When Wealth Can Be Detrimental to Your Health

$25 million bought one family everything except a coherent approach to healthcare

A few years ago, I engaged a new client Richard, and his wife Annette, both 72. He was recently semi-retired after the sale of a successful business, owned multiple homes in Virginia and Florida, and had multiple trusts, sophisticated estate planning, and a strong investment portfolio.

They hired me because my team had rescued Annette’s mom from bad financial decisions in the face of multiple chronic illnesses before she died. Our work had also rescued her portfolio, so Richard and Annette asked me to manage the legacy left in her estate. Their net worth: $25 million.

Because Richard and Annette had gone through the harrowing experience of Annette’s mother’s poor decisions, I expected they would embrace thoughtful planning. However, like many very affluent retirees, Richard thought he’d already solved his future healthcare problems. He had concierge physicians, executive physicals, access to top medical centers, and a network that would secure appointments with specialists quickly.

Despite Richard’s ample resources, I was unsettled to learn how terrified he was of dementia, which ran in his family.. His father had declined rapidly in his late seventies and an older sibling showed early signs of cognitive impairment.

Richard rarely spoke about this directly, but he quietly had begun pursuing aggressive anti-aging therapies like GLPs (even though he did not need to lose weight), peptides, stem cell treatments, hormonal interventions, and experimental longevity protocols like VO2 maxxing.

As I asked Richard about these treatments, I learned that his physicians only knew some of the pieces of his treatments. None of them knew about all of it. That’s when I zeroed in on the real risk: complexity without coordination.

Wealth can create the illusion of control

One of the biggest misconceptions affluent families have about healthcare is that resources reduce vulnerability. In reality, wealth often increases complexity faster than it improves judgment. Complexity is not inherently bad, but it needs to be coordinated and purposeful. Richard was a classic case of uncoordinated complexity. At a glance, his healthcare ecosystem looked impressive:

a concierge internist in Florida
specialists in Washington and New York
executive health evaluations at a nationally recognized clinic
private longevity consultants
separate wellness providers managing anti-aging therapies
multiple pharmacies and supplement regimens

All of these resources gave Richard more confidence, and as an intelligent, successful man who was used to operating independently, he also believed he could coordinate all of this himself. But this array of impressive healthcare resources lacked integration, coordination, and alignment with Richard’s healthcare goals.

The hidden risk of “optimization”

Richard viewed his anti-aging efforts as proactive. In his mind, he was staying ahead of decline.

What concerned me wasn’t the existence of the therapies themselves. It was the fragmented secrecy surrounding them. For example, when I asked about what his primary doctor thought about Richard’s stem cell therapies, he said, “He doesn’t know about that. He’s old school and will give me a lot of untested blah blah blah pablum.” Richard saw these treatments as separate from his “real” medical care.

As my own career has put me in the service of some very affluent families, I’ve learned that those families often build personalized yet unaligned healthcare systems:

traditional medicine
longevity medicine
concierge medicine
optimized nutrition
private experimental therapies

From the patient’s point of view, they believe they are assembling an elite strategy. However, each silo can operate independently (at least in some form) and each provider may only see partial information. That creates real risks such as:

medication interactions
conflicting recommendations
missed warning signs
delayed diagnoses
fractured accountability

And weirdly, it became obvious that Richard’s overconfidence amplified all of these things.

Complexity is the real risk factor

I’m not a medical professional, but my experience has helped me spot a variety of decision-making behaviors that can become problematic. For Richard and Annette, I brought my concern back to the table from the financial angle first.

“Richard and Annette, it looks like you are spending well into the $X00,000’s annually for all of this medical stuff,” I said. “How do you know it’s working or going to work?”

“Tom, you should think of anti-aging as a lifestyle commitment more than medical expenses,” Richard answered.

“Sure, I believe everybody should do what they can to be the best version of themselves for as long as possible,” I said. “But for the sake of argument, if you need a prescription for it or if you can deduct it as a medical expense on your taxes or it comes from a doctor or licensed medical professional, can we call it a medical expense? I think exercise and nutrition maybe fall out of that category.”

As they agreed to that framing for my benefit, it occurred to me that most people think aging risk is primarily medical. For affluent families, it is often operational, as they have money to buy almost any service. But that makes fragmentation easier, as people like Richard can see another specialist for any new concern, pay for another treatment pathway, and pursue another optimization strategy.

Richard interpreted this as sophistication. In reality, the system was becoming harder and harder to manage coherently because he was the imperfect conduit of the totality of all of his treatment regimens.

At one point I asked Richard a simple question: “If you had a neurological event tomorrow, who has the complete picture?”

He was silent. Finally, Annette spoke up. “I don’t think anyone knows everything he’s doing.” Richard glared at her, but she countered with, “Don’t look at me, this is all your voodoo stuff. I have no idea what you are doing.”

Pursuing control, creating disorder

My clients from affluent households are often deeply identified with competence, autonomy, mental sharpness, and control. The possibility of losing those things to cognitive decline can trigger anxiety and an obsession with “solutions.” For Richard, he was chasing certainty in an area where certainty did not exist:

Studying longevity podcasts
Following emerging therapies obsessively
Poring over studies
Searching constantly for the next intervention that could reduce his risk

The irony was painful: his pursuit of control was creating more disorder. This happens more than most professionals realize as affluent clients mistake aggressive “optimization” for disciplined strategy. But optimization without coordination simply becomes noise.

A treatment for everything except poor planning

The complexity extended beyond Richard himself. One adult daughter believed in pursuing every possible intervention indefinitely. (Richard referred to her as the “Hippy Dippy Star Child” without a hint of self awareness.) His other adult daughter privately questioned whether Richard’s fear was driving a consumption of snake oil.

Annette worried her husband was being targeted all the time to buy another supplement. She also gave up trying to track all of his medications, providers, travel, and treatments across multiple systems.

To top it off, despite all of this “planning,” the family had hardly discussed key practicalities:

What happens if Richard’s cognition declines?
Who will make the decisions?
What level of intervention aligns with Richard’s actual values?
What risks are acceptable?
What role should experimental therapies play over time?

Like many affluent families, they had legal preparedness without operational preparedness.

How we built a system to support good decisions

My role was not to stop Richard from pursuing longevity therapies—that would have failed immediately. My goal was to create structure around complexity by focusing on:

Consolidating provider communication
Organizing records and treatment disclosures
Clarifying family decision-making roles
Discussing cognitive decline openly
Identifying where secrecy and compartmentalization were creating risk
Aligning experimental therapies with broader care planning
Creating continuity across locations and providers

Most importantly, we reframed the goal. It was no longer about finding every possible anti-aging intervention. It was about building a system capable of supporting good decisions over time. That shifted the entire conversation.

Being proactive does not mean doing more

A lack of access is often one of the greatest healthcare challenges, but for very affluent households, access often becomes the problem. The ability to afford all the things creates a volatile mix of overconfidence (look at all the things we’re doing!) with unmanaged complexity (what are all the things we’re doing?).

Money can enable families to build fragmented healthcare ecosystems that no one fully understands.

Near the end of one meeting, Richard said something I still think about often. “I thought being proactive meant doing more.”

As the family worked with a number of advisors, medical and financial and others, they began to see that real solutions are built in the form of durable frameworks that regularly come down to this process:

Build consensus about what the priorities are and communicate openly among decision-makers and advisors
Do a thorough evaluation of your current state (i.e. know where you are starting from)
Identify and evaluate options
Execute on appropriate options and finally
Monitor and evaluate steps 1-4 for effectiveness and alignment, and then repeat.

When you do that, you really will have an approach to long-term care that’s healthy, wealthy, and wise.