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 6
Example #3. Dexcom, Abbott Labs, Medtronic, UHG, and EPIC –
performance, decision making, and data ownership influence real
value and innovation in modern markets………………………………………..……. page 6
Previous Rules ………………………………………………………………………… page 11
System Complexity……………………………………………………………………. page 11
Market Remedies & Rulemaking …………………………………………………… page 13
Medical negligence…………………………………………………………………… page
Example #4. I attempt to get prescriptions written in early 2026 ……………..…. page
References ……………………………………………………………………………. page 15-17
Appendix A. Previous submission to DOJ – Docket No. ATR-2025-0001-0141 (https://www.regulations.gov/comment/ATR-2025-0001-0141)
Appendix B. Medical Device Security & Diabetes
Appendix C. The documentation that I produce to obtain an insulin prescription
Civil Liberties
My civil liberties are being violated. The magnitude of those violations is directly related to 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 on American soil with the support of Congress, the Judiciary, and regulatory agencies. (Figure 1) Can we perform rulemaking that requires DOJ and/or FTC to keep record of civil rights violations and address those 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. Beyond that, and the monopoly’s propensity to financially extort citizens and taxpayers, the market’s ability to provide patient care (it’s primary service) might regularly be described as ‘incompetent’ or ‘medically negligent’ in a manner that puts patients at risk of loss of life or limb. The magnitude of incompetence and neglect of their professional responsibilities and duty to provide care is so great as to negate the entire reason for the industry’s existence. It so often constructs artificial barriers to care that the system itself might be imagined as the primary disease or source of disability in our economy. That disease can be cured. Americans must not be disabled by it.
Figure 1. My Grandmother
Unrestricted market power by a monopoly prompts the market to disregard all stakeholder interests, other than its own. This dynamic inevitably results in infringement and the eventual 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 submission to DOJ under Docket No. ATR-2025-0001-0141. It is Appendix A.
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 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 (IV) 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 incapable 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 loss of consciousness. By the time she reached the hospital she was fully oriented to her surroundings and capable of legal decision making, due to her medic’s administration of IV glucose during ambulance transport.
Her medical staff performed a blood glucose test (at an equipment cost of $0.50) after IV treatment 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 ambulance 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 market 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 retaliatory 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 because it forces a trade in the currency of Dr Porter’s democratic freedoms. [1] 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, to subjugate 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 offered 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 my personal medical data also own it?
I didn’t invent the machine that collects my blood glucose data. As a result, do I have rights associated with 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? In both cases the right to the data has been purchased in some sense, but in the first case I have an undisputable natural right to the data my body produced and to perform decision making based on that data because I am the only person who bears risk associated with any treatment.
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 and what types of questions can be asked. 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. [2] They built Tidepool and other information systems used for data analysis. [3] 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, DIYPS, XDrip, and Loop APS. [4, 5, 6, 7]
Loop APS 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 participation from the stakeholders most invested in improving patient care. [8] For a history of diabetics leading industry innovation see the attached Appendix B. [9, 10]
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. (figures 4 and 5) Both Abbott and Medtronic locked patient data up inside a proprietary software system, restricting patient options for analysis and investigation of their own personal medical data.
MDT & the Siphoning effect study.
Figure 3. Abbott threatens lawsuit against patients for trying to access their own personal medical data via their own personal medical devices [11]
Figure 4. United Health Group prevents coverage for any insulin pumps other than those produced by Medtronic [12, 13]
Figure 5. UHG 2019 statement regarding insurance restriction to only Medtronic insulin pumps [14]
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.
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 capability 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. Figure 6 shows that it took Epic until 2025 to choose to facilitate a doctor’s ability to access and analyze diabetic patient data collected by their personal medical devices. [15] Does Epic have less technical capability than patients?
Figure 6. Abbott integrates data into Epic HER [15]
This discussion is meant to highlight how easily my right to access my own personal medical data can be removed. It highlights how Americans innovation triumphed in spite of the markets, not because of them. 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, “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. Early models of Medtronic insulin pumps had no encryption. It calls their competence into question, but that lack of competence opened doors for patients to innovate around the market. 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 could 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? 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” [16] 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. [17] This catastrophic failure in critical infrastructure was attributed to the UHG’s failure to secure a server. That’s the type of mistake that a baby makes. Do we expect our large American corporate entities 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 system behavior depends. They may not be able to perform good prediction of how the data will behave. Some systems, like blood glucose dynamics, exhibit behavior in between ‘predictable’ and ‘chaotic’. We call them “complex systems.”
In software engineering, software system complexity is rarely the result of modeling a system that is inherently unpredictable. Software system complexity is most often the result of poor engineering. When software systems are poorly maintained, not built to serve 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. Similar problems are exhibited by our U.S. healthcare system. Brittle systems require stakeholders to dedicate enormous amounts of unpaid time and resources to supporting the system because, left to its own devices, it fails immediately. Systems like these are inherently nonfunctional.
Software is a relatively new industry. It does not have long-standing first principles or standards the way that the field of medicine or physics does. It is described as, “The Wild West,” of the industries. A common strategy implemented by software developers is to build something so poorly that no one can understand it other than them. That makes a company dependent on the specific individuals who built the software. They can never be replaced because the systems they build are so irrational and nonsensical that they are the only ones who have any idea how the software operates or why it is failing. The more it fails, the more a company depends on them to troubleshoot it when it fails. It fails often. Building a system as poorly as possible is one of the most common strategies to make yourself irreplaceable. The government shouldn’t tolerate that.
