Silent
Silent provides the tools for seekers to recognize their path and enables self-reliance for spiritual and magickal growth.
Seekers gain insight from his work and find their inner calm from his ability to listen and help others reflect.
The Insurance Question
Silent • January 12, 2026
Modeling in 2025, Reality in 2026?
There is a quiet phrase circulating in boardrooms, policy circles, and payer strategy decks right now: “We’re modeling it.”
Modeling coverage.
Modeling demand.
Modeling risk.
But modeling is not commitment. And in healthcare, especially where emerging modalities and non-traditional interventions are concerned, modeling is often a euphemism for delay.
In 2025, insurers and health systems are actively modeling. In 2026, they will be forced to decide.
That year will be the pressure test.
Why Insurers Are Hesitating
Insurers are not villains in this story. Their caution is, in many ways, rational.
First, risk exposure remains undefined. Without standardized protocols, insurers cannot reliably price risk. Variability in practice creates variability in outcomes—and variability is the enemy of actuarial confidence.
Second, training and competency gaps are real. When interventions depend heavily on practitioner skill, supervision, and judgment, the absence of formalized credentialing makes it impossible to separate qualified care from well-intentioned improvisation.
Third, outcomes uncertainty persists. Anecdotal success does not translate into population-level confidence. Insurers need repeatable, measurable, and comparable data. Without it, coverage becomes a bet, not a strategy.
So insurers model. They watch. They wait.
And that waiting creates a vacuum.
What 2026 Must Deliver to Move the Needle
If 2026 is going to be the year coverage decisions move from theory to practice, several non-negotiables must be in place.
1. Standardized Protocols
Not rigid scripts—but clear, documented standards of care. Protocols that define scope, boundaries, escalation paths, and contraindications. Without these, insurers cannot distinguish responsible practice from reckless expansion.
2. Credentialing and Supervision
Coverage requires accountability. That means credentialing bodies, defined training pathways, continuing education, and supervision requirements. Not self-attestation. Not social proof. Formal structures that insurers can trust.
3. Adverse Event Reporting
If something goes wrong—and eventually, something will—there must be a transparent, non-punitive reporting mechanism. Healthcare advances when failures are studied, not hidden. Insurers will not step in unless they believe the system can self-correct.
4. Measurable Outcomes
Not vibes. Not testimonials. Data. Outcomes that matter to patients, providers, and payers alike: reduced utilization, improved quality-of-life metrics, lower downstream costs, and longitudinal impact. If it can’t be measured, it can’t be covered.
These are not bureaucratic hurdles. They are the cost of legitimacy.
The Real Danger: Coverage Without Standards
Here is the risk few are naming aloud.
If coverage arrives before standards, the result will not be access—it will be exploitation.
Commercialization without care invites volume over vigilance. It rewards speed over skill. It turns complex human experiences into billable events before the ethical scaffolding is complete.
We have seen this movie before in healthcare. Early enthusiasm followed by rapid scaling, followed by harm, followed by regulatory backlash. Once trust is broken, it is extraordinarily difficult to rebuild.
The irony is painful: the very coverage advocates are pushing for could, if rushed, destroy the thing they are trying to protect.
This Is a Leadership Moment
This is not just an insurance question. It is a leadership test.
Do we build the container before we pour into it?
Do we insist on discipline before demand?
Do we protect patients even when the market is impatient?
The temptation is understandable. Billability signals legitimacy. Reimbursement unlocks scale. But scale without integrity is not progress—it is erosion.
“If it becomes billable before it becomes ethical, we lose.”
Not metaphorically. Systemically.
A Call to Action: Preconditions, Not Permission
The path forward is not obstruction. It is sequencing.
Coverage should be the result of readiness, not the catalyst for it.
That means leaders—clinical, operational, and policy—must align around clear prerequisites:
· National or regional credentialing standards
· Defined scopes of practice and supervision models
· Mandatory adverse event reporting
· Outcome frameworks tied to patient and system value
· Integration requirements with existing care teams
These are not barriers. They are bridges.
Insurers will move when they see seriousness. Health systems will follow when risk is shared responsibly. And patients will benefit when care is delivered inside structures designed to protect them.
2026 is coming whether we are ready or not.
The question is not whether coverage will arrive—but what it will land on when it does.
Onward.
