Conjecture

Crypto's parallel-infrastructure playbook does not carry over to health coverage, because coverage is a risk pool and a parallel pool people opt into selects the currently healthy. Health care sharing ministries are the working case: outside ACA rules, free to exclude pre-existing conditions, guaranteeing no payment, and grown from under 200,000 members before 2010 to perhaps 1 million by 2018 by their own count; in Alaska about 10,000 against a 20,000-person individual market. The selection is predicted by design and feared by regulators but not yet measured. A parallel payment rail can be better for everyone on it; a parallel risk pool is cheaper for those it admits by leaving the rest in a sicker pool. The objection covers pools only: rails that do not pool risk, such as cash-pay pricing or direct contracting between patients or employers and providers, are outside it.

Health and flourishing