Take a look at just one of these, and notice how the top ten holdings only make up about 40% of the fund--and how, if you're into the markets in any way, these companies are "competitors" of one another. They also span the whole damn thing, meaning not just hospitals, but developers, building contractors, technology, training ("academics"), research, pharmaceutical, certification agencies, friggin' delivery services...companies that make customized retrofits for those very specific delivery vehicles...it doesn't end. It's the whole thing.
We can look at that a number of ways as relates Marx or Smith or even Lenin. Does capital always conglomerate such that it's a monofacetious, sorry, singular entity? Is there no capitalism without trust? Sure, America has a lot of "antitrust law" that very, very carefully defines how it's acceptable for post-Rooseveltian (Teddy, in case you're stuck an era later) investors to control the entire marketplace for a single service, over which they've legislated exclusive patent (modern: "license"), for companies to own stock in other companies that own stock in them, for fund managers to work for companies that channel and rechannel different corporate investments into apparently-convoluted-but-actually-quite-simple ratios that leave, really, the same old same old selling the same old same old.
Inevitable? Fair? Yeah, there's the dinner-table conversation with some hapless functionary who thinks that something called "competition" exists, and because of all the pretty logos, believes there is more than one face behind the curtain. And there's the deeper truth behind that, that there may have once been a competition, a hundred years ago or maybe a thousand, where certain arrangements were hashed out to ensure that there wouldn't later need to be any harmful competitions, yeah. Even a thousand years ago (if that's the time we arbitrarily pick), was there competition, or has it always been subject to prior monopoly arrangements, like a crooked 50s game show or a pointlessly non-crooked tweens reality show?
The fund above is, of course, only one fund, and only about $5B, but as you may have guessed by now, they're all like that, and the total numbers involved are far greater than $5B. Maybe, really, all the money, save for a few houses and savings accounts--all the money is all the money, a conglomerated mass of however many imaginary trillions, justifying a godawful number of separate fictitious entities that "do business."
Sorry; let's talk basics. A "trust" is, in this kind of economic sense, a "monopoly," or a racket of people who get together to drive competition out of the market in order to make more money for less effort. It's in theory illegal since, oh, somewhere around the end of the Guilded Age, excuse me, the Gilded Age, when President Theodore Roosevelt, running on a platform of hope and change, staved off revolution by pretending to break up the great trusts--sugar, tea, banking, shipping, etc.--with "antitrust legislation." Believe it or not, it actually fooled people. It fooled so many millions of people that, a century later, their distant descendants think of the murdering rapist of the Caribbean as a "reformer," and believe that something good was accomplished.
Just lookit this inane, stuperific (and MC) quiz, where modern schools teach that it was all good and true. This kept the peasants tricked for a while, until the next Roosevelt came up with his own "reforms" to end monopolies. (Remember how the hungry people enjoyed playing the Monopoly?) Meanwhile, Obama is progressively fixing things yet again. Banana republics move aside; here come oil republics, soaked in the blood of as many inconvenient children as he can joke about at a media conference.
What we're trying to remember here is that, despite the shell game, the only changes were that people got less honest. Through cross-corporate holdings and mutual funds, the moneyed class owns everything. It owns Microsoft and Apple. And Samsung. And the next one. There is no competition because they don't want to play if there's the chance they might lose. Even if competition accidentally arises, a reduction in Microsoft's price means a corresponding rise in Apple's, and if the latest war fails, a reduction in Halliburton means a rise in Whole Foods.
How does it hurt? Well, why should your hospital cut its overnight rates if its owners also own the hospital across town, and the one on the south side, and all the ones in the next state, too? Where ya gonna go? They own all the internet access providers and phone service providers; there is zero motivation to either employ or serve well. The best part is, with antitrust laws and mutual funds, this stuff doesn't have to be hidden anymore. We all know and accept that there are "lobbyists," so why not believe the ruse that mutual funds are somehow A-OK for free market capitalism? They own all the parties and the politicians, of course, with the same standardized non-competition results, but you probably already knew that.
If your hospital's holding company also owns shares in a company that does medical transportation, then you can bet that, instead of having an in-house laboratory, there'll be a separate "lab" in a different part of the complex, or across town, so that you can pay for the sample to get shipped there. Well, not you, but your insurance company, which is okay, too, because the same fund owns any of your four options in your area given your health. So we bring it from floor 9 to floor B-2, transfer to a little white non-emergency transport van, drive it to Invorum Labs, have it done up, drive it back, and there's a little tithe at every stage of the game, rather than just having a microbiologist on floor 7 take a couple minutes to do a report on it. And of course, if a CT machine costs $800K, we'll order more of those scans than we would otherwise, because, well, you know. As long as you have half a brain, you can make it sound altruistic, responsible, and justified, and you have plausible deniability at every stage of the game. No one needs to lie anymore; we all actually believe the bullshit we spout. The Watergate scandal isn't possible when every single citizen believes Liddy actually was just vacuuming as an independent contractor.
Back to the murder swamp, what did you think those "lobbyists" were doing, anyway? Waiting for their chance to make their case based on logic alone? Handing over briefcases of cash while wearing black eye-masks? No, the former is the child's view, while the latter is the patronizing adult's view--too obvious, too easy to catch, and therefore, the answer must be something respectable, right? What they're actually doing is passing on subtly worded threats, gifts, and job offers, but all above the table. There's no need to hide anything anymore, because it's all in plain sight and nobody cares. Everybody knows the fight was fixed, after all, because the poor stay poor and the rich get rich.
There are no revelations. You can have intelligent arguments, hours long, with people who have PhDs in economics, and who wouldn't give their teenager signature authority over their bank account during a 6 week sabbatical, but who still claim, straight-faced, that there's no problem with competing companies and investors owning each other's stock. This ruse is so internalized it's like we've forgotten there ever was a dream about not living in a cage. You know, the boring old saws, "War is Peace," and "Ignorance is Strength," and "Murdering Children With Drones is Saving Humanity." We're really having our faces rubbed in it, here. Throw out the fancier theories; maybe this culture is all about submissive BSDM play after all.
Bond markets sometime later.