Andy Schoonover: Defecting from Corrupt Healthcare

↓ Jump to the video and timestamps

Andy Schoonover, founder and CEO of CrowdHealth (a TFTC sponsor I've used with my family for over a year), came back into the office and we sat down to work through what's actually happening with his model, the Lightning integration they've been building, and whether doctors are starting to defect from the insurance system the same way patients are.

I'm not a neutral observer here. My family is on CrowdHealth. We have a direct primary care pediatrician, Veronica at Ultra Personal Healthcare, and my wife has said more than once that finding Veronica is probably her favorite part of our move to Austin. That's healthcare neither of us had ever experienced before.

And the whole DPC plus CrowdHealth stack still costs less than a Cigna family plan. That's the context I'm coming from.

The through-line of this whole conversation is the same one that runs through Bitcoin, the Beef Initiative, and every other opt-out movement worth paying attention to: the incumbent system is a racket, the incentives are completely backwards, and the people inside it are starting to feel the weight of that and defect. It's happening in healthcare right now, and the Lightning Network is about to make it stranger and more interesting than most people expect.

The receipts, if you want them before you decide: we compiled every month CrowdHealth has published into one place — what the community actually funded, how long it took, and what got refused.

Key takeaways

• The family health insurance math is insane before you spend a single dollar on care. Andy's own family plan example: $1,400 a month in premiums plus a $14,000 deductible means roughly $30,000 out of pocket before insurance covers anything. CrowdHealth's first-$500 model with community crowdfunding costs a fraction of that for most healthy families.
• Health insurance companies are incentivized for you to be sick. They make more money when bills are higher. CrowdHealth's flat $50/month subscription removes that perverse incentive entirely. It's the only revenue they take.
• DPC plus CrowdHealth is the actual stack. Direct primary care for everyday care, CrowdHealth for the big bills. I've texted our pediatrician at 1am on a weekend and gotten an answer. My son got a rock in his ear, paid $500, the community crowdfunded the rest inside of minutes. Combined cost is still less than a standard employer plan annually.
• Doctors want out of the insurance system as badly as patients do. CrowdHealth gets daily inbound from physicians asking to be connected with patients. More MDs followed them in the prior 30 days than ever before. The defection wave is underway.
• Lightning integration makes healthcare the proving ground for Bitcoin as a medium of exchange. CrowdHealth is building in-app Lightning wallets using the Breez SDK, enabling peer-to-peer bill crowdfunding in sats. Veronica already accepts Bitcoin. I've paid two months of invoices over Lightning. Andy's target: even 10 basis points of the $4.3 trillion US healthcare market proves the use case.
• Hit the hard button. Andy's framing, and I'm adopting it fully. Go to CrowdHealth.com and use code TFTC instead of sitting in a boardroom letting HR walk you into another garbage Anthem plan. You will understand your healthcare spending for the first time in your life.

The Racket You're Paying Into

It's open enrollment season. That means millions of people are sitting through HR presentations getting walked into the same set of terrible options they've been sold for years, psyoped into thinking this is the only way healthcare can work.

Andy put the math on the table plainly. For his family on healthcare.gov, the options ran between $12,000 and $16,000 in annual deductibles. His premium was $1,400 a month, which is roughly $16,800 a year. Stack the deductible on top and you're looking at around $30,000 before insurance pays a single dollar toward your family's care.

Then above the deductible you're paying 20% of everything up to a max out of pocket that could run another $20,000. My response on tape: "That's insane." It is.

The mechanism driving these costs isn't complicated. United Healthcare in some markets accounts for 40 to 60% of a given doctor's revenue, by Andy's account. When one customer is that concentrated in your revenue base, they own you. They come back and demand 20% rate cuts or they walk. Doctors then sell to hospital systems. Hospital systems consolidate.

Austin is a near-duopoly between St. David's and Ascension. Basic economics takes it from there: prices go up.

On top of all of this, healthcare.gov now requires you to submit your W2s to validate your income as a condition of access. Your right to get healthcare, Andy's phrasing, gated behind your paychecks. This is all moving toward single payer, and the push is coming from large employers who are telling legislators they can't compete globally because US companies carry the healthcare cost burden that governments absorb in Europe and China. They're striking at branches instead of the root, and they're going to hand the government another massive piece of the economy in the process.

What CrowdHealth Actually Is and Why the Math Works

The model is simple enough that it confuses people trained by the insurance industry to expect complexity.

You pay $125 a month. If you have a health event, you bring the bill to CrowdHealth. They negotiate it down. You cover the first $500, and the rest gets crowdfunded by the community.

