America's Concentration Crisis

An Open Markets Institute Report

In June 2019, Open Markets published exclusive new concentration data on the health care sector. While concentration among insurers is broadly recognized and well-documented, the data presented here illuminates concentration in a broad range of healthcare-related markets, from syringes to medical patient financing. Growing monopoly power in the health care sector contributes significantly to the high prices, poor quality, and lack of access that millions of Americans experience when interacting with the health care system.
Pharmacy Benefit Management
Pharmacies and Drug Stores
Medical Waste Disposal Services
Electronic Medical Records Systems
Clinical Trial Data Management Services
Ambulance Manufacturing
PET Scanner Manufacturing
X-Ray Machine Manufacturing
Hospital Bed Manufacturing
Surgical Apparel Manufacturing
Weight Loss Services
Orthopedic Products Manufacturing
Pacemaker Manufacturing
Wheelchair Manufacturing
Hearing Aid Manufacturing
Syringes & Injection Needle Manufacturing
IV Solution
Medical Device Manufacturing
Healthcare Consultants
Diagnostic and Medical Laboratories
Medical Patient Financing
Dental Insurance
Dental Clinical Instrument Manufacturing
Dental Equipment Dealers
Dialysis Equipment Manufacturing
Eye Glasses & Contact Lens Stores
Dialysis Centers
Contact Lens Manufacturing
Baby Formula
Dry Cat Food
Adult Websites
Corn Seed
Cell Phone Providers
Smartphone Operating Systems
Meat Processing
Cigarette & Tobacco Manufacturing
Washer & Dryer Manufacturing
Search Engines
Social Networking Sites
Home Improvement Stores
Coffin & Casket Manufacturing
Peanut Butter
Mobile Home Manufacturing
Pet and Pet Supplies Stores
Craft Stores
Mattress Manufacturing
Car Rental
Domestic Airlines
Diaper Manufacturing

Monopoly power is all around us: as consumers, business owners, employees, entrepreneurs, and citizens. When we purchase everything from washing machines to groceries, website domains to medical supplies, and even when we select a coffin for a recently deceased loved one, we are constrained by the small set of actors who increasingly control America’s commerce.

Due to extreme concentrations of wealth and political power, our country is experiencing severe economic inequality, stagnant household income, the collapse of business formation and innovation, and historic levels of political polarization. This report shows that such concentration is not unique to one or two economic sectors. It is persistent across a diverse range of industries. And it is often even more extreme in a regional, rather than national, context.

As the charts also illustrate, monopolistic corporations often present themselves as champions of consumer choice. But while it may appear as though there are endless brands to choose from online and on the shelf, most are owned by a few large parent companies, the array of labels a mere façade creating the illusion of abundant options.

Locating data on how few companies control individual markets, though, has long been difficult, and not by accident. Although Americans used anti-monopoly policies throughout much of the 20th century to preserve competition, a shift in ideology in the late 1970s allowed increased monopolization across the economy. To shield this pro-corporate turn from the public, the Federal Trade Commission halted the collection and publication of industry concentration data in 1981.

To remedy this gap in public knowledge, Open Markets purchased extensive, up-to-date industry intelligence from IBISWorld, a team of analysts who collect economic and market data, with the intention of releasing the information regarding industry concentration to the public. Our hope is that these startling numbers will accelerate action to re-establish the choice, competition, and liberty upon which our democracy depends.