But a fine is a price: unlike breakups or other muscular antitrust interventions, cash settlements don't deter monopolies. Instead, they become part of the cost of business, priced into the next round of predatory tactics.

Thus it was that after a quarter-century of antitrust fines and settlements, the company doubled down on its illegal conduct.

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As Dayen points out, hospitals buy new beds at 10-15 year intervals, and strive to standardize on a single manufacturer across wards or facilities. By insinuating itself into this cycle, Hillrom ensures that its 5-7 exclusive deals become perpetual.

Hillrom's vast patent portfolio expands that perpetual dominance, by thwarting rivals who want to make interoperable products - say, systems that integrate with Hillrom's nurse-call system.

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It established a "strategic salesforce" targeting "integrated delivery networks" (giant, monopolistic hospital chains like Providence). This salesforce locked the giants into 5-7 year exclusive contracts ("corporate enterprise agreements") with Hillrom for ICU, birthing and standard beds. These agreements required the hospital chains to force their member hospitals to buy Hillrom beds, regardless of their own preferences (these Hillrom beds got Hillrom accessories, like nurse-call buttons).

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For years, I've been fighting against Big Tech. There are a lot of potential allies in the fight to demonopolize our tech world, because tech is woven into so many facets of our lives: romance, employment, civics, culture, education, family life, etc. But as vast as that resistance might be, it's minuscule when compared to the legions who are harmed by *all* forms of monopoly.

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Monopoly has infected every part of our economy. From running shoes to pro wrestling, shipping to finance, eyeglasses to semiconductors, textbooks to novels, candy to oil, movies to music, every part of our lives is being organized by a handful of massive, lawless monopolies who openly collude to rig the system against their customers, their workers, and their communities.

https://www.openmarketsinstitute.org/learn/monopoly-by-the-numbers

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All we need to do is realize that owls and the ozone layer are part of the same fight. All we need to do is name a common enemy (monopoly) and a common cause (pluralism).

After all, monopolies didn't happen by accident. Since the Reagan years, orthodox economists have embraced the idea that monopolies are "efficient" and have demanded that regulators leave them be.

https://locusmag.com/2021/05/cory-doctorow-qualia/

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That's the bad news. But it's also the good news. It means pro wrestling fans have common cause with bank tellers who get screwed by Wells Fargo, and that both are fighting the same fight as microbrewers and cheerleaders and meat-packers. It means that as powerful as these monopolies are, they face a potential resistance movement that encompasses nearly *everyone*, save the vanishingly small number of beneficiaries of monopoly (top executives, finance bros, and ultra-wealthy shareholders).

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Tiny forces like our individual voices, railing against the 1,000% increase in eyeglass prices or gigaships stuck in the Suez canal or the conversion of the internet into "five giant websites, each filled with text from the other four."

https://twitter.com/tveastman/status/1069674780826071040

Monopolists and their apologists and enablers do their best to stave this off, of course. They go to great lengths to obscure the degree to which our markets are structured by colluding CEOs of giant companies.

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That orthodoxy - part of the neoliberal revolution fomented by the Chicago School of economics - has been in retreat for years, and that phenomenon has accelerated through the pandemic as giant companies boosted their profits while the world burned. The seemingly impregnable edifice of monopolism may collapse like an avalanche: slowly, then all at once. Avalanches are triggered by the cumulative pressure of a myriad of tiny forces.

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No one does this better than David Dayen, whose 2020 book "Monopolized" is a masterwork of compact, compelling storytelling that reveals the connected nature of every kind of monopoly:

https://pluralistic.net/2021/01/29/fractal-bullshit/#dayenu

Dayen is the executive editor of The American Prospect, where he carries on his excellent antimonopoly reporting. Today, he kicked off a new section in The Prospect called "Rollup," which tracks "obscure, under-the-radar monopolies."

https://prospect.org/topics/rollups/

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They go to even greater lengths to make us think each monopolized industry is a unique tale, driven by the distinct characteristics of its products. For example, tech monopolists like to pretend that their dominance is the inevitable product of "network effects":

https://www.eff.org/deeplinks/2021/08/facebooks-secret-war-switching-costs

One of the main tasks of antimonopolists is revealing the lie behind this exceptionalism - to show that all our monopolies follow the same playbook, executed by the same coterie of ultra-rich schemers.

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The inaugural edition of Rollups tells the tale of a monopolist I'd never heard of: Hillrom, a giant corporation that has rigged the market for...*hospital beds*.

https://prospect.org/power/rollups-theres-a-hospital-bed-monopoly/

Dayen's story is based on filings in *Linet v Hill-Rom Holdings*, a new federal antitrust lawsuit just filed in the Northern District of Illinois:

https://www.scribd.com/document/550035591/Linet-v-Hill-Rom-Holdings

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Rollups is just the kind of thing we need: a way to hasten the antimonopoly movement's "ecology" moment by teaching us that no matter what kind of corporate fuckery you're laboring under, it has a common root in monopolism.

(Another excellent source of this cross-industry fuckery-revelation is Matt Stoller's Substack, BIG.)

https://mattstoller.substack.com/

11/

The company bought its way to dominance, using its access to the capital market to acquire and kill or absorb its competitors. Its acquisitions include companies that produce bed-adjacent products, creating a kill-zone around hospital beds where competitors can't find purchase.

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The lawsuit accuses Hillrom of cornering the hospital bed market, with a 70% market share that includes standard beds, ICU beds, birthing beds, and more. It details "a series of secret, exclusive deals" that lock in the (monopolized) hospital sector to buying its beds and accessories, forever.

As Dayen points out, the Hillrom playbook looks a lot like every monopolist's.

13/

Hillenbrand spun out Hillrom in 2008. Now, Hillrom is a division of med-tech monopolist Baxter International, whose gadgets are tied to Hillrom beds and vice-versa - hospitals that invest in Hillrom beds are arm-twisted into buying Baxter med-tech, and hospitals that buy Baxter med-tech need to buy "compatible" Hillrom beds.

This Baxter/Hillenbrand hybrid produced a kind of superpredator in Hillrom, a company with monopolistic conduct in its very DNA.

16/

Monopoly begets monopoly. Hillrom started out as a division of Hillenbrand, a massive conglomerate that has monopolized the casket market and uses its dominance to lock in funeral directors (another highly monopolized market) and prey on bereaved families, gouging them on coffins.

https://thehustle.co/casket-industry-monopoly-batesville/

15/

Hillrom's sales force routinely lies to hospitals to ensnare them in its web, stealing the tactics of sleazy card dealers everywhere. The quotes they provide to hospitals are for "bare bones" beds that are useless until they are kitted out with high-priced accessories whose prices are only revealed once the deal is done.

Hillrom has repeatedly settled antitrust suits over this conduct, paying out over *$500,000,000* in the past quarter century.

18/

Hillrom jacked up the prices of its beds and accessories, but then offered 10% "discounts" to hospitals that agreed to buy 90% of their gear from Hillrom. As it acquired company after company, it used technological lock-in to ensure that Hillrom bed customers had to buy the diagnostics, monitoring, positioning and other products it got from 15 mergers over 18 years.

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All that changes with "ecology." The introduction of that conceptual umbrella term turns 1,000 issues into one movement with 1,000 on-ramps. It welded thousands of fragmented activist causes into a single, solidaristic force to be reckoned with.

Which brings me to Big Tech.

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