is really a “sick-care” system. It reacts to illness with costly treatments but invests little in keeping people healthy in the first place. The reason? We value quick fixes over preventive measures. In the United States, less than 5% of health expenditures go to preventive services, while about 90% is poured into treating people with chronic diseases after they develop [6]. We wait for people to get severely ill, then spend hundreds of billions on surgeries, medications, and hospital care. It’s the epitome of high time preference thinking: ignore the future payoff of prevention, and pay exponentially more later to manage avoidable problems.

This short-term mindset shows up everywhere. Many of us would rather pop a pill to control blood pressure than commit to years of a healthy lifestyle. Hospitals and pharma companies have more financial incentive to administer drugs, scans, and procedures - immediate billable services - than to counsel a patient on lifestyle changes that might not show results for decades. Public officials slash funding for pandemic preparedness and community health clinics, only to panic when a crisis hits. The result: we spend fortunes treating late-stage cancer and advanced heart disease, while basic public health programs limp along. It’s like letting a small fire smolder until it becomes an inferno because putting it out early wasn’t a “priority.” High time preference in healthcare means treating symptoms over causes. And the costs, human and economic, keep exploding. We’ve created a feedback loop where our impatience today breeds the emergencies of tomorrow.

Meanwhile, what if we treated donations the same way we should treat health - investing them for long-term protection rather than burning through them in reactive panic? That’s what EverGive is proving out: that even charitable capital can be reoriented toward prevention, not just treatment.

Infrastructure: Collapsing Under Short-Term Thinking

Perhaps nowhere is short-termism more tangible than in our physical infrastructure. Across the developed world, highways, bridges, railways, and power grids built by previous generations are entering old age. They require regular maintenance and upgrades - long-term investment - to stay safe. But far too often, those in charge defer upkeep year after year. Politicians find it more tempting to fund flashy new projects they can take credit for than to repair an aging bridge that quietly keeps people safe. Maintenance isn’t sexy; it’s inconvenient and costly upfront, even if it saves far more down the line. So the can gets kicked. Rust accumulates. Cracks spread. Only when infrastructure literally falls apart - a bridge collapses, a pipeline bursts, the lights go out - do we spring into action, scrambling to patch the very failures we caused by neglect.

The numbers are jaw-dropping. A recent analysis found that deferred maintenance on U.S. public infrastructure has blown past $1 trillion [7]. That is a trillion-dollar repair bill lurking in the background - a direct result of years of “we’ll fix it later” thinking. The American Society of Civil Engineers consistently grades America’s infrastructure near failing, citing years of underinvestment [8]. Every delay makes eventual repairs more expensive, yet we keep delaying. It’s financially and literally pound-foolish: save a nickle today on road repairs, pay a dollar tomorrow when the road needs full reconstruction. This is high time preference governance - sacrificing the future state of our cities and towns for short-term budget relief or political gain.

We see the consequences all around. Water systems in some cities are a century old and leaching toxins, but upgrades get postponed until a Flint-like water crisis erupts. Power grids are pushed to their limits with minimal resilience built in, so a single storm or cold snap causes multi-day blackouts. Commuters endure aging trains and collapsing transit systems because investment was put off by those who would be out of office when the breakdowns occur. Short-term thinking turns infrastructure from an intergenerational asset into a ticking time bomb. We are living off the capital accumulated by low time preference ancestors (who built robust bridges, dams, and grids), while contributing little to that capital ourselves. Eventually, the bill comes due - with interest.

Debt: Borrowing from Tomorrow, Living for Today

If high time preference has a poster child, it is debt. Government debt. Corporate debt. Personal debt. All boil down to the same impulse: enjoy now, pay later. Over the past decades, we have essentially pulled future prosperity into the present by binging on credit. The world’s total debt has surged to over $324 trillion (an all-time record) [9], which is roughly 325% of global GDP [10]. In other words, humanity owes more than three times what it produces in a year - a staggering indicator of how much we’ve mortgaged the future for the comforts of today. Governments routinely run massive deficits, piling up IOUs that our children and grandchildren will somehow have to fulfill. Consumer economies run on the fumes of easy credit: why wait to save up for a car or a phone when you can buy it now on installment? Why sacrifice and invest when someone will lend you the money instead?

