“My vision is that every American is wearing a wearable within four years.”
- Secretary of Health and Human Services Robert F. Kennedy Jr.
RFK Jr. spoke those words at a House Energy & Commerce Committee hearing on June 24, provoking a split reaction from MAHA supporters and medical freedom advocates: Some seemed blindsided by the ringing endorsement of personal health-monitoring tech, while others hit social media with I-told-you-so posts.
Many commenters in the I-told-you-so camp pointed to the influence of Calley and Casey Means. The Means siblings have been viewed with skepticism by many in the grassroots medical freedom movement ever since they suddenly appeared on the scene in 2024 as members of the MAHA leadership. Because they are consumer health industry entrepreneurs, critics point to them as RFK Jr. whisperers working on behalf of the industry and their own financial interests.
I have a different take on RFK Jr.’s enthusiasm for wearables: It’s not at all surprising, but it isn’t due to the influence of the Means duo. It’s part of his core strategy for “making America healthy again,” which is simply to accelerate the implementation of long-standing health data infrastructure development plans.
Building the Internet of Health Information
The United States (and the world) was well on its way to creating a seamless, ubiquitous internet of health data many years before RFK Jr.’s arrival at HHS. Important landmarks on the roadmap to its completion include the 2009 HITECH Act, the 21st Century Cures Act signed by President Obama in 2016, and the regulatory documents that hashed out the details of their implementation, including the ONC Final Rule and CMS Final Rule.
These documents set the course for standardizing the way digital health information is handled, so that the data stored in America’s multitude of separate, walled-off systems, could be seamlessly shared. They initiated the rollout of standardization efforts like TEFCA, the national health data network, and FHIR (more on that in a minute), and tore down the walls with prohibitions on “information blocking.”
This new interoperable health information system has always been designed to allow the free flow of health data throughout an infrastructure that includes personal devices and apps, electronic health record (EHR) systems, public health and biomedical research databases, and private sector health service companies.
The internet of health information being built will be just like the regular internet, allowing individuals to connect and exchange data with service providers and authorities in the cloud through their smartphones, laptops, and other personal devices. If you use health apps on your smartphone or Apple Watch, or access your medical records online, you have already headed out on this health information superhighway.
From the very beginning of RFK Jr.’s tenure as HHS secretary he has made it clear that he sees a smoothly functioning health information superhighway as the path to making Americans healthy again. He has consistently promoted solutions that rely upon a vast interoperable health data ecosystem. Even at his Senate confirmation hearing he spoke glowingly about value-based payment, telemedicine, and AI tools. This week’s remarks about wearables are a continuation in that vein.
RFK Jr.’s other notable statements this week included an announcement of plans to improve the prior authorization process. The current system often involves long delays between the time when a health care provider asks an insurance company or Medicare/Medicaid to cover a service or prescription and the time when the payer approves the coverage. The delays are problematic for patients who need timely care, costly for health care systems, and a pain in the neck for doctors.
The reforms announced this week include commitments for Medicare Advantage, Medicaid Managed Care, Health Insurance Marketplace and major commercial insurers to:
Standardize electronic prior authorization submissions using Fast Healthcare Interoperability Resources (FHIR®)-based application programming interfaces.
Reduce the volume of medical services subject to prior authorization by January 1, 2026.
Honor existing authorizations during insurance transitions to ensure continuity of care.
Enhance transparency and communication around authorization decisions and appeals.
Expand real-time responses to minimize delays in care with real-time approvals for most requests by 2027.
Ensure medical professionals review all clinical denials.
These are promising plans, but they are mostly not new. The lynchpin that will enable faster, more efficient prior authorizations is the adoption of the FHIR data exchange standard. In early 2024, the CMS Interoperability and Prior Authorization Final Rule, which details the implementation of 21st Century Cures Act requirements for Medicare and other government-run health plans, set a 2026 deadline for adoption of FHIR for prior authorizations. The deadline was later moved up to 2027.
The plan RFK Jr. announced basically expands that mandate to include many commercial health plans. Adopting the FHIR standard for health data exchange is one of the most important requirements for a smoothly functioning internet of health information, so what RFK Jr. is doing here is simply accelerating its long-planned completion.