ABOUT THE AUTHOR
Walk into any forest in the Cascades and you are standing on the dead. The fir that fell forty years ago is now the nurse log feeding a row of saplings. The salmon carried uphill by an eagle became the nitrogen in the cedar's needles. Nothing in that forest is wasted, and nothing in it is afraid. We have built an entire industry on pretending we are exempt from this. We drain the body of its blood, fill it with preservatives, seal it in lacquered hardwood, and lower it into a concrete vault—as if the earth were a contamination to be defended against rather than the place we came from. Cremation, for all its simplicity, burns fossil fuel and sends the body skyward as carbon. There is another way, and it began here in Washington. Human composting—the law calls it natural organic reduction—was legalized in this state in 2019, the first in the nation. The process is unhurried and honest. The body, unembalmed, is laid into a steel vessel and surrounded by wood chips, alfalfa, and straw. No chemicals are added. The microbes that already live on the plant material, and on us, do the work they have always done. Over eight to twelve weeks, the body becomes soil—about a cubic yard of it, dark and alive. Families may take some home for a garden or a tree, or donate it to forest conservation land. What was a person becomes, quite literally, ground for new growth. I have sat with the dying, and I can tell you that the question underneath most deathbed fear is not what happens to me? It is did I matter, and will anything of me remain? The Hávamál answers plainly: cattle die, kin die, the self dies too—but what one leaves behind endures. We usually read that as reputation. I have come to read it more literally. A body that becomes soil leaves something behind that you can hold in your hands. Something that feeds. For those of us who keep the old ways, this is not innovation. It is restoration. Our ancestors were returned to barrows and bogs and burial mounds, given back to the land that fed them. The vessel and the alfalfa are new; the covenant is ancient. The earth gives, and the earth receives. Every harvest festival we keep is built on that exchange. It would be strange to honor the cycle all our lives and then opt out of it at the end. This choice is now legal in a dozen states and counting. If it speaks to you, say so—out loud, in writing, to the people who will one day carry out your wishes. Death plans left unspoken become burdens; death plans spoken become gifts. A leaf falls. A seed sprouts. The tree does not grieve the leaf, and the soil does not refuse the seed. When my own time comes, I intend to be useful one last time. That, too, is a kind of prayer. —Silent
For the Pagan and Contemplative Community
There is a grief that arrives before the death. It does not announce itself. It does not have a name that anyone uses at the dinner table, or in the waiting room, or in the parking lot of the care facility where you sit in your car for a few minutes before going in, gathering yourself. It lives in small moments. The first time they didn't recognize you. The day you realized you were making decisions for them that they would have hated. The night you caught yourself hoping — just for a second, just once — that it would be over soon, and then spent the next three days punishing yourself for the thought. This is called anticipatory grief. And it is real, and it is heavy, and almost no one will name it for you while you are living inside it, because you are the strong one, and the person you are losing is still here, and grief, we have been told, comes after. It doesn't always come after. Sometimes it comes alongside. Caregiving is one of the most demanding things a human being can do. It asks you to be present to someone else's diminishment, day after day, while managing your own fear and your own exhaustion and your own sadness — and while the world around you continues as though nothing unusual is happening. You go to the grocery store. You answer emails. You show up. You are praised for your strength, which is a kindness people offer because they don't know what else to give you. What you actually need is someone who will let you put the strength down for an hour. Not fix you. Not give you a plan. Not tell you that you're doing a great job, or that they couldn't do what you're doing, or that everything happens for a reason. Just someone who will sit with you in the weight of it. Who will not be frightened by what you are carrying. Who will let you say the unsayable things — the anger, the ambivalence, the love that is so tangled up with loss that you can no longer tell them apart. That is what I offer. I am a death doula and spiritual director. I work with caregivers who are in the middle of it — not at the end, not after, but now, in the long middle stretch where the grief has no official start date and the world has not yet given you permission to feel it. We meet, usually by video, for an hour at a time. I listen in a particular way — not for problems to solve, but for what is actually present beneath the exhaustion and the competence and the careful management of everyone else's emotions. You do not have to have it together when you come into this space. That is the point of it. A few things I will not do: I will not tell you how to grieve correctly. There is no correctly. I will not rush you toward acceptance or silver linings. Some things do not have silver linings, and pretending otherwise is a small violence. I will not give you more to manage. You are already managing too much. What I will do is be present — fully, unhurriedly, without an agenda — for whatever you bring into the room. If you are a caregiver and you are reading this and something in you recognized itself in these words, that recognition is an invitation. I have a small number of spaces available for caregivers who are navigating the approach of death alongside someone they love. The intake questions at tokeepsilent.me are where we begin. Or you can reach me directly. There is no script for this conversation. We simply start. — Silent