I’m starting to write today.
I’m going full blown, take no prisoners, "civil liberties” on this issue….
TABLE OF CONTENTS
Civil Liberties …………………………………………………………….. page 2
Example #1. The medical markets exercise ‘false imprisonment,” as a side effect of inordinate physical and financial power over patients …………..…………….………. page 3
Example #2. The medical markets exercise their ability to restrict freedom of speech and seize physician property …………………………………………………………….. page 5
Ownership & Innovation …………………………………..…………… page ___
Example #3. Dexcom, Abbott Labs, Medtronic, UHG, and EPIC – performance, decision making, and data ownership influence real value and innovation in modern markets
Market Remedies & Rulemaking ………………………………………………
Civil Liberties
My civil liberties are being violated. The magnitude of those violations is a direct result of the magnitude of monopolization in the market. My Grandmother didn’t fight as a nurse in the Pacific so that my civil rights could be subjugated with the support of Congress, the Judiciary, and regulatory agencies on American soil. (Figure 1) Can we perform rulemaking that requires DOJ and/or FTC to keep record of civil rights violations and address them via market remedies? It is my position that by the time an instance of market monopolization lands on the desk of the DOJ and/or FTC, civil rights abuses to citizens are profound and endemic in the market.
Figure 1. My Grandmother
Unrestricted market power by a monopoly prompts the market to disregard all stakeholder interests, other than that of the monopoly power. This dynamic inevitably results in infringement and eventually the complete loss of civil rights by every market stakeholder other than the monopoly. I document recent, practical examples of HOW that infringement takes place, from a patient perspective, in my previous detailed submission to DOJ under Docket No. ATR-2025-0001 (https://www.regulations.gov/comment/ATR-2025-0001-0141).
It is, “The mission of the Department of Justice is to uphold the rule of law, to keep our country safe, and to protect civil rights.” I believe that the previously documented examples for DOJ constitute insurmountable barriers to, “life, liberty, and pursuit of happiness,” 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.
The more severe the infringement on civil liberties is, the greater the magnitude of market monopolization can be inferred to exist. 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 than in the case of the medical monopolies. I ask that when civil rights and civil liberties are being impeded in the markets, federal agencies respond in a powerful and decisive way. Let’s extend our previously documented examples to show, in a concrete way, how markets exercise inordinate control over citizen’s enumerated and unenumerated rights.
Example #1. The medical markets behave in a manner that might be reasonably described as ‘false imprisonment,” 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 “hypoglycemia,” commonly known as ‘low blood sugar.’ Hypoglycemia can result in a patient losing consciousness. It is a common medical emergency encountered by the medical system.
An EMT responds to this circumstance by providing a snack to the patient, if they are conscious. If a patient is unconscious, medics provide intravenous 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 for up to an hour. Until then, they might not be fully ‘conscious’ and capable of legal decision making. In many 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 medic’s administration of IV glucose during transport.
Her medical staff performed a blood glucose test after IV treatment that costs $0.50 and indicates that she was capable of legal decision making (blood glucose = 100) within 30 minutes. EMT’s and paramedics will typically perform another practical test to evaluate a patient’s level of consciousness and their capability to perform conscious decision-making. To do this, they ask the patient three open ended questions and determine if the patient can verbalize: 1.) Who she is; 2.) Where she is, and 3.) What time of day it is. If a patient can answer all three questions, she is determined to be, “Alert and Oriented to Person, Place, and Time (AOx3).” This patient was AOx3, meaning capable of making legal decisions within 30 minutes.
The patient asked to be discharged and was refused. She was kept in hospital for 5 days. During this time, she was desperate to be released because she knew 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. That cost amounted to many thousands of dollars.
In this way, the market exercised insurmountable financial leverage over her, such that her civil liberty to refuse further medical treatment was effectively extinguished. The only option effectively afforded her was to accept ‘false imprisonment’ in the hospital. When we see market practices contradicting centuries of common law and common medical practice, that should raise the attention of our federal agencies because it suggests that very powerful market forces are at play to undermine the interests and legal rights of stakeholders.
Within a day of admission to the hospital, her blood glucose increased to a value of 250, then 300, then 400, where hospital staff chose to maintain it. She got sick. She became weak and nauseated. She vomited. Her physical suffering increased and the hospital refused to administer insulin to bring her blood sugar back into a physiologically normal range of around 100. She became 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 has now drifted from purely financial leverage into physical leverage. It changes the goal of the hospital from patient care and limiting the associated liability of that care, to one where their exclusive interest is to limit their own financial liability with the insurer. Centuries of “Do no harm,” principals and professional standards go out the window under the financial leverage exercised by insurers. This is a situation that I have, myself, encountered in a hospital situation.