The negotiation piece is where the economics get compelling. Andy's stated figure is that CrowdHealth pays bills at roughly 140 to 150% of Medicare rates. Commercial health insurance plans pay 250 to 300% of Medicare, per Andy's account, a spread that's broadly supported by independent research on hospital billing.

That gap is where the savings live. As a concrete example Andy gave from his own family: his father-in-law had gallbladder surgery in Austin that came in at $45,000. A CrowdHealth member had the same procedure in Arkansas around the same time for roughly $5,000. That's an illustration of what's possible, not a guarantee for every case, but the magnitude is real.

The community participation rate Andy cites from two years of operation: 98% of crowdfunding requests get funded. That number comes from CrowdHealth's internal data, but the behavioral logic behind it is strong. You're in a community with people you share values with. My son had a rock in his ear, the procedure ran $1,500, I covered the first $500, and the community funded the rest almost immediately.

I've funded other members' bills too. That's not an abstraction, that's how it actually works.

Andy projects CrowdHealth will hit around 6,000 members by end of the month, roughly 3x year-over-year growth. Profitability hits at 7,000 to 8,000 members, which he expects around Q1 of next year. Those are his projections at time of recording.

As Parker says about sustainable energy: nothing is sustainable unless it's profitable. A company reaching profitability within three years on a $50/month subscription revenue model is the real signal that the economics work.

DPC Plus CrowdHealth: The Actual Stack

Direct primary care means you pay your doctor directly, on a monthly subscription basis, outside of insurance entirely. Veronica's practice, Ultra Personal Healthcare, runs about $150 per adult and $50 per child per month, based on what we pay. That covers your primary care relationship entirely. No insurance company in the middle, no permission required for what the doctor can or can't do.

Andy's framing on this is exactly right: you work for whoever pays you. Right now, most doctors work for the insurance company. In a DPC practice, the doctor works for you.

The difference in experience is hard to overstate. We texted Veronica at 1am on a weekend and got an answer. Andy had a cardiologist who, upon learning Andy was direct pay, offered to just call him with his scan results instead of scheduling a $200 follow-up office visit. "Can I just call you?" Yes, you can. That call costs the doctor nothing to make. The only reason he would have billed for an in-person visit is because insurance made it billable.

My wife has said multiple times that finding Veronica is probably her favorite part of our move to Austin. She's never had healthcare like it in her life. Healthcare that involves a conversation, that accounts for the actual person in front of the doctor, that doesn't route everything through a form.

And when you show up at a non-DPC provider and say you're direct pay, you see the system's reaction: the front desk staff start whispering. They're confused. Direct pay is treated as a warning sign. Andy wants to wear an "Uninsured" t-shirt just to own it publicly. I get that impulse completely.

The impersonality of the corporate healthcare system is so extreme that I've said on tape I'd pay more for what we have with CrowdHealth plus DPC. The fact that it also costs less is the kicker.

Defection: Doctors, Patients, and the Tipping Point

We just recorded with Mike Benz, executive director at the Foundation for Freedom Online, about the censorship industrial complex and the intelligence apparatus that embedded itself in private institutions. One thing he said that stuck with me: the defection phase is coming, because the weight of the immorality eventually becomes unbearable for the individuals inside these systems. I think you can watch the exact same dynamic playing out in healthcare right now.

Doctors are reaching out to CrowdHealth on Twitter asking to be sent patients. Andy said the number of MDs following CrowdHealth in the prior 30 days was higher than at any previous point. Direct primary care was one wave of defection. Specialty care is beginning to follow.

The wait times for patients inside the insurance network have gotten bad enough that the case for defection is making itself. Andy cited neurology waits running around six months and gastroenterology around three months, with ENT booked out into February or March, based on his observation at time of recording.

CrowdHealth is building a nationwide database of doctors who accept Bitcoin, and doctors who don't yet accept it are telling them: send us patients and we will. One dentist in Denver with around 120 Twitter followers at the time tweeted that he accepts Bitcoin, and Andy's recollection is that the tweet reached around 150,000 people. The demand signal is real. Bitcoin-accepting doctors will get more patients.

Andy estimates roughly 25% of CrowdHealth members are actively ditching employer-based plans to come over. That's his internal data. The Beef Initiative parallel is obvious: a rancher in Indiana heard Adam Carey mention the Beef Initiative on Joe Rogan, went to the website, signed up, and said his numbers exploded without ever meeting Slim.