High time preference permeates fiscal policy. Elected officials love to cut taxes or increase spending (or both) now, because it wins votes - and they quietly assume someone else (you!), years down the road, will deal with the resulting debt. Central banks have enabled the habit, keeping interest rates ultra-low for years. Cheap money was like adrenaline for high time preference: it encouraged everyone to borrow more, spend more, worry about the bill later. The inevitable result? Mountainous debts and looming crises. We see countries grappling with debt ceilings and default risks, yet politicians still rarely campaign on belt-tightening or long-term financial health. Why? Because “in the long run we are all dead,” as the economist John Maynard Keynes quipped. That quip has been taken far too literally by policymakers. The long run has become somebody else’s problem - until suddenly it isn’t.

On a personal level, the story is the same. Not long ago, during a rare moment of collective prudence, Americans briefly saved at record rates (thanks to pandemic stimulus and caution). But that didn’t last. By 2023, U.S. personal saving rates had plunged back near historic lows (around 4%, roughly half the post-war average [11]), and credit card debt surpassed $1 trillion for the first time. It’s as if a cultural impulse kicked in: given the chance, we return to spending every dollar and then some. High time preference is addictive. Buying something on credit gives an instant reward; saving requires patience. As a society we’ve largely lost that patience. We want the house now, the vacation now, the economic growth now - even if it means loading up a debt bomb that will eventually blow up. But debts, unlike wishes, don’t just vanish. They accumulate compound interest. They constrain future choices. Whether it’s a family living off credit cards or a nation running up the tab, the basic pattern is unsustainable: if you live beyond your means today, you live below your means tomorrow. We are setting ourselves up for a tomorrow of austerity and hard choices because we couldn’t moderate our appetites today.

It’s worth noting that this isn’t about moral failings of individuals so much as systemic incentives. Our economic and political systems often reward high time preference behavior. CEOs are pressured to maximise next quarter’s earnings, not profits ten years from now. Politicians are judged on short-term results - if they don’t deliver immediate benefits, they may not be around in five years. Even voters and consumers, conditioned by years of plenty, demand instant solutions and gratification. In effect, we’ve built a society that runs on a high time preference fuel: instant dopamine hits, instant returns. But that fuel is corrosive. It’s burning up the social capital, physical capital, and financial capital that took generations before us to accumulate. No complex system - not an economy, not an empire, not a human body - can survive for long on a diet of shortcuts and deferred costs. Eventually reality catches up.

If high time preference is the disease, low time preference is the cure. To heal a culture of immediacy, we need to rediscover the value of patience, deferred gratification, and long-term thinking. This sounds abstract, but it comes to life through concrete ideals and examples. Let’s look at a few that show what a low time preference mindset can achieve: Bitcoin, cathedrals, and long-term investing.

Hard Money (Bitcoin)

Money is at the heart of our economy, and it powerfully influences time preference. Easy money (the kind that can be printed or devalued at will) tends to encourage spending and debt - why not borrow if the currency in which you must repay is gradually losing value? Hard money, by contrast, rewards saving and thinking ahead.

Bitcoin is often hailed by its proponents as “low time preference money.” Unlike fiat currencies, Bitcoin’s supply can’t be expanded arbitrarily; there will only ever be 21 million bitcoins. This imbues it with a built-in resistance to inflation. Holding cash under your mattress is foolish when prices rise 3% each year - that drives people to either spend now or watch it lose value over time. But holding Bitcoin (so the argument goes) might make sense if you expect its value to hold or increase over time as adoption grows. The psychology shifts from “consume now before my money loses value” to “save now because my money might buy more later.”

Indeed, many in the Bitcoin community speak of how adopting a hard money mindset changed their behavior: they start saving for the future, valuing financial security over conspicuous consumption. Bitcoin essentially reintroduces the idea of scarcity and patience into our monetary system - much like gold did for millennia. It’s not a panacea (and it’s certainly volatile in the short term), but it represents a compelling bet that a sounder, future-oriented economy can be built on sounder money.

A society on a hard money standard will see lower consumer debt, more productive investment, and less wild speculation - because the incentive to spend it as soon as you get it would diminish. The rise of Bitcoin, alongside growing interest in things like gold and decentralized finance, signals a hunger for financial systems that encourage foresight instead of reckless abandon. In the long run, a monetary order that enshrines low time preference could help align our economic behavior with sustainability. It’s much harder to fund endless deficits or asset bubbles when money itself is hard to come by.