The markets power exercised by insurers manifests as a catch-22 for providers and patients that always involves trading in the currency of civil liberties. Patients are forced to choose between financial ruin and even greater financial ruin. The insurers say, “Give me your house in exchange for your life,” or “Give me your house and be in debt for the next decade, in exchange for your life.” A citizen has no choice at all in any practical sense. Those choices aren’t indicative of a free market or free citizens.
Example #2. The medical markets exercise their ability to restrict freedom of speech and seize physician property
Doctor Elizabeth Porter dedicated her life to building a business – a large medical practice. When she chose to discuss the experience of operating that business, the insurers snapped their fingers and kicked her business out of network so that she could not accept insurance payments from patients. Patients lost the ability to see their provider in any practical way because of insurers’ construction of arbitrary and malevolent financial barriers.
Those barriers might be likened to the construction of a physical barrier that prevents a competing railroad from accessing a specific geographic region in the U.S. But it is more nefarious than that because it forces a trade in the currency of Dr Porter’s democratic freedoms. https://www.gofundme.com/f/stand-with-a-surgeon-facing-retaliation Her choice is, “Trade your property (medical practice) and all future earnings from it, for your freedom of speech.” In this way, Americans are continually asked to purchase their democratic liberties (which already belong to them) from the insurers.
In this way, market monopolization enables seizure of BOTH private property AND democratic freedoms. It forces large segments of the U.S. population to live in a separate economy, modeled after that built by Russia. It fundamentally alters citizen participation, innovation, and ownership of property in the modern economy in a manner that is devastatingly destructive for American prosperity.
These examples are meant to illustrate how a market dominated by monopoly power are identical to the power dynamic that the U.S. Constitution was constructed to prevent – the power of a single entity, or king, from subjugating the natural rights of citizens, including the professional rights and responsibilities of medical providers who are beholden to centuries of law based on adherence to their Hippocratic Oath. The insurers offer bank loans to providers as a tool to recover from problems that they themselves created in the Change Healthcare attack. They alone created the terms and the circumstances that necessitated those loans. The insurers are the sole decision makers in the establishment of “Do Not Hire Databases,” where doctors can be exiled from the profession and right to practice for any decision making that conflicts with the insurers will. In a healthy market and free society, alternative routes of decision making are possible. We have lost that.
Ownership & Innovation
“The answers you get, depend on the questions you ask.” – Thomas S Khun
Who owns the data that my body produces? Who has the right to ask questions about that data? Who owns the right to access, interpret, innovate, and act on that data? Does the hardware or software that physically collects that data also own it?
I didn’t invent the machine that collects data on my heart rhythm (an electrocardiogram). As a result, do I have any right to see that data? U.S. taxpayers pay a lot of money to the health insurers and hospital systems. Do taxpayers have any right by association to see or interpret data related to patient care or its financing? We see people answer these questions, and related ones, in a wide variety of ways in U.S. markets.
Figure 2. The realities of data ownership
Access to data enables analysis and informed decision making. Patients have a fundamental right to perform informed decision making when they evaluate risks associated with any treatment. When health insurers or medical device manufacturers restrict data access, they determine what questions can be investigated and the type of analysis can be done. They determine what types of problems can be solved. It’s no surprise then that when data access is limited to one stakeholder in the system, innovation follows the interests of that stakeholder.
Example #3. Dexcom, Abbott Labs, Medtronic, UHG, and EPIC – performance, decision making, and data ownership influence real value and innovation in modern markets
Three companies built Continuous Glucose Monitors (CGMs) to collect patient data on blood glucose. Dexcom was the only company that allowed me full, open patient access to my personal medical data. What resulted was an ecosystem of innovation as patients built tools atop that data.
Patients built Nightscout, a tool to assist parents and caregivers remotely monitor a diabetic’s blood glucose and increase patient safety (https://nightscout.github.io/). They built Tidepool and other information systems used for data analysis (https://www.tidepool.org/). They built the first Automated Pancreas Systems (APS) (Now, commonly known in the commercial market as Automatic Insulin Delivery systems, or “AID” systems). These included openAPS (https://openaps.org/), DIYPS (https://diyps.org), XDrip (xdrip.readthedocs.io/en/latest/#what-is-xdrip), and Loop APS (https://loopkit.github.io/loopdocs/). Loop required some discussion with agencies like FDA because of the scale it was deployed at. FDA permitted development of class III medical devices by patients because it was widely recognized that there would be no innovation in patient care without allowing participation from the stakeholders who were most invested in improving patient care.
What choices did other companies make? Did they choose to add real value into the economy? Abbott chose to sue patients. (figure 3) United Health Group and Medtronic teamed up to market fix. Both Abbott and Medtronic locked patient data up inside proprietary software system, restricting patient options for analysis and investigation of their own personal medical data.
