Is it? VIPs are regularly held for ransom in unstable countries, so much so that ransom insurance is a thing[1]. If those ransoms can be safely received, why can't it be the case for ransomware ransoms?
[1] https://en.wikipedia.org/wiki/Kidnap_and_ransom_insurance
It streamslines it, yes, but it doesn't make it "almost impossible" to pull off like gp claims. Russia is listed as a "high risk" area in the wikipedia article for ransoms, so if they can pull off a ransom exchange (with human hostages) there, I can totally imagine russian hackers being able to pull off a ransom exchange with cryptographic keys. If anything, it's probably easier to pull off than a regular ransom because you don't have to contend with a human hostage.
Also, a quick skim of wikipedia[1] suggests that buying/selling of stolen credit card info predates the creation of cryptocurrency. If cybercriminals were able to find ways of transferring money back then, I'm sure ransomware authors can use the same methods to transfer money today.
[1] https://en.wikipedia.org/wiki/Credit_card_fraud -> https://en.wikipedia.org/wiki/Albert_Gonzalez -> https://en.wikipedia.org/wiki/ShadowCrew
From the comment you were replying to
> we're democratizing large scale crime. Previously only large organized crime organizations could perform such an attack. Now, almost anyone can.
That seems true and the main point. That it's gotten significantly easier for anyone to do this.