Cathedral Thinking

For a truly inspiring illustration of low time preference, look to the great cathedrals of medieval Europe. Consider Notre-Dame de Paris, an architectural masterpiece that broke ground in 1163 and wasn’t completed until 1345 [12]. That’s almost two centuries from first stone to final touches. Generations of artisans dedicated their lives to a project whose payoff they would never see.

Why? They were motivated by service to a higher ideal, yes - but also by a cultural norm that accepted that great achievements take time. The people who began planting the foundation knew they were really building for their grandchildren’s grandchildren. This is “cathedral thinking,” and it’s practically extinct today.

We marvel at those old builders’ patience and foresight. But we too are capable of such thinking, if we choose to be.

Long-term projects don’t have to be literal cathedrals; they can be any endeavor where we invest effort now for rewards much later. Space programs that plan colonies on Mars, research initiatives to cure diseases over decades, massive reforestation and climate-adaptation projects - these all require cathedral thinking.

Sadly, modern society often opts for cheap, fast, and easy. We throw up glass skyscrapers in months, only to tear them down 30 years later when fashions change. We favor software apps that can be coded in a weekend and sold for billions in an IPO a year later. There’s nothing wrong with efficiency, but we’ve lost balance. The pendulum has swung so far toward instant outcomes that we’re forgetting how to embark on endeavors that might outlast our own lives.

But cathedral thinking is exactly what powers EverGive’s model. Donations aren’t given to make noise now - they’re given to echo for generations. Like the cathedrals, they’re laid brick by brick. EverGive is built block by block, with humility, knowing the true beauty may never be seen by the one who starts the work.

Long-Term Investing

Another domain where low time preference shows its power is investing. The miracle of compound interest is often called the eighth wonder of the world. $1 invested wisely today can become $2, $4, $10 over decades. But compounding only works its magic with time - which means the investor must be patient and forward-looking.

Legendary investors like Warren Buffett preach the gospel of patience: buy good assets and let them grow over years and decades. This approach, unexciting as it sounds, has created vast wealth and stable growth. Compare that to the get-rich-quick mindset (very high time preference) of meme-stock gamblers or casino high-rollers - most end in ruin or disappointment.

Societies, like individuals, benefit immensely from long-term investing. When a government or community invests in education, in R&D, in child nutrition, it won’t see the full benefits for many years. But those benefits will eventually be huge: a more skilled workforce, a scientific breakthrough, a healthier population. The problem is that, under high time preference politics, such investments are chronically underfunded. Why allocate a budget to something that pays off in 2040 when there are voters to please in 2025?

It takes courage and vision to invest for the long run. Yet history vindicates this strategy every time. The countries that prospered - think of post-war Germany or Japan rebuilding with focus on industry and education, or South Korea and Singapore investing heavily in future industries - are those that delayed gratification. Instead of consuming all their earnings, they saved and invested a large share. Over a generation, the returns were astronomical.

Even on the philanthropic front, we see the difference. A donor with a high time preference might splash money on a high-profile project this year for accolades, whereas a low time preference donor sets up an endowment that will fund causes century after century. The latter is how many great universities and charities were built to last.

EverGive takes that model and democratises it - turning every donor into an endowment builder, every contribution into a seed that never stops growing. It’s long-term investing, for humanity’s survival.

Conclusion: Playing the Long Game

High time preference is the cancer we’ve not been talking about, but it’s time to talk about it - and more importantly, to treat it. The treatment begins with each of us and extends to the institutions we shape. We have to flip the script that’s dominated our era: the idea that only the here and now matters. We need to play the long game again.

What does that mean in practice? It means cultivating awareness that every “shortcut” we take today becomes a long-cut we bequeath to our children. It means rewarding leaders who tell us not what we want to hear (comforting lies) but what we need to hear (uncomfortable truths about the future). It means redesigning incentives so that businesses profit from sustainable growth and quality, not corner-cutting. It means balancing our personal lives too: spending a bit less and saving/investing more, even when every ad and algorithm nudges us to consume right now. Essentially, it means remembering that the future matters - not as an abstraction, but as the very real life that our descendants and even our later selves will inhabit.

