Must be shorter than 19 pages. Due Apr 24th.
They want you to talk about competition in the markets. They just handled the insulin problem. We have more problems than that.
Request from FTC: Federal Trade Commission and Department of Justice Seek Public Comment for Guidance on Business Collaborations | Federal Trade Commission
Let me explain how this impacts diabetics.
We just got a settlement with 2 out of 3 of the large PBMs. The government agencies (primarily Federal Trade Commission) have made a formal judgement of market fixing, with regards to insulin price gouging. https://www.healthcaredive.com/news/express-scripts-ftc-reach-settlement-insulin-lawsuit/811369/ But Dept of Commerce and Labor are also on the move to try and repair this situation.
The situation now is this - federal agencies act on behalf of the executive branch. They also provide guidance to Congress. They are handling corruption in the markets, which is deemed to require specialized knowledge (law, economics, policy) that the courts and the legislature donāt have. FTC and DOJ are complaining that they are required to have, āvery clear rules,ā about when they can act and how they can act in the case of monopolization of the markets. But all their rules were deleted in 2024. Those rules are here: https://www.ftc.gov/sites/default/files/documents/public_events/joint-venture-hearings-antitrust-guidelines-collaboration-among-competitors/ftcdojguidelines-2.pdf
So, now they need to rewrite those rules. They also complain that the previous rules were totally outdated and didnāt take into account how digital property and innovation work in the modern day.
I had to do a little research and found a video series on administrative law that helped me prepare to write to the government, should I chose to. That series is this:
FTC sued UHG, Express Scripts, and CVS in administrative court.
Iām just thinking broadly about what sort of rules would help me as a diabetic patient.
Iām interested in input/perspective from the community. It took a few days before CEOs, lawyers, people from other patient communities, doctors, and pharmacists started discussing this with me. Itās a little complicated for everyone to understand (including me).
Hereās some of the spitball-ing that is occurring:
Me to member of a different patient community:
āI think they are doing rulemaking to replace all the rules that got thrown away in 2024? I want DOJ to provide effective deterrent for corporate crime & thievery of both my financial property as a taxpayer and an individual, and my civil libertiesā¦I donāt want any thieving of my civil liberties. I want that rule. Maybe we should list every time DOJ has NOT provided an effective deterrent, but we are limited to 18 pages. Itās not possible. 
When DOJ gives a penalty, it should be greater than or equal to the losses incurred by someoneās bad behavior. Damages should be greater than loses.
Part of me feels like the magnitude of damage is so great by the time a corporate antitrust case falls on their desk, that FTC should be obligated to break the company up. Thatās preferable to an infinite black hole of rulemaking to try and control them. How much is that gonna cost us? Just break 'em up into tiny little pieces as punishment.ā
Member of another pt community to me:
ānice thought. Your civil liberties involve property to a much greater extent than popularly understood. Meaning the Fourth Amendment is taken way less seriously than it should be.ā
Member of another pt community:
āYes! Maybe there is also an analogy between someone taking control of a railway in the olden days and taking control of data or a data pipeline or a single software package available in the market todayā¦to play off your historical example from Detroit. 
Ex. Epic, Change Healthcare I need to google what the 4th amendment is. https://www.youtube.com/watch?v=QvejiwkPRO8 The fundamental problem with being a diabetic is that powerful companies have so much control over me physically, financially, and legally as to infringe profoundly on my rights to life, liberty and pursuit of happiness, I think. @personpersonpersonperson who testified in front of congress recently - can you help further this discussion within the context of your paradigm of the modern medical markets? We are just kinda throwing things at the wall and seeing what might stick.ā
Healthcare CEO (who is a type 2 diabetic):
āI donāt know that breaking up companies is always the best answer. I read recently that the breakup of Standard Oil didnāt really accomplish much except to make Rockefeller much richer. Epic, etc., came out of making regulations by a ācapturedā agency. You get what you ask for. The smartest people arenāt working for the government.ā
(This CEO is referencing a problem called Regulatory Capture in healthcare - thatās where the large insurers control congress thru campaign donations. āRegulatory capture is a situation where a regulatory agency, created to act in the public interest, instead serves the interests of the industries it is supposed to regulate. This often happens due to lobbying and the close relationships between regulators and industry insiders, leading to biased decisions that favor established firms over the public.ā)
One of the young female doctors:
āI commentedā
(This doctor is young and full of fight. Sheās a NAVY veteran. She wants healthcare regulated the same as a utility company - as critical infrastructure. It takes real guts for her to participate because insurance companies will have doctors put into a āno hireā database for stuff like this sometimes. Sometimes the insurers retaliate by kicking their medical practice out of network. Fundraiser by Elisabeth Potter : Stand with a Surgeon Facing Retaliation They do all sorts of terrible things to them.)
