What do you do?

Further it's all short vs long term pricing. In the short term a company will setup lower prices to kill of competitors, the when there is no competition they raise prices significantly to have a long term war chest. So, on a day to day basis they might be the cheapest option, but their average price over decades is more than their short lived competition.

So even if a competitor with 10% cheaper goods comes along, the consumer sticks with the monopoly 100%, for fear of being dicked by the consumer's 99% prices.

In an ideal world, such agreements would be illegal, leading to a freer market.

A sizable fraction of large markets are dominated by monopolies or oligopolies. While it's arguable which factors contribute most, it's an observed fact that this happens, so I'm not sure I'd call any particular instance "a bit odd." Sadly.

I also found interesting the only two brief mentions of patents in the article. One, a dominant vendor historically using patents to quash startups. Two, the startup the article focuses on has patents that would expire soon (maybe have, the article is from 2010), so other companies would benefit from their innovation (the article mentions a Chinese manufacturer, where the startup eventually took their product).

If the startup's product was really better, why didn't they license their patents to the big vendors? Was the startup simply greedy? The startup's research was largely paid for by taxpayers, why did they need a patent at all? It seems odd to expect inventors will also be good entrepreneurs and litigators: this seems a situation in which grants or prizes without patents would be superior. Alternatively, it points to some market failure in licensing patents that maybe could be solved by some kind of compulsory licensing, eliminating the problem of too greedy startups holding out. How am I wrong?

Finally, with articles like this about the health care industry, I'm always struck by intense focus on bringing innovations to market in the US, and the huge barriers to doing so. I realize that the US is the largest market, but still. Maybe BRIC and other companies should get better at delivering innovations stalled in the US, or maybe the innovations aren't actually so great?

Go to congress. Lobby. While you may be outspent, that isn't everything. You can also apply pressure via an ad campaign, asking voters to demand that nurses are safe. There is some real emotional appeal potential here.

End result: the dominant company is forced to cave in some way. They can buy the syringe, allow an exception for the syringe, or just lose 100% of their customers.

I get paid well, but there is something really strange going on: I can't get my contracts directly. I always have to go through a company whose sole business it is to be an intermediate between the (large) company that wants to hire a freelancer and the freelancer. Note that those freelancers are not employed by that company and the relationship is pretty loose. The business pays the intermediary and they pay you, it's a per-project contract.

The large companies won't hire someone directly even though they would save lots of money (and freelancers would get more). Suspicious as you guys are you probably think that well, there must be a logical business reason that it actually really is worth the additional money being spent on the intermediary. For example, finding and bundling lots of freelancer resumes. While that sure is a reason it isn't nearly sufficient for an explanation, not only because they actually do precious little for the money they keep. Also, the legal side can't be the reason either when I look at how the contracts between me and the intermediary are set up.

To give one example from a very large client I worked for for 1.5 years as a freelancer, the reason I was told they go through the intermediary is that it makes their accounting much easier. Since I once worked for that company and experienced the exact same thing I was not surprised: When I worked for them in Silicon Valley I saved the company a lot of money by looking for an apartment myself. I ended up sharing one with somebody else. However, the expensive all-inclusive one-bedroom apartment I had had in Mountain View had the advantage that there only was a single bill (paid by corporate Amex card). The (far cheaper) shared apartment I got instead produced a handful of different invoices (furniture rental, cheques for the rent instead of Amex, etc.), so the company told me they would have preferred to pay the much higher amount from a single source. Which I don't quite understand - I do have some business background and understand accounting, in the computer age, what's the big deal? In the freelancer scenario they said it just works better with their SAP system then having lots of individual contracts. That company also had a big program to "streamline" and centralize their purchasing, which of course means having significantly less firms to deal with as a goal that overrides other concerns.

So, it seems the large businesses prefer to work with other large businesses, no matter how much money they could save. We don't even need to argue whether and/or how much legal and business reasons are valid or not, I think the only thing that matters for the purpose of the discussion is that the effect exists, and that that means "market" is more and more a lie the more of a countries wealth creation is done by big businesses. You don't need to look for actual "monopolies" in the classical sense, those firms quite voluntarily restrict themselves (and again, the bottom line is that it exists, how justifiable it is from the individual firm's POV is a different question, let's assume they know what they are doing and that it makes sense for them).

Meanwhile, "managing" contracts is almost as expensive as managing employees.

At some point having an accounting dept manage 10K contracts is simply impossible.

Its a labor and control fraud limitation not technological.