This happened once with the State of Minnesota’s DMV software system, called MNLARS. [18] The system became so aged and complex that no one could write down the rules that governed it. The people who knew the rules had died years ago. But the misery inflicted by that software system lived on. Elderly women were being arrested at gunpoint because titles didn’t transfer. Companies hired to rebuild the system quit left and right. Members of the legislature referred to any attempt to fix the problem as, “the goat rodeo.”
It was all made worse by the fact that outdated software requirements were sometimes based on outdated laws that made no sense in a modern context. To change the software requirements, you had to change the law. I, personally, couldn’t keep a driver’s license valid to save my life because the paperwork allowing diabetics to drive cars required paperwork to flow through BOTH Drivers & Vehicle Services (DVS) software systems AND the medical system (two of the most failure prone systems that anyone might ever hope to encounter). It took me 5 years to remove one outdated law so that I could reliably maintain my driver’s license as a diabetic and participate in the economy. (figure 7)
Figure 7. Changing outdated laws as a mechanism for changing outdated software systems
The People no longer controlled the software system. The software system controlled The People. The burden of industry incompetence falls on ordinary people to remedy. No one knew how to rebuild it. Brittle systems are difficult and expensive to change. Any little change that you make intentionally, unintentionally breaks large portions of unrelated functionality. That’s the cost of poor engineering. Change is inevitable. Systems that are well engineered allow for change – changes in law, changes in desired functionality, and changes in technology. Society should not seize up around poorly designed software. That is absurd.
Previous Rules
Reading the previous rules outlined in the 2020, “Antitrust Guidelines for Collaborations Among Competitors,” made me feel patronized and unrepresented as an American. They gave an impression that the agencies were ‘out of touch,’ and unable to grasp the depth of market realities for citizens.
In 1999, I was 17 years old and a trained EMT. My friends and I used to prank call the local hospitals making hysterical statements to the operator like, “My friend has a broken leg! I want to bring him into the ER, but I need to know how much money to bring.” Knowing that they could give no answer, one of us would scream in agony in the background while the operator panicked and they struggled to come up with an estimate. The more they panicked, the harder we laughed. While our actions may have been dark and juvenile, they reveal that even children understood that the markets were broken. Today, I think that understanding is deeply embedded in American culture and requires remedy because it teeters on provoking violence.
Americans have always been inclined to hate powerful systems that exercise undo control over them. It’s a foundational cultural trait that traces back to the country’s birth. The rules, as previously written, read like an answer to an assignment created for the nephew of someone at the agency, if that nephew were a graduate student with a C-average who needed his uncle to help him pad his resume. Delete and rewrite all that ■■■■ according to real world hardship of Americans who have been living under monopoly power for the last 25 years. Do so with recognition of the bankruptcies, loss of life and limb, loss of civil liberties, loss of hope, and loss of progress that has been inflicted on our society.
Market Remedies & Rulemaking
For non-industry specific rulemaking, I urge regulators to return to first principals. Recognition that profound violations of civil liberties propagate in a market dominated by monopolization is important. Individuals have very little power to protect their own liberties by suing the largest companies in the nation, like a large insurance company or hospital. They have even less ability to challenge them when those same companies are taking 120% of an individual’s earned income and providing no service in return. System complexity impedes a court’s ability to understand problems and constrains their ability to protect civil liberties.
That complexity is a result of market failure. System complexity increases the amount of public resources and money required to handle the problems that develop until eventually they are too much for even state governments to handle. [18] It begs the question, is there a practical limit on the amount of public resources that one industry should be allowed to subsume? If Congress can’t handle the complexity, or is itself financially disincentivized to do so, the financial wellbeing of the entire country is in jeopardy.
When the combined public resources of many states combined cannot break free, then the market has seized up around the interests of only one stakeholder. We ought to continually see a reflection of those problems when they manifest as practical problems in the day-to-day lives of citizens. For me, someone who has always loved medicine, I want nothing more than to be free of its control. But I can’t even get a job in a different industry because the only industry that is currently hiring (forever marching to its own, uniquely disfigured drum) is healthcare. [19] Go figure. It’s not a coincidence. Healthcare has eaten the country like a ravenous pig, snorting up disproportionate resources and wealth from every business in the country, as giant monopolies apparently do.
Antitrust rulemaking ought to respond proportionately to the practical problems that Americans have experienced in a modern context. Once unfair market practices have been proven to exist at a large scale by federal agencies, either Congress or the agencies ought to be tasked with the responsibility of breaking those companies up to restore the economic freedom and civil liberties of its citizens. Without effective government intervention, the markets are handicapped and the monopolies just continue to expand and cripple the economy. [20] Financial penalties must be greater than, or equal to, the financial benefits of breaking the law. As capitalist economies have learned time and time again, companies can make more money by bringing legitimate value as opposed to simple market fixing. [21] Companies may sometimes need to be forcibly reintroduced to that business paradigm.
Where criminal conspiracy is suspected, it should be prosecuted. It should result in jailtime. Penalties should flow to the decision makers who benefited from installing instances of market corruption in the first place. Effective deterrence has not been demonstrated by DOJ in the past. Ineffective deterrence only promotes bad behavior and a brittle economy.
If insurers interfere in the practice of medicine, then they must simultaneously accept liability to balance market interests. One-sided markets where insurers exercise undo stakeholder power over decision making in patient care, but doctors and patients bear all the risk does not represent a free market and real value being added to the economy. It promotes the building of increasingly complex financial tools to benefit the insurers. We saw how this type of problem played out in 2008 when bankers and Wall Street did something similar.
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.