Iāve been rallying doctors and pharmacists (they showed up pre-rallied for a fight) and CEOs onto the side of diabetics for PBM reform (for about a year) because thereās only 1 million T1Dās in the country and we needed more fight to move policy. Those guys are hiding in the tall grass everywhere, ready to fight on our behalf (patients). They are doing stuff like we used to do - they are searching for software solutions to launch attacks against the system (like we did with open source AID systems). The government agrees with us.
I donāt want patient perspective and interests to get left out because the others are showing up in great numbers. Patients are the primary stakeholders who the government is trying to help. I canāt do this all on my own. Iām used to receiving a bunch of feedback from my community. Itās possible I have reached a point where no one knows what the heck Iām talking about. That makes me nervous because I trust and rely on the judgement of you all. You all have always provided me with input on policy initiatives. Donāt leave me out here fighting on my own. I wonāt do as well as if I have you all helping. I know that I am deep in the weeds and it is difficult. But you all come up with some genius ideas and perspectives with regularity, so I gotta keep you in the loop. Itās your future on the line. This is a giant gunfight for our economic freedom.
I try to keep the government honest. You keep me honest.
If @CatLady permits, or perhaps if anybody requests it, I can upload my previous public comment to DOJ. Itās a lot of reading, so you might not be interested. Itās the reason they put a 18 page limit on this round of comments. But the government will try to make rules that address as many of those patient concerns about the market as possible.
Policy stuff is simultaneously extremely boring/slow, and very exciting.
Unfortunately it does tend to go pretty far over my head. 
Maybe if you could explain it like Iām ten years old? Which I know is incredibly hard with issues that are so complex, with lots of background info and contextā¦
Hereās a link to me trying to explain to the DOJ how monopoly power affects me as a diabetic. Link to DOJ paper v10 for download
I think the pharmacists explain it best. Even they take forever to explain it in their video explanation. United Health Group threatened to sue when they released this explanation, but itās very good. It took YEARS to explain this to Congress because its so complicated. They built it that way on purpose. Itās built to confuse everyone. No one explains it in less that 100 pages.
Episode 1. https://www.youtube.com/watch?v=k0bcWlI4ht4
Episode 2. https://www.youtube.com/watch?v=oil1ifvg6z8
You see employers starting to sue under RICO - thatās conspiracy, which this was - conspiracy to fix markets. O'Reilly Automotive sues insulin producers, prescription managers
FTC wrote two reports on this topic. Hereās a link to the 2nd: FTC Releases Second Interim Staff Report on Prescription Drug Middlemen | Federal Trade Commission
FTCās job is to make laws that ensure free markets in the U.S.
DOJ helps enforcement of those rules.
But Congress started taking money. In return for that $ they allowed (and encouraged) giant healthcare monopolies to develop.
Monopolies do worse than limit your financial freedom. They prevent innovation in the markets. They remove the civil liberties of citizens.
I think a really good example of this is how they limit fundamental liberties, like free speech. They were able to have the pharmacists documentary removed from the internet because of their market power. UHG forces takedown of docuseries criticizing PBMs | NCPA They would conduct malicious audits of small pharmacies who spoke up about those practices.
They were able to snap their fingers and remove a doctor from the market because she spoke out. They removed her access to the market and essentially took away her clinical practice (her property). Fundraiser by Elisabeth Potter : Stand with a Surgeon Facing Retaliation But what they did to patients was worst of all.
