How affordable healthcare looks in 2025

Boulder, Colorado, 2025: Ava hears brakes screeching and hits the crosswalk hard. The car had sped into the intersection from nowhere and away just as fast. She is shaken up but doesn’t feel injured, so she takes a moment to check her vitals on her watch. She plugs in an earbud, and calls her health pool’s care line. Javi picks up on the second ring.

“Care line. What’s going on?”

“I got grazed by a car at Balsam and 14th. I think I’m all right, but I’m not sure.”

“Got it … looks like there’s a top-rated clinic up the street on 10th. Dr. Zevon can see you in 15 minutes. Can you make it?”

“I think so. I’m new to this pool. How much will this cost me?”

“Cost you? We need to make sure you’re okay. We’re going to pay you to go.”

The nervous system of healthcare is here.

Marcus and Catherine are health pool veterans. They joined the very first pool back in 2019, when they were freelance developers and Catherine was pregnant with their daughter Bea. A company called Decent was offering a new comprehensive health plan. Looking back, it had been a good decision — it rewarded them for making smart health choices, covered various types of tests and preventative care, and got bigger and better every year — but at the time, cash was tight and they had picked it because it was the most affordable option they could find.

Decent’s health plan has evolved into a decentralized protocol and network that makes it simple to spin up a legal health pool with no waste or middleman. There are hundreds of pools worldwide, covering a diversity of treatments from acupuncture to nutrition coaching to workout tracking to guided meditations and beyond. Marcus is diabetic, so they’ve joined a pool that rewards him for staying on top of his care. There are free pools for low-income members, and protocol logic ensures that cost savings are shared across pools and the healthy help cover care for the sick. The fee-for-service model is disappearing — doctors are rewarded for keeping patients healthy. New pools are being formed every day, and if the treatments they cover are effective, their premium costs go down and more members join and save more money. The work once done by traditional insurance companies — like admissions, claims management, and negotiations — is increasingly handled by software and smart contracts. What software can’t handle is farmed out to qualified members of the decentralized network, who are rewarded with tokens for their efforts. Members control their health information, and new data storage methods help providers coordinate treatment without compromising privacy. The protocol serves 100 million members and counting.

Decent aligns our incentives around quality affordable care.

Traditional health insurance companies are required to spend at least 80 cents of every premium dollar they collect for medical care. Their profit and administrative expenses are capped at 20%, creating a perverse incentive: so long as they can pass rising costs on to their members, they can take 20% of a growing pie and actually have more opportunity to make money when costs go up.

At Decent, we believe the deepest problem in healthcare is misaligned incentives. We think we’ve found a better way to align our incentives with our members, and we just raised $8MM to start to prove it. Our mission is to deliver a fairer and healthier future: affordable healthcare for all.

If this resonates with you, let’s talk about it. We’re hiring, in San Francisco and Seattle. And we’re building an early community on Telegram that is already helping to inspire us, kick the tires on our vision, and hold us accountable to get there. Please join us today and make your voice heard. We need your help to make Decent work for everyone.

Decent’s team in June 2018

How affordable healthcare looks in 2025 was originally published in Hacker Noon on Medium, where people are continuing the conversation by highlighting and responding to this story.