Nobody had to build a persuasion campaign. The model just had to become visible. CrowdHealth needs the same moment.

Lightning, Bitcoin, and the $4.3 Trillion Target

This is the part of the conversation I was most fired up about before we hit record, and Andy didn't disappoint.

The full vision: CrowdHealth builds Lightning wallets into their app using the Breez SDK as the back-end. When your son gets a rock in his ear and you've covered the first $500, CrowdHealth sends Lightning invoices to 15 community members for $100 each in sats. They accept. The money hits your wallet in minutes.

If your doctor accepts Lightning, you pay directly from that wallet. If not, you hold it in Bitcoin or off-ramp to pay in fiat. Either way, you've transacted healthcare in Bitcoin.

Veronica already accepts Bitcoin through her practice. My wife saw the message in the Ultra Personal Healthcare app: we're accepting Bitcoin, using Zap. We've paid two months of invoices over Lightning. I can do it directly from my stack or I can use Strike to convert what was already a fiat line item.

That monthly DPC payment was leaving my bank account as dollars anyway. Converting it to sats that land in Veronica's wallet changes nothing for my cash flow and everything for the circular economy we're trying to build.

Andy's year-one expectation is 1 to 2% Lightning-to-Lightning circularity, meaning the payment goes out in sats and the doctor holds it in sats. From there you scale: 3%, 5%, 10%. The US healthcare market, per CMS National Health Expenditure data, is over $4 trillion annually. Andy says $4.3 trillion. CMS now puts national health spending at $5.3 trillion as of 2024, so the target has only grown since we recorded this.

Even 10 basis points of that is enough to permanently retire the argument that Bitcoin isn't a medium of exchange. Nobody can say you can't spend it anywhere when the largest industry in the country is running on Lightning rails.

Jimmy Song sat with Andy at the Capital Grille a few years ago and said: these health insurance companies are holding a big bucket of fiat that's depreciating by the minute. What if you held that bucket in Bitcoin? That conversation is still playing out. Andy is now thinking about how members hold excess funds in Bitcoin rather than fiat reserves bleeding away.

The incentives of the Bitcoin standard are doing exactly what they're supposed to do: orienting every decision toward harder money.

The Incentive Argument: Why This Works When Insurance Doesn't

Health insurance companies are incentivized for you to be sick. Most people haven't fully internalized that sentence. When you're sick, more services get billed, more claims get processed, the whole machinery runs hotter. The insurance company's revenue is tied to that flow.

There is no version of that structure where the insurer's interests and yours are aligned.

CrowdHealth takes $50 a month per member. That's their only revenue. It's a fixed subscription. There is no upside for them in you getting sicker or in your bills going higher.

The entire incentive structure points in the opposite direction: a healthy, low-cost community is the best possible outcome for the business.

Andy talked about a member in his mid-30s with colon cancer who came back to CrowdHealth not demanding the most expensive possible treatment path, but asking: can you find me doctors who will treat me at a reasonable cost? I don't want to screw the community. That behavioral change doesn't come from a policy or a rule. It comes from incentive alignment.

You're not some anonymous patient burning through a faceless insurance pool. You're in a community of people you know, people who are funding your care directly, and you care about them.

The CDC's data on American metabolic health makes Andy's concern about the food system completely understandable. Something like 73% of American adults are overweight or obese according to CDC NHANES data, including about 42% who are clinically obese. A self-selected community of people who take their health seriously, who work out, who watch what they eat, who have low time preference, will just have lower medical costs.

That's not complicated. The Bitcoin crowd and the CrowdHealth crowd are substantially the same crowd, and the numbers reflect it.

Andy wants to build metabolically-segmented communities inside CrowdHealth: a metabolically healthy crowd that pays lower rates because everyone in it is metabolically healthy, which creates an incentive for borderline members to clean up their numbers to get access to better pricing. That's the Bitcoin incentive logic applied directly to physical health. I go to Lifetime Fitness two to three times a week with my kids in tow. My oldest can have a real conversation now and I want to still be running around with him decades from now.

That motivation is the same low time preference logic that runs through everything worth building.

The Hard Button

Dr. Malone's upcoming episode on Andy's own podcast touches on the moment you reach a fork: the easy path where you keep your comfortable consulting business and stay quiet, or the hard path where you say what you know to be true and take the consequences. Andy connected that directly to every meaningful decision in the Bitcoin world.

You can go to your employer tomorrow, sign the sheet of paper, get the insurance card, and never think about it again until the explanation of benefits arrives. That's the easy button. Or you can spend an afternoon actually understanding how the system works, what the incentives are, and why you're paying $30,000 before insurance covers a dollar, and then do something different.