UHG own shareholders sue them: https://www.youtube.com/watch?v=9jLvJFvdVaU&list=PLUQ9-A6uTgNQAKV-QLLjcneKQcGw_L75S&index=36
Iām trying to put something on paper. Trying. Hereās me brainstorming with the others:
Me to them:
How do we make a rule so that somebody does some jailtime? FTC is kinda academic. They write papers. But DOJ seems peeps who will cuff people and throw them in jail. DOJ deals in criminal law, right? Whereās retired pharmacist Gary Bohler? He & I arenāt connected. I havenāt been talking to the pharmacists so much lately and they get knocked out of my feed. Gary wants to throw some people in jail. But how? I ask for ācriminal penalties?ā
The problem is the magnitude of harm is just so great that however you slice it, it ends up like Purdue and thereās no deterrent effect.
From me, personally, they might have unfairly benefited from a free $15,000 a year for the last 15 years. I donāt know. Add State & Fed damages. Itās incalculable. Itās a lot of $. The IRS would throw people in jail over far less.
Maybe they owe me $225,000. They owe me a house. Thereās 1M T1Ds in the US. 225,000 x 1M. But my pain and sufferingā¦well beyond that. What is justice or what sort of penalty would prevent them from doing it again? For example, I think I caught some criminals last week, but think I I caught the same ones 8 years and they just came right back again. The police say thatās impossible, but I recognize them.
(If you donāt know what happened with Purdue, you can watch something like this on HBO: The Crime Of The Century: A Gripping Two-Part HBO Documentary | The Sober Curator)
RULE #1.) I propose that we construct an extremely complicated algorithmā¦something that takes a team a week to figure out, after a full-bore effort - we obfuscate the ā ā ā ā out it. But it boils down to just us honestly estimating the total damages. Whatever they donāt pay in fines, gets entered into this equation:
(total damages - paid fines)/(annual salary of CEO) = J, where J = The years and months (donāt drop the remainder) of jailtime SOMEBODY in the company has to do.
You are allowed to distribute J years across multiple people, but we should tip the scale somehow so that the people at the top are more likely to do jailtime. Let J = 50. Then, the top 50 positions at the company each do a year in jail, (unless they squeal & shower DOJ in proprietary documents, then they get less jailtime).
The gov thinks Iām gonna write them another 50 pp, but I might just write 1p. Rule 2 is hard because itās abstract & agencies want clear rules. But we canāt write things like, āban spread pricing,ā because its industry specific. One characteristic of monopoly power is that it infringes on the personal liberties of people who do business with it.
EX1. When insurers punitively used market leverage to kick Porterās practice out of (network) & effectively bar ANY participation, that crossed a line into removing her and her inalienable rights, not just market access.
EX2. When the insurer/pharmacy/doc software or software processes donāt allow me to purchase a life preserving medication, thatās a threat to my life and limb and thus crosses a line.
Ex3. When I use a piece of hardware to collect my personal medical data and that data is subsequently locked up inside a piece of software, I am told I no longer own it. Thatās a violation of my civil liberties because that data belongs to me. They are separating me from my personal property.
RULE #2.) If a company makes significant (Let Congress or the Judiciary say what āsignificantā means) intrusion into the civil liberties of individuals, then it gets broken up.
Them basically providing moral support to me trying to figure this out:
You are catching on wonderfully!! The 4th Amendment says much about property, because we exercise our freedom by putting material objects to use. Ideas we carry around in our brains, only become meaningful when they guide our actions. A theory about how to cure a disease, only matters if people use it to create the cure.
They tell me not to worry about submitting anything fast. They say the surgeons will submit something fast because they are trained to be fast. They say Iām supposed to just be thoughtful and look at the details.
I want to reiterate @RachelMaraiiās comment. To get engagement, it has to be simplified. 1 or 2 sentences describing the problem. 1 or 2 sentences explaining why the problem exists. And then 1 or 2 sentences describing a solution.
I clicked on the first 2 youtube videos you posted above. The first one was an hour and fifty minutes. The second one was about 1 1/2 hours.
Iād like to be aware of the problem, but I canāt watch videos like that.
Think of Schoolhouse Rock. A short 3 minute animated video like āIām Just a Billā.
I think something like that would go a long way in helping people understand it and getting them involved.
