Karl Marx was right. Over time, capital concentrates and centralizes, the effect of which is to produce monopolies. What devotees of the free market expect from their preferred economic system is competition that ensures the best firms survive and the weakest fall off, producing an efficient system that allocates goods and services where they’re needed. If more supply is needed, a firm will emerge to provide it. The market is also meant to keep costs down. Costs too high? A new entrant will compete with the old at a lower rate and displace or correct it. Fairy tales are made of this.

In Canada, private equity (PE) money is busy these days. As the Globe and Mail reports, “major corporate players” are at work in human and nonhuman medicine: “Fuelled by international private equity funds, consolidating firms have been on a tear in other health-professional industries as well, buying up practices in fields such as veterinary medicine, dental care, optometry and pharmacies and assembling them into chains.” Capital scoops up practices, whose practitioners are leaving the field or who stay on to work for their purchaser, enjoying “back-office support through the firm’s technology and staff, help with marketing, and reduced management responsibilities.”

We know what a market monopoly or oligopoly produces: higher prices and poor service, in health care and outside of it. In a constrained field such as the one in which health-professionals work, smaller competitors stand little chance against well-capitalized corporate oligarchs. Chains may battle against one another — at least on the surface they’ll appear to — but monopolies and oligopolies are happy to give the illusion of competition and choice while cornering and exploiting a market.