We have exactly one hospital in town. We have exactly one ambulance company in town. We have two medi-vac helicopter providers but you don't get to pick. We have one garbage company (Waste Management) that you're legally required to use in a residential property. One power/gas utility. One water utility.
All of those are private companies, but I have zero ability to switch. There's no competition. They're completely monopolistic either through regulation or naturally. If this is healthy capitalism I'd hate to see unhealthy.
Garbage pickup is particularly galling. It used to be public, government employees, with no profit motive. You had a complaint process. For ideological or "campaign contribution" reasons politicians gave it away to Waste Management, complaints are now handled by nobody, and fees climb year upon year.
God, I hate that phrase. There's a grain of truth to it, in certain contexts, but at this point its just an unthinking regurgitation used to protect the utterer from uncomfortable realities.