Hi!

Today, I bring you more questions than answers. In fact, I’d love to hear your thoughts and ideas on this topic.

As we all know, the healthcare system is fundamentally broken. This isn’t just a Portuguese problem, or a British one, or even uniquely American (though the U.S. system is particularly broken). It’s a global issue.

We’ve become incredibly good at keeping people alive and preventing death. Acute care has never been stronger - healthcare teams perform daily miracles. Disease management is improving, too, helping people avoid rapid deterioration or severe complications.

And yet… we’re losing the bigger battle.
Health levels are declining. Chronic conditions are on the rise. Most adults rely on at least one medication daily. Healthcare spending keeps ballooning, and we don’t have much to show for it.

How is this possible?
How can we develop life-saving treatments but fail to meaningfully improve population health?

The explanation that came to mind is simple, yet powerful:
The interests of the parties involved are not aligned. Not even close.

Here’s what I mean:

A few years ago, I was interviewed for a national TV program and found myself saying,

“As a society, we’d be better off if we simply acknowledged that healthcare is a business and that decisions are made with that in mind.”

I believe it even more today.

Let me be clear: I deeply believe that most healthcare professionals genuinely want the best for their patients. I include myself in that. But the real problem lies in where incentives are placed.

• Patients want to get better as fast as possible, with the least number of appointments, pills, or interventions. If something can be resolved in 3 months, why wait 9?

• Healthcare professionals, on the other hand, are usually paid per session or procedure. The more appointments, the better, financially speaking.

• Hospitals operate on volume: more procedures, more billing.

• Pharmaceutical and supplement companies profit from ongoing dependence, not full recovery.

• Researchers can only run large-scale RCTs (the gold standard) if there's financial return. If a non-patentable or low-profit solution works, but no one invests in proving it, does it matter?

So often we hear,
“There’s no evidence for that.”
But maybe the truth is: no one paid to gather it.

The bottom line?

Our personal health goals are misaligned with the entire healthcare industry.
And that feels deeply wrong.

Why it matters

Pursuing health and performance optimization is a lifelong journey. It’s an ever-evolving process that requires:

• Deep integration of insights from multiple disciplines

• Data from labs and wearables

• Context from daily life, stress, routines, even home layout

But more than anything, it requires time.

In my work with high-achievers, real breakthroughs often came between appointments through casual check-ins, reviewing notes and test results, or reflecting on personal dynamics.

The more pieces we gather, the clearer the picture. And that takes time and space.

That’s why I’m increasingly convinced that what my clients need isn’t just a doctor, it’s:

A health strategist. A performance coach. A partner with the time and bandwidth to understand their lives and design impactful, timely solutions.

But our current pay-per-appointment model isn’t designed for that.
It works when the issue is acute and straightforward (think: an ear infection). But it falls short for anything that requires back-and-forth, adjustment, support, and habit change.

In fact, the system actively disincentivizes depth - especially when clinicians are under pressure to see more patients in less time.

So… what are the alternatives?

I don’t have all the answers but here are three models I’m considering, inspired by others and by my own experimentation:

1. Fee Based on Results
   This model aligns incentives perfectly: you pay to achieve a goal. The faster, more sustainable the outcome, the better for everyone.
   Challenge: How do you define success? What if either party isn’t compliant? What’s the guarantee?
   

2. Membership Model
   For long-term health and performance optimization, this model offers flexibility, continuity, and time.
   Doctors like Peter Attia follow this model. I also offer a limited version to a small group of people who want direct access and long-term partnership.
   Caveat: It’s a premium model, and only a few can access it.
   

3. Group Support Hybrid
   Combines 1-on-1 care with the power of community. It’s scalable and helps foster accountability and connection while still providing personalized guidance.

I’d love to hear from you.

What do you think about these ideas? What else could work?

One thing is certain: if we want a system that truly prioritizes people’s health, something has to change.

Let me know what resonates. I’m listening.

Warmly,
Miguel