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Before cryptocurrency you had to buy things from shady online pharmacies or send/fund Visa gift cards. Source: https://www.varonis.com/blog/a-brief-history-of-ransomware/

Crypto is really what's made ransomware at the scale we see it now possible.

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I suspect it changes the profile of who gets hit. Individual-level targets would get extorted for maybe a couple hundred bucks - sums that are reasonable to transact in iTunes cards or whatever. Those numbers are low both because it's what that category of target is willing/able to cough up financially, and what they were able to transact irreversibly. Conversely, your meat-packing CEO isn't going down to the corner store for $11m in phone credits, so it was less worth it to go for targets with deep pockets, that might be better-protected, instead of casting a wide net for a lot of easy small hits. The ability to irreversibly and kinda-anonymously transact large amounts definitely incentivizes going for institutional targets.

Crypto makes it more efficient. It would still occur without crypto just fine. Your talking about a black market worthy many millions, maybe billions.

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