Figure 3. Abbott threatens lawsuit against patients for trying to access their own personal medical data via their own personal medical devices [XX]
Figure 4. United Health Group prevents coverage for any insulin pumps other than those produced by Medtronic [13, 19]
Figure 5. UHG 2019 statement regarding insurance restriction to only Medtronic insulin pumps [12]
When the success of your innovation depends on restricting data access or the civil liberties of other stakeholders, it may not be an innovation at all. It might be a strategy to restrict innovation in the market to provide you with unfair advantage. That damages the prospect of future innovation and free markets. Epic software is the primary Electronic Health Record (EHR) in the U.S. Does Epic win market share through the production of a superior product and use of superior technical capabilities to better serve the interests of stakeholders like patients and physicians? If so, why were diabetic patients able to make their medical devices and information systems interoperable starting in 2013. It took Epic until 2025 to choose to facilitate a doctors’ ability to access and analyze diabetic patient data collected by medical devices. [23] Does Epic have less technical capability than patients?
This discussion is meant to highlight how easily my right to access my own personal medical data can be removed. If a company can build a device as mechanically simple as an insulin pump (basically just an infusion pump with a actuator) and use that device as a mechanism for locking up my ability to access all the data related to my medical treatment, is that an honest trade? Patients have answered, in no small way, “no.” FDA supported that position and bluntly told medical device manufacturers that if they wanted their device data secured, then ought to build secure devices. In hindsight, that might seem obvious, but Medtronic’s first models of insulin pump had no encryption. It calls their competence into question. FDA recognized that the companies tasked with innovation and protecting patient safety were doing the opposite. They were using their leverage to prevent innovation that would otherwise lead directly to increased patient safety.
Does United Health Group (UHG) demonstrate superior technical capability to meet the demands of its stakeholders? Did its acquisition of Change Healthcare facilitate competition and innovation in the healthcare markets? Doctors, patients, and computer security professionals argue that it did not. Dr Eric Bricker discusses his perspective in the 2022 video, “United Health Group Acquisition of Change Healthcare… Healthcare Data Goldmine” https://www.youtube.com/watch?v=be4vrnUu9J4 He raises the idea that the Change Healthcare acquisition represents a physical bottleneck for market data. How is that different than building a physical barrier to prevent a competing railroad from transporting goods? Creation of that bottleneck represents a chokepoint that brought down hospital systems, medical practices, and patient care all over the country by February of 2024. ( https://www.aha.org/system/files/media/file/2025/02/Change-Healthcare-Cyberattack-Underscores-Urgent-Need-to-Strengthen-Cyber-Preparedness.pdf) ( https://www.forbes.com/sites/insights-kyriba/2026/01/12/4-insights-cfos-need-to-master-end-to-end-liquidity-performance/) This failure was attributed to the company’s failure to secure a server. That’s the type of mistake that a baby makes. Do we expect our large corporate entities in America to have more capability, competence, and responsibility than a baby? Maybe not anymore.
System Complexity
Systems exist along a spectrum of complexity. Some systems, like heart rhythms, are fairly predictable and deterministic. Some systems are inherently chaotic. Engineers may not have a good understanding of the underlying variables on which their behavior depends. They may not be able to perform good prediction of how the data will behave. Some systems, like blood glucose dynamics, exist in the middle of those two extremes and we call them “complex systems.”
In software engineering, software system complexity is rarely the result of a systems inherent unpredictability. It is most often the result of poor systems engineering. When software systems are poorly maintained, not structured around the primary goals we hope to achieve, are highly complex and unpredictable, and fail frequently in unpredictable ways, we call them, “brittle systems.” Poorly engineered software systems are ‘brittle,’ and don’t have a long-life expectancy. This is the problem currently facing federal regulators with regard to healthcare.
that require every other stakeholder to dedicate enormous amounts of unpaid time and resources to supporting the system, which left to it’s own devices would be immediately fail because it is inherently nonfunctional. Software engineering example.
Market Remedies & Rulemaking
For non-industry specific rulemaking, I urge regulators to return to first principals. Recognition that profound violations of citizen civil liberties propagate in instances of market monopolization is important. Those violations make action by citizens burdensome and often impossible. System complexity impedes a court’s ability to understand. System complexity increases the enormous amount of public resources and money required to handle the problems that develop. Where a complex, monopolistic system might have previously demanded enormous personal and corporate resources in order to ensure critical business activities occur, the whole system degrades even further when the public resources of every state need to dedicate themselves to the problem. https://www.naag.org/press-releases/state-and-territory-attorneys-general-call-on-congress-to-prohibit-pharmacy-benefit-managers-from-owning-or-operating-pharmacies/ It begs the question, is there a practical limit on the amount of public resources that one industry should be allowed to subsume?
Jailtime
Deterrence
Penalties should flow to the decision makers who benefited from installing market corruption.
Dr Bricker is an amazing communicator. We all keep joking that we need to send him in to talk to the Senate, but that we will need to ship a giant whiteboard with him. He always uses a whiteboard. He has a giant library of videos, so I just needed to spend the time to located the relevant ones for ya.
