In the US, insurance companies and Pharmacy Benefit Managers (PBMs)[0] are the biggest threat to smaller, independent pharmacies. Even if your neighborhood has a Mom and Pop pharmacy (a rarity, as you suggest), if most insurance providers do not provide coverage for that pharmacy I doubt many folks will go there. Instead they would go further across town or use online services - driving independent pharmacies out of business.
On the side of the PBMs influence, the consumer might not see a difference in the price in order for the indie pharmacy to stay competitive, but the cost of medicine for indie pharmacy can be much higher than the corporate pharmacy - meaning they make no money on a sale and in some cases actually lose money. (I recently learned that in some cases, specifically with GoodRx, indie pharmacies can be forced to pay the PBM when a customer uses a PBM discount card at their pharmacy - so the consumer pays the PBM and the pharmacy pays the PBM)
Large corporate pharmacies have the strength and power to influence insurance providers and PBMs - and some even control them. That in my mind is the bigger issue in the US.
Just like with purchasing products made locally/sustainably, it is often a matter of convenience and lack of effort which leads people to believe that there are no other options than what is being marketed towards them.
I found them the same way I found my pharmacy-- the National Community Pharmacists Association pharmacy locator: https://ncpa.org/pharmacy-locator
> it is often a matter of convenience and lack of effort which leads people to believe that there are no other options than what is being marketed towards them.
I had this exact conversation recently. When I pointed out that we have a mom and pop drug store within walking distance of our neighborhood, the conversation shifted to imagined complaints that they wouldn’t have necessary medications in stock, they might not accept the right insurance, or that prices would be higher.
Many people’s stated preferences favor small, independent products. Often their revealed preferences favor the large company, cheapest, or most convenient option.
This conversation plays out for cheap Amazon products, too. I’ve heard so many people complain that Amazon is full of cheap foreign products, followed by them bragging about how little they paid for some cheap thing from Amazon recently.
It seems to me that the modern American way is duopoly. You have unlimited free market capitalist choice: you can choose Google or Apple, Walgreens or CVS, Lowe’s or Home Depot, Kroger or Walmart, Uber or Lyft, Cox or Centurylink, Ford or Chevy. It’s like a cosplay free market.
It feels like everywhere at all times, people are playing dirty to protect their cash flows, doing anything they can get away with to keep new entrants out of markets. They even weaponize it against other giants, too (eg JEDI, or wielding the EPA against SpaceX).
This doesn’t seem like a failure of capitalism to me, but a failure of government. Not that the government failed to regulate, no; that they were explicitly captured in such a way that results in regulation that ensures nobody except the existing, connected players can participate.
If you want to have even a tiny chance to edge in, you have to be backed by immense capital and be connected with someone who can put in a word with the right people. In tech, VCs like YC or a16z or the so-called PayPal mafia come to mind.
Innovation, but only via undocumented, preapproved channels.
It’s illegal or effectively illegal to make new pharmaceutical factories, or new retail pharmacies, or new hospitals, or new financial services and payment systems, or new banks, or new safe deposit boxes, or transit services, or ISPs, or schools, or any myriad other verticals that have been regulated to oblivion for entrants in the name of “consumer safety”. If search engines or public libraries were invented today they’d be shut down in days, perhaps hours. Even Tesla fought the biggest uphill battle to be able to sell cars direct to consumers, as it was outlawed in many states.
I really want to see orders of magnitude more new small businesses, but the American population seems to be regarded as a resource to be harvested rather than an economic talent pool to be developed.
Everyone wants more mom-and-pops, except the existing ownership class, because they aren’t on SecondMarket.
Everything you mentioned does take a lot of capital to build physical infrastructure.
There are way more than two car manufacturers and for prescriptions in particular, just near me there is CVS, Walgreens, Publix, Target and Walmart.
Cable is very much a natural monopoly because of the infrastructure and right of way issues.
None of the rest of your list is illegal or hard to do. But it takes capital to build physical stuff.
I travel a lot and my wife and I did the digital nomad thing for a year. I got my prescriptions refilled at CVS from San Juan to Las Vegas that year.
Speaking of deposit boxes, we also have a virtual mailbox whose physical location is in the back of a tax preparation office. Our important mail is sent there and when we were traveling, we could have it scanned and discarded once we viewed the image or bulk shipped to where we were. It’s dead simple to either get 1Postal or UPS franchise.
You aren’t going to have a mom and pop transit service that works globally. Again as frequent travelers, Uber and Lyft were a god send.
Banks definitely have capitalization requirements and dozens of virtual banks went out of business around 2008. I worked at a company that did bulk commercial physical and virtual mail for them - not spam, statements, notices, etc
I think you're leaving out a few obvious ones to force the duopoly narrative.
> Lowe’s or Home Depot
Harbor Freight, random local lumber yards
> Cox or Centurylink
Comcast. A few others too. Usually you only have one choice though. Dish if you're talking about TV instead of internet, various phone company offerings if you're talking about internet.
> Ford or Chevy
There's more auto companies than I can count, particularly if you include all the foreign brands sold in America, which you should because some of them are very popular and are broadly recognized to have superior vehicles.
> * Kroger or Walmart, *
Giant, Food Lion, Aldis, Target, Wholefoods, Trader Joes, more regionals than you can shake a stick at.
There’s this weird glitch in our collective psyche where an arbitrarily bloated and rapacious central committee fixing prices and wages and regulations in favor of an insular elite is somehow still called “capitalism” as long as the party insiders are called things like “CEO” or “venture capitalist”.
It’s late USSR economics with feel good nomenclature.
With e.g. Elon Musk getting heavily involved in government in sort of a vague way we’re stepping into some new stage of this. We must slash entitlements to fund corporate tax cuts comrade.
Apparently we’re kind of over it on even pretending a tiny corporate elite doesn’t just directly set policy in flagrant, naked, unapologetic self-interest.
I am lucky to have a family owned drug store near my house. The pharmacists are brother and sister and grandma runs the cash register. Grandma can't walk good or see good, but she sure can sell you some cookies or pens or sunscreen or German sausages. She makes sure you don't leave empty handed.
So much faster then going to CVS, you just give them the scrip, they put the pills in the bottle, done in 5 min. Pay cash, no insurance BS. No ID since they know all their customers. Somehow they always have what you need, even when there is a shortage of a particular medicine.
Sometimes grandma tries to give me free stuff when she rings me up and I am like, no dammit, I need you to say in business or else I am doomed deal with the megacorps again. Take my money please!