One initiative that embodies this long-range ethos is EverGive - a Strategic Bitcoin Reserve envisioned as a sovereign wealth fund for humanity, essentially a safety net for our species. Guided by a low-time-preference philosophy, EverGive emphasises deliberate long-term planning, intergenerational responsibility, and institutional foresight in its mission. Rather than spending donations immediately, EverGive invests them into a growing Bitcoin fund so they compound over time, ensuring contributions last across generations, and continue giving long after we’re gone. In doing so, it transforms present-day generosity into an enduring endowment for humanity’s future, exemplifying the kind of civilisation-scale initiative that puts humanity’s survival, safety, and thriving future first.

We sit at a crossroads. Down one path, the high time preference path, we continue chasing instant gratification, and we watch our problems compound: debts leading to fiscal crises, neglected infrastructure leading to disasters, shallow thinking leading to one fiasco after another. That path ends in decay - a society that frittered away all its advanced knowledge and wealth like a trust fund baby on a bender, with nothing left for the morning after.

Down the other path, the low time preference path, we consciously dial back the obsession with immediacy. We undertake the hard reforms and investments that won’t pay off this year or next, but will yield a flourishing society a generation from now. We might have to sacrifice a bit of short-term comfort - higher taxes now to pay down debt, more discipline in budgets, patience for results. But that path leads to renaissance: a renewal of stability, prosperity, and genuine progress that lasts.

The encouraging news is that humans are not inherently blind to the future. We carry within us the same capacity for foresight that planted crops each spring knowing harvest was far off, that built stone cathedrals knowing they’d stand for centuries. We just need to rekindle it.

Instead of “live for today, let tomorrow sort itself out,” our mantra should become “live a little for tomorrow, so tomorrow isn’t worse than today.” We must relearn to plant trees whose shade we might never sit in. That ancient wisdom - to defer some gratification for the sake of children and grandchildren - is the foundation of any enduring civilization.

Every one of us can contribute to this shift in mindset. Encourage long-term plans in your community. Support businesses that prioritise durability over quick profits. Teach your kids the value of patience. When a leader comes along with a 20-year infrastructure vision or a 50-year climate plan, give them your ear (and perhaps your vote), even if it means you won’t see all the benefits yourself.

We need more “cathedral builders” and fewer self-interested opportunists. More marathoners, fewer sprinters. For all our good will, the wealth, health, and happiness of the generations to come won’t benefit from our intentions - but what we’ve actually built.

It’s time to start thinking in centuries again. 

[1] World Health Organization. Global Health Estimates 2023: Deaths by Cause, Age, Sex, by Country and by Region. Geneva: WHO, 2023.

[2] Institute for Health Metrics and Evaluation (IHME). Global Burden of Disease Study 2023 Results. Seattle, WA: IHME, 2023.

[3] Intergovernmental Panel on Climate Change (IPCC). AR6 Synthesis Report: Climate Change 2023. Geneva: IPCC, 2023.

[4] GBD 2019 Risk Factors Collaborators. “Global burden of 87 risk factors in 204 countries and territories, 1990-2019.” The Lancet, vol. 396, no. 10258, 2020, pp. 1223-1249.

[5] https://press.un.org/en/2023/sgsm21872.doc.htm?

[6] https://healthcostinstitute.org/hcci-originals-dropdown/all-hcci-reports/spending-on-preventive-services-represents-a-small-fraction-of-total-health-care-spending-but-costs-to-individuals-could-be-high-without-aca-protection
https://www.cdc.gov/chronic-disease/data-research/facts-stats/index.html#


[7] https://t4america.org/2025/03/25/the-countrys-civil-engineers-agree-1-5-trillion-didnt-produce-good-infrastructure/?

[8] https://infrastructurereportcard.org/making-the-grade/

[9] https://www.reuters.com/world/china/global-debt-hits-record-over-324-trillion-says-iif-2025-05-06/

[10] https://www.reuters.com/world/china/global-debt-hits-record-over-324-trillion-says-iif-2025-05-06/

[11] https://www.cnbc.com/2023/04/27/us-personal-savings-rate-falls-near-record-low-as-consumers-spend.html

[12] https://en.wikipedia.org/wiki/Notre-Dame_de_Paris

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