All it really takes is one person with a now terminal illness that has previously been denied lifesaving healthcare to decide they want to take someone with them on the way down. I’m sure there are quite a few people in the US in that situation.

I do, but only because the UX around federated entities isn’t great at the moment. There’s no doubt that it could be made way more intuitive and streamlined for the average user, and that more effort could be put into migration between federated entities so that it doesn’t feel like as much of a chore to jump between instances. The average user won’t care about federation, and they just want to quickly get some content.