I have to agree with @Eric! I want to be informed and involved, but the videos posted, at least to me, say the same thing over and over and over rather than spitting it out and proposing solutions. I get it PBMs, as currently existing, sound good but the intent has been perverted by a focus on profit vice peopleā¦if you will, theyāve turned to the ādark side.ā My take: the videos and proponents need to point out the problem(s), propose a solution, and be done. It may take a bit more than @Ericās 1-2 sentences, but it canāt take much more; peopleās interest will waneā¦and thatās if people agree with topic or proposed solution to begin with.
First, letās recognize this is bigger than diabetes, itās the entire medical system in the US (perhaps other parts of the world). Only a fraction of the issue falls within FUDās diabetic realm. As such, it runs the risk of becoming very political, vice diabetes centric, and we here on FUD need to remain focused on FUDs diabetes related interests (yes, we occasionally stray to cats, dogs, bikes, roadsters, family, friends, etc.). Second, you/we have to decide what you/we want: correction of the problematic law(s)ā¦in our case diabetes supplies and treatmentsā¦or we can try to hold people accountable, not both. Reparations and accountability for the past wonāt fix our T1, T2, or Tx issues; only fixing or passing new law will improve our access to diabetes supplies and treatment or eliminate the need for for them. One fixes a problem long term for everybody; the other gets a relative few people some benefit and satisfaction, leaving the task of resolving the cause for others.
That said, yes itās an issue, yes it needs resolution, no I donāt have a solution, no I donāt think I understand the system well enough to develop one. Itās a worthy cause for many more reasons than diabetes and something one could spend a lifetime working on.
No one has a solution, not even the government. Thatās a problem for us.
The government knows it screwed up. It knows that it lacks important understanding about how the healthcare markets operate.
DOJ started hiring healthcare workers about a year ago. They formed a team of āexpertsā who can help them unravel this mess and do better enforcement. DOJ has been really ineffective in the past at stopping bad behavior.
Me writing to a guy about that āteam of expertsā effort:
āI think that the āBig in the worksā is called the DOJ-HHS False Claims Act Working Group (Working Group). It was announced July, 2025.
https://www.kirkland.com/publications/kirkland-alert/2025/07/doj-and-hhs-announce-new-working-group I canāt find the conference proceedings online for the, ākeynote remarks delivered at ACIās 13th Annual Advanced Forum on False Claims and Qui Tam Enforcement, Deputy Assistant Attorney General Brenna Jenny discussed the fiscal year 2025 False Claims Act statistics and US Department of Justice enforcement priorities for 2026,ā but there is a summary here: https://www.morganlewis.com/pubs/2026/01/commercial-litigation-branch-head-outlines-doj-enforcement-priorities-reinforces-c2a-dismissal-authorityā
āperverted by profitā - This is a problem that people cite a lot. Specifically, we have CEOs at large healthcare companies who are LEGALLY beholden to shareholders and the price of stocks. Their legally defined mission is to propel stock price, patients be damned. Nobody really has a strategy for how to deal with that.
A weird thing that happened with United Health Group is the stockholders sued the company because they felt that the company was drumming up so much ill will in the American public that it was destroying the company. That doesnāt happen very often. https://www.reuters.com/sustainability/boards-policy-regulation/unitedhealth-sued-by-shareholders-over-its-reaction-backlash-executives-killing-2025-05-07/
No one can explain the problem in a sentence. Itās a system engineering problem. Everyone complains about this. This is part of why it took 18 years to get a legal judgement. Everyone contributes what he/she is able or interested in contributing to detailed policy discussion. The guys at Tu started talking about this with me ten years ago. I didnāt understand. People who are interested will look at the details. But you have to be interested, otherwise its too much work.
They build complexity into the system on purpose because it makes problems harder for regulators and the public to solve. Itās an effective strategy. Thatās what most people say, anyway. I kinda feel like complexity is a natural side effect of incompetence and not being obligated to compete or solve problems. I think itās half a side effect from monopolization in the markets. We see systems devolve into increasingly complex and nonsensical systems in software a lot. We also see that happen in the law.