Information Superhighway to Health or Infrastructure of Totalitarianism?
I don’t think RFK Jr. is wrong about the potential benefits of a seamless, ubiquitous internet of health information. As I have always emphasized, having access to massive troves of health data that can be analyzed with powerful AI tools promises significant new health insights, treatments, and inventions.
Individuals also stand to benefit from having higher-quality information about their own health that is easily accessible to them. Wearables are already helping people improve their own health and head off problems before they reach an emergency-room-crisis point. Devices like heart and glucose monitors can be lifesaving.
The problem is, the civil liberties and privacy risks this new infrastructure poses are equally significant. A system that is able to constantly collect health data on individuals through biometric devices and make our health records accessible everywhere to anyone who has the authority to access them raises crucial questions about how that authority is granted and how the information is owned and controlled.
As it stands, both federal and state laws give public health officials the authority to access individuals’ health information without their knowledge or consent for public health purposes. A patchwork of state consumer health data privacy laws is gradually coming together to give individuals more control over how businesses can use their data, but it’s far from complete or cohesive.
And that’s not all. With the integration of social determinants of health data into health records, a vast catalog of detailed information about all aspects of an individual’s life can be encoded, stored, and made accessible to authorized users via the internet of health information.
A recent HHS request for information pointed to the department’s interest in tying such records to digital IDs as well, moving the system closer to the kind of infrastructure that could easily be used to impose a pervasive social credit system. FHIR is an international standard, and the internet of health information will eventually be international too.
The picture that forms, of a technological system that stores an extensive file of personal information on every individual and makes it available to authorities everywhere, has been sketched out before:
They are putting in place all of these technological mechanisms for control that we've never seen before. It’s been the ambition of every totalitarian state from the beginning of mankind to control every aspect of behavior, of conduct, of thought, and to obliterate dissent. None of them have been able to do it. They didn't have the technological capacity.
Even in Hitler’s Germany you could cross the Alps into Switzerland. You could hide in an attic like Anne Frank did. I visited in 1962 East Germany with my father and met people who had climbed the wall and escaped, so it was possible. Many died trying, but it was possible. Today the mechanisms are being put in place that will make it so none of us can run and none of us can hide.
That was RFK Jr. speaking on the steps of the Lincoln Memorial in January 2022. He was addressing the crowd of protesters at Defeat the Mandates. The protesters had come from New York, Los Angeles, and other places where authorities imposed draconian restrictions based on personal medical information, stripping people who refused to be injected with a novel pharmaceutical product of their incomes, careers, homes, savings, and more.
When the internet of health information is fully up and running, the tools that will be available to authorities wishing to impose such restrictions will make COVID-era vaccine passport apps look like a flip phone from 2002. That’s why I have referred to this infrastructure not only with the relatively optimistic term “internet of health information” but also the more ominous “health data leviathan.”
The system that RFK Jr. 2025 is so energetically rolling out as MAHA’s grand solution looks just like the one RFK Jr. 2022 warned us about. Its power to do good should be recognized, but its potential to serve as the infrastructure of totalitarianism should not be underestimated.
What Can the Grassroots Do?
In the face of this, advocates of medical freedom—and every kind of freedom, really—don’t have to just cross their fingers and hope for the best.
Technologists are creating new ways to put control over personal health information back into the hands of individuals. Attorneys and advocates are continuing their fight to limit the power of authorities to impose restrictions and violate rights on the basis of health information.
This is the moment to put legal and technical protections in place so that not only our privacy but our rights are preserved. Simply rejecting pieces of the growing infrastructure by refusing to use a wearable or a digital ID or opting out of a registry or database won’t do the trick.
Giving individuals control over their personal information requires addressing the infrastructure as a whole and creating mechanisms that individuals can use to exert control as their data flows into and out of all of its endpoints. It requires understanding how new technologies that grant individuals control can work within the technical and regulatory framework that is already being rolled out, so that they can be implemented.
The health data leviathan is rising. Now is the time to limit its power.
Excellent report Aimee!
It ends with a chip in your hand however you want to dress it up