21st Century Cures, 20th Century Accounting: Why a $3M Gene Therapy Just Broke Insurance

A 6-month-old named KJ Muldoon just received the first personalized CRISPR gene therapy ever made — designed, manufactured, and administered for his exact mutation in six months. Nature named him to the Top 10 People Who Shaped Science of 2025.The miracle is real. The financing model isn't.Gene therapies run $2M to $3.5M each. Insurance contracts are annual. Gene therapy benefits last a lifetime. The employer who pays in year one rarely sees the savings — average commercial plan tenure is three years.In this episode:— Why the "gene therapy tsunami" narrative is overstated (EBRI's numbers tell a different story)— The free-rider problem and why annual contracts can't price lifetime cures— The concierge medicine paradox: we pay $3M to cure you, but won't pay $300/mo to keep you healthy— Four financing models worth knowing for 2026: gene-therapy-specific stop-loss, outcomes-based agreements, risk-pooling platforms, and performance-based annuities— How AI is compressing drug development timelines — and why that compounds the budget problemWe have 21st century cures and 20th century accounting. Eventually, one of those has to change.Watch the full video: https://youtu.be/ap2XjNf3LN0Read the Substack companion piece: https://open.substack.com/pub/danmccoymd/p/21st-century-cures-20th-century-accountingFull sources and the deep dive: danmccoymd.substack.com