I said on tape that we're going to face a lot of those forks in Bitcoin specifically. When KYC/AML compliance decisions get made at the infrastructure level, a lot of people will hit the easy button. That will be a mistake.

The pattern is the same everywhere: money, food, healthcare. Opt out of the rackets. Shake your doctor's hand the same way you shake your rancher's hand.

We've had about 500 signups through the TFTC code over roughly 18 months, per Andy's internal data, and only two people left, both because their employer covered their insurance in full. Two out of five hundred. That's the retention number. It speaks for itself.

Go to joincrowdhealth.com/tftc and use code TFTC. $99 a month for your first six months. It is open enrollment season. You have a decision to make.

About Andy Schoonover

Andy Schoonover is the founder and CEO of CrowdHealth, a community-funded alternative to health insurance he started building in 2021 after his own insurer denied a claim for his daughter. He is based in Austin, Texas, and has appeared on TFTC multiple times to discuss hospital billing, direct primary care, and CrowdHealth's model for taking the insurance company out of the doctor-patient relationship.

Sources mentioned

• CMS National Health Expenditure Data: the federal accounting of total U.S. healthcare spending, the pool Andy describes as the target
• KFF Employer Health Benefits Survey: annual data on what employers and employees actually pay for coverage
• KFF Affordable Care Act resources: premium, subsidy and enrollment data behind the ACA discussion
• DPC Frontier: mapping and legal reference for direct primary care practices, the model Andy pairs with CrowdHealth
• DPC Alliance: physician-run organisation for direct primary care, useful for finding a practice
• NIDDK overweight and obesity statistics: NIH data on U.S. metabolic health, context for the segmented-crowd argument
• CrowdHealth: how it works: the mechanics of membership, contributions and bill submission
• CMS Medicare fee schedules: the Medicare rate benchmark behind the 140-150% figure
• Peterson-KFF Health System Tracker: comparative data on commercial prices as a multiple of Medicare
• CMS: Medical Loss Ratio: the 80-85% rule that shapes insurer incentives
• KFF: ACA Marketplace premiums in 2026: current premium trend data for the healthcare.gov comparison
• Lightning Network paper: the technical primary source for the payments layer discussed
• HealthCare.gov: COBRA continuation coverage: context for employer-plan costs when you leave a job
• AAFP: direct primary care: the physicians' college definition of the model, with typical membership fees of $50 to $100 a month
• DPC Frontier Mapper: the live national registry of direct primary care practices, now over 3,100 across all 50 states
• Eskew and Klink, Direct Primary Care: practice distribution and cost across the nation (JABFM, 2015): the peer-reviewed DPC pricing census, which found 141 practices at an average $93 a month
• AMA: Competition in Health Insurance, a comprehensive study of US markets: in 47% of metro markets a single insurer holds at least half the commercial market, and insurer input-market power pushes physician payments below competitive levels
• RAND Hospital Price Transparency Study, Round 5: private plans paid 254% of Medicare on average in 2022, 279% for outpatient facility services
• Philips and Whaley, commercial price variation for common services in general surgery (JAMA Network Open, 2025): negotiated prices for laparoscopic gallbladder removal sit near a median of $8,696, which is the gap between a billed charge and a paid price
• 2025 AMA prior authorization physician survey: practices complete 40 prior authorisations per physician per week and spend 13 staff hours on them
• AMA Physician Practice Benchmark Survey: practice characteristics in 2024: private practice fell to 42.2% of physicians, 18 points lower than 2012, which is the defection trend from the other direction
• NAIC: not all products are health insurance: state regulators' guidance that health care sharing ministries are not insurance and are not supervised as such
• HealthCare.gov: out-of-pocket maximum: the statutory ACA out-of-pocket ceiling, $10,600 for an individual and $21,200 for a family in 2026

Watch the conversation

Timestamps

• 0:00 - Intro
• 7:36 - CrowdHealth growth and community overview
• 12:32 - How the crowdfunding model works in practice
• 14:23 - Doctors embracing the direct pay model
• 17:00 - Grassroots growth and member referrals
• 23:19 - Direct primary care and patient experience
• 29:06 - Implementing Bitcoin and Lightning Network
• 43:46 - Barriers to adoption and double whammy problem
• 51:19 - Employer health benefits and regulatory hurdles
• 56:32 - Food health and metabolic wellness incentives
• 1:04:14 - Doctor defections and healthcare consumerization