Frequently, companies hire software developers without any formal education about HOW to build complex systems because itās cheaper upfront. They build a garbage system that canāt be maintained. That benefits them because no one can maintain or operate the system over time, as complexity naturally increases. Those software devs can never be replaced. I donāt like that. Thatās what people do when they have no professional integrity. It makes systems extremely expensive and impossible to repair in the long run.
Those failures impact me as a diabetic because complex system fail in unexpected ways. 
I go to pick up an RX and thereās some software bug that I canāt see or combat. Failure is suddenly built into the system. It represents an insurmountable barrier (or it takes 30 hours to get around). If there was competition in the market, maybe someone would be able to introduce a better solution. I write a lot about that in my DOJ complaint. Unfortunately, the government has come back and said, āWe recognize those problems exist. How do we fix that?ā Thatās a hard question.
We did have legislation and regulatory action go thru recently. Leg was included in the appropriations bill. Appropriations bills are primarily for financing things and are therefore not intended to fix widespread problems in the markets. Thatās really FTCās responsibility. The government kinda forced legislation through via the appropriations bill because all of our legislative members are all taking money from insurers and are thus not incentivized to act.
That being said, there is further legislation proposed to break up the companies now that the regulatory agencies have formally declared monopoly power. Congress acted. A day later, FTC acted. They are working in unison. A lot of work needs to happen through the regulatory agencies. The agencies whoās responsibility that is, is FTC and DOJ. But Department of Commerce is now getting involved. They are seeking comment from companies who are getting price gouged on health insurance premiums. See how the government all agrees that we have a terrible problem? But they work together as a system to try and fix it.
Thereās additional work that has had to happen to control large, multinational companies called GPOās. GPOs are Group Purchasing Organizations that supply drugs to the U.S. As soon as the U.S. would start to regulate, those companies fled overseas where we couldnāt reach them. The Feds had to handle that. How did they handle that? They used tariffs to strong arm them and penalize the companies financially. That worked, but it was creative & unconventional. We donāt totally know if those tariffs will hold, long term.
Iām mostly just asking broadly about the patient experience of living under a monopoly power and asking what that is like for people in order to propose ways of fixing it.
One diabetic said, āI sold my home to afford insulin.ā
A doctors said, āWhen UHG got hacked and the software went down, I couldnāt receive payment for the practice of medicine anymore. I couldnāt pay my bills or my employees. UHG came and offered to loan me money, under the promise that we wouldnāt be asked to repay that money until systems were functional and business was stabilized again.ā Then, UHG wanted the money back immediately and they wanted interest. UHG broke the system, loaned doctors money to get by (via the bank that UHG owns), acted in a predatory manner by recalling those loans before business was stabilized, and then benefited financially from those loans and breaking the system in the first place.
So, then I go off and I think about how to communicate with the government about the real world experience of living under monopoly power.
One diabetic said, āMy insurer (Cigna) says that I can ONLY use the pharmacies that they own (CVS). But I have to either drive an hour to reach a CVS locations, or I have to participate in their mail order pharmacy. I am afraid that the insulin will not be safe if I get it thru the mail.ā You have to know, in the background, that the insurer and the pharmacy are the same company. Thatās what makes it a concern about market control.
One guy said recently, āI live in Georgia. My friend who works for the state says she pays 40K per year for her premium and all her supplies for her pump and everything.ā He said, āI have better things to spend 40K on, so I just donāt use tech or insurance. I pay out of pocket for insulin and syringes.ā He traveled down to some impoverished south American country and saw that the insulin was free there. He didnāt understand or care about the details related to PBM reform, but he knew he was being ripped off. So, he decided to leave the U.S. That made me feel real bad because he had decided there was no place for someone like him in America.
The lawsuits are beginning by employers. https://insurancenewsnet.com/innarticle/lawsuit-accuses-cigna-pbm-of-demanding-kickbacks-from-drug-maker
I still donāt know all the ins and outs of how insurance plays with all the pieces of thisā¦ but insurance (and the money we give them) has been a massive influence in the direction of my familyās life.
When my dad got laid off as our primary income, with two of three kids with T1D, we were forced onto COBRA. I didnāt even realize how much money that meant, especially while we were living on my momās income as a part-time school lunch worker. My dad found a new job after a couple months and was our primary income again. Shortly after, my mom got a full time public sector job primarily for the benefits and stability. She wasnāt taking home much money, but was earning more than her take home in insurance benefits.
