When Crypto Comes to Health Care

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By KIM BELLARD

The conflict between Ukraine and Russia has been called many things.  To most of the world, of course, it’s considered an invasion, a war between the two countries.  To Russia, it’s a “peacekeeping” mission.  The description that I can’t get out of my head, though, is one that I believe The Washington Post first used:  it’s the world’s first crypto war.  

“There is something about the war in Ukraine that feels different,” a former U.S. intelligence official told Nick Bilton. “We’ve seen wars documented on Twitter and images shared on the internet before, but this time it isn’t just bombs and bullets; this war is digital from the top to the bottom.” And, Mr. Bilton says: “At the center are cryptocurrencies.”  

If crypto has come to war, can healthcare be far behind?

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The Post article was in the early days of the war, and focused mostly on how Russia might try to use crypto to lessen the impact of many financial sanctions that have been imposed. That remains a concern, but what has transpired since has opened up many people’s eyes about the use of crypto.  Ukraine has raised around $60 million in crypto contributions, according to blockchain analytics firm Elliptic, both directly to the Ukrainian government and to Come Back Alive NGO.  These contributions are being used not only for supplies and humanitarian relief, but also for purchase of military equipment.  Ukraine is, in part, crowdfunding the war using crypto. 

Crypto has become a favorite means of donating money because the transaction is quicker and cheaper than bank or other more traditional methods, and can be done even when banks or other financial institutions may be under cyber or physical attack (or, if they are in Russia, have been sanctioned). Professor Gavin Brown writes: “By going straight to the people of the world, Ukraine’s government has been able to raise finance quickly without the need for financial intermediaries.” 

“Cryptocurrency is particularly suited to international fundraising because it doesn’t respect national boundaries and it’s censorship-resistant — there is no central authority that can block transactions, for example in response to sanctions,” Elliptic’s chief scientist, Tom Robinson told CNBC.  

Dan Primack of Axios asserts: “This is the crypto industry’s moment of truth.”  

“For nearly a decade,” he goes on to explain, “crypto evangelists have said that one of the tech’s greatest benefits would be in helping users avoid macro economic disruptions…Russia’s war on Ukraine, including the financial impacts on both countries, is kind of what they had in mind.”  The tests, he believes, will be utility and adoption. 

Ukraine was particularly ready for a crypto war.  Even before the conflict, Chainalysis had ranked Ukraine as the top European adaptor of cryptocurrency, and fourth in the world.  Last September it legalized cryptocurrency, and was already piloting its form of digital currency, the e-hryvnia.   It has a Ministry of Digital Transformation, whose 31 year-old deputy minister Alex Bornyakov is creating a lot of waves. 

Cryptocurrency hasn’t always been known for its stability, but if you are a Ukrainian refugee, carrying cash might seen risky, so putting your money in a digital wallet might seem like a prudent strategy. Similarly, if you are a Russian citizen whose bank is collapsing, whose rubles’ value are crashing, and whose Mastercard/Visa no longer work, putting your money into cryptocurrency suddenly makes a lot of sense. 

Mr. Primack suggested: “But it’s hard for even the most hardened Luddite to not at least wonder if it’s prudent to sock away a little “digital gold,” just in case he finds himself suddenly living in the next Ukraine or Russia.”  

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This seems rather far afield from healthcare.  The U.S. isn’t at war (unless you count cyberattacks), and our healthcare system has no shortage of ways to get money.  Nobody really likes how healthcare’s payment mechanisms work, and everyone agrees they are wildly inefficient, but, so far, there’s no hue and cry to introduce cryptocurrency into them.  Oh, sure, there are some start-ups claiming to offer health cryptocurrencies, but they’re not close to being a threat to any payors or healthcare payment intermediaries.

But, still, crypto is coming to healthcare.

The U.S. is still in the early stages of developing a digital currency strategy; last month, for example, the Federal Reserve issued a report on a Central Bank Digital Currency. “I think it’s more important to do this right than to do it fast,” Fed Chair Jerome Powell has said.  Congress has held hearings, will undoubtedly hold more.  Advocates for digital currency point to lower transaction costs, and potential to help the unbanked.   

There is a need for regulation, most believe, but Senator Ron Wyden, chair of the Senate Finance Committee, warns: “There is obviously a debate [about stricter regulation] but I want to be on the side of the innovator,” comparing the current crypto environment to the early days of the internet.

That’s sort of the point. We don’t know what cryptocurrency will be used for – who thought it’d be a key part of an actual war? – but we’re undoubtedly not thinking big enough.  Lower transaction costs?  Hello, healthcare payments!  The unbanked?  Hello, the uninsured!  Bypass intermediaries?  Goodbye, health insurers!

Let’s just hope that healthcare isn’t as slow (and as limited initially) to crypto as it was to the internet.  

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The war in the Ukraine did not come as a surprise.  The U.S. told the world for weeks what President Putin was going to do, and he did.  But, as Alex Bornyakov told TechCrunch last week, “The war didn’t start four days ago.  It’s been going on for eight years,” referencing Russia’s 2014 occupation of Crimea.  One of the ways that Ukraine prepared during those eight years was to get ready for crypto, and now they are benefiting.

Similarly, no one paying attention can believe our current healthcare system can go on as it is.  It’s due for a fall.  It has to get cheaper, faster, more efficient, more equitable.  Crypto is not the solution, but it is going to be part of the solution.  We should be preparing.

So: cheer for Ukraine, donate to it if you can, and, if you care about your health or your pocketbook, start thinking more seriously about what crypto could mean for our healthcare system.

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor