TFTC: A Bitcoin Podcast #681: The Health Insurance Death Spiral Is Here with Andy Schoonover
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Nov 10, 2025 Andy Schoonover, founder of CrowdHealth, dives into the crisis of skyrocketing health insurance premiums and the ACA's looming death spiral. He reveals how CrowdHealth offers a cash-pay alternative that empowers members to opt-out of the traditional system. Discussing the problems with fraudulent billing and price inflation, he highlights how their negotiation techniques save money for members. Andy also touches on the growing interest in integrating Bitcoin into healthcare and the cultural shifts towards a cash-pay model, challenging the status quo.
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ACA Subsidies Hid A Brewing Death Spiral
- The ACA masked rising costs via temporary subsidies, and those subsidies are now ending.
- Insurers expect healthy people to leave, which forces huge premium hikes and risks a death spiral.
Pay Less If You Stay Healthy
- Reward healthy behavior with lower costs by linking measurable tests to discounts.
- Use financial incentives to motivate lifestyle changes rather than blanket subsidies for unhealthy behaviors.
Calculate The Real Opportunity Cost
- Do the math: if premiums plus deductibles exceed your expected risk, self-funding may be rational for healthy people.
- Consider negotiating cash-pay and using community funding instead of expensive ACA plans.