I stayed on my momās insurance until the day I turned 26. I was an emotional wreck in the months leading up to that birthday. I just kept spiraling on the anxiety that if I lost coverage for a single day, I might become uninsurable. (I realize now how lucky I am that the ACA allowed me those extra years.)
I had graduated from college, went into a job I had loved related to my degree. But it was a small company without benefits besides leave. When I told them I needed insurance, they offered me a $50/month stipend to help purchase a planā¦ I knew that wouldnāt cover anything with my prescriptions, so I also moved to the public sector for the benefits. Luckily I love my job now. The insurance is fine. Express Scripts is our PBM.
I also got married when I did because my husband was going to turn 26. I had the better insurance, so it just made sense.
I donāt know if people who donāt have chronic illnesses worry about any insurance stuff quite this muchā¦
Weāre all lucky that it requires insurance companies to cover those like us with pre-existing conditions.
Nearly 70 years ago my adult cousin had a kidney removed. Blue Cross/Blue Shield covered the operation and promptly cancelled her coverage. That was the seed planted in my young mind that blossomed into strong distrust on insurance companies.
Absolutely unconscionableā¦ I remember when my mom told me about lifetime benefit caps before the ACA too. Just horrendous.
And yet, itās still that way with so much insurance. My coworkerās house got hit by a drunk driver, and the home insurance company paid for the claim, and then immediately dropped them. My husband is $10k into periodontal surgery, and our dental insurance has generously covered $200 of it. 
Insurance stinks.
I would argue that this represents a civil rights issue for diabetics because you are profoundly limited in your freedom to participate in the economy - it limits where you can live and whom you can work for. Thatās a big deal.
P.S. Some diabetic somewhere convinced Scott to write to me. Thanks a bunch! It helps. Scott is one of our antitrust experts on PBM reform from Tu. Heās not been around for some years now. Scott S (@sstrumello1): "FYI, the FTC posted the aforementioned settlement agreement which closes on March 16. Use the text I proposed previously. Search http://regulations.gov using āExpress Scripts, Inc., et al.; Analysis of Agreement Containing Consent Order To Aid Public Commentā and leave your commā¦"
I think I write something like thisā¦Iām just brainstorming hereā¦
Unrestricted market power that results in monopoly prompts the market to disregard all stakeholder interests, other than that of the monopoly power. This dynamic inevitably results in infringement/complete loss of civil rights by every market stakeholder (other than the monopoly). I document recent, practical examples of that infringement, from a patient perspective, in my submission to DOJ (https://www.regulations.gov/comment/ATR-2025-0001-0141). It is, āThe mission of the Department of Justice is to uphold the rule of law, to keep our country safe, and to protect civil rights.ā I believe that the documented examples constitute insurmountable barriers to my, ālife, liberty, and pursuit of happiness,ā for which DOJ is obligated to respond. The more severe the infringement on civil liberties is, the more obligation our federal agencies have to respond. I believe it would be difficult to find an example in the U.S. markets where the magnitude of civil rights infringements has been greater. That is likely a direct result of the magnitude of market monopolization that we experience. I ask that when civil rights and civil liberties are being disregarded in the markets, that federal agencies respond.
In an effort to be thorough, letās document several additional examples of how markets exercise inordinate control over citizenās enumerated and unenumerated rights.
Example 1.) The medical markets behave in a manner that might be reasonably described as āfalse imprisonment,ā as a side effect of inordinate physical and financial power over patients.
I spoke with a diabetic who was transported to the hospital after an emergency event called āhypoglycemia,ā commonly known as ālow blood sugar.ā Hypoglycemia can result in a patient loosing consciousness. It is a common emergency medical event encountered by the medical system. An EMT responds by providing a snack to the patient if they are conscious. If a patient is unconscious, medics provide intravenous administration of glucose. Patient condition improves within 15 minutes. Perhaps, in a severe event or when they receive less effective treatment, the patient may not be fully oriented to their surroundings and fully āconsciousā and capable of decision making for an hour. In the majority of cases, the cost of treatment is the cost of a candy bar and does not require hospital transport.
I spoke with a diabetic who was hospitalized for hypoglycemia. It was a severe event that resulted in her losing consciousness. By the time she reached the hospital she was fully oriented and capable of legal decision making, due to the medics administering IV glucose during transport. Her medical staff performed a blood glucose test that costs $0.50 indicating such (blood glucose = 100). She asked to be discharged and was refused. She was refused discharge for and was kept in hospital for 5 days. During this time, she was desperate to be released because she was aware of how expensive her hospital stay was. She was told that if she left the hospital against medical orders, the insurer would not cover any of the associated costs of transport and treatment. In this way, the market exercised insurmountable financial leverage over her, such that her civil right to refuse further medical treatment was effectively extinguished. The only option effectively afforded her was to accept her āfalse imprisonmentā in the hospital.
During this time in the hospital, her blood glucose increased to a value of 250, then 300, then 350. She began to get sick. She was unable to eat. She became prone to infection. Why? Because the insurers penalize the hospital financially if a patient experiences a blood glucose value less than 70. The hospital responds by NOT acting in the interest of the patient, but in the interest of the insurer. The impact of monopoly power now drifts from purely financial leverage into physical leverage.
blah, blah, blahā¦
Follow up with an example of doctors rights being limited.
Iām sorry but youāre too deep in the weeds.
A couple of points for starters.
FTC is a rule-maker, not a law-maker. They can only create rules that show companies how to be in compliance with the laws passed by Congress.
DOJ has US Attorneys that can bring civil/criminal indictments where the laws passed by Congress have been violated.
The āeasiest fixā for the healthcare system in the US is to scrap it and move to universal healthcare available to every person in America. Unfortunately, there is currently ZERO chance of that happening.
That leaves us, especially PWDs and others with chronic conditions to essentially nibble at the edges and fix ālittleā things. Donāt get me wrong, we have to do the advocacy, and I wholeheartedly do the work, but we wonāt get massive changes.
Just to make you not feel depressed @yogao , hereās some recent wins & loses:
WINS:
Congress just made a move. This is the government moving at rocket speed. Small efforts take 5 years. Large efforts take 20. How this will work, in reality, is that it requires action from every major player within gov.
We had action out of Congress via the Appropriations Bill (see Rep Buddy Carterās work). FTC has settled with 2 out of the 3 large PBMs. The executive branch acted on the GPOs (people are currently fighting on if they can bring that action down). GPOs are the large multinational companies exercising control over drug pricing.
Congress is probably going to be the actor to break up the companies, should we chose to do that. There is a bipartisan bill called Break up Medical Monopolies Act. U.S. Senator Elizabeth Warren | Warren, Hawley Introduce ...
Department of Labor is on the move. https://www.statnews.com/2026/01/30/pbm-drug-rebate-transparency-proposed-rule-department-of-labor/
We setup drug manufacturing plants as leverage. That took less than 10 years. Thatās fast. They purchased a facility and might be up and running. That was really a joint effort between government, diabetics, and doctors at the Mayo.
FTC and DOJ seek public feedback.
DOJ has a new branch of enforcement that is specifically designed for enforcement efforts in healthcare. Justice Departmentās antitrust division forms task force on health care monopolies and collusion
This took 18 years to bring about. This is a drug costs fight, not a fix the entire healthcare system fight (although that is certainly in the back of our minds and we are working that direction). We havenāt gotten around to that yet. Itās no small achievement to provoke the entire government into hunting the PBMs. Of course, the other side has had big wins too. Their wins are our loses.
LOSES:
The judiciary has been a flop. They overturned Chevron doctrine. That weakens agency power across the board. We have done a lot of work thru the agencies, so that is bad for us.
They recently revoked FTCās ability to do anything about mergers. https://www.beckershospitalreview.com/legal-regulatory-issues/federal-judge-vacates-ftc-premerger-rule-5-things-to-know/ Maybe that responsibility falls back on the states who lack the resources, historically, to handle it. Every state is different. Some are bulking up their antitrust capabilities, but some only employ only antitrust lawyers. Thatās not helpful at all.
The large medical monopolies just keep expanding. Cigna acquires CarepathRx, a major pharmacy used by hospitals | STAT
