If incoming Senator John Fetterman is looking for an issue to prioritize after he is sworn in, he should read Luke Goldstein’s new article in The American Prospect. It’s the story of how the University of Pittsburgh Medical Center (UPMC), “a leading health insurer in Western Pennsylvania, and Express Scripts, the pharmacy benefit manager for UPMC,” are fucking destroying independent pharmacies and screwing over rural Americans and veterans in the process.

This story focuses on health care and Pennsylvania but the broader issue impacts many industries and every state. Monopolies are gobbling everything in sight and leaving a smoking crater in place of the vanished American Dream.

The small town entrepreneur who ran a pharmacy or a bike shop, a hardware store, an auto repair garage, a local bank, or a grocery is getting crushed, and their communities are hollowed out as a result. Rural hospitals have closed, creating countless medical crises, especially for pregnant women.

It’s not an accident that the people left behind have gone stark raving mad. They can work for Wal-Mart or Amazon or they can fake an injury and get worker’s comp and a boatload of opioids with enough street value to make several mortgage payments. What they can’t do is make a profit going into business for themselves. They aren’t hiring folks, they’re not renting out local office space. They’re serfs as the mercy of far-off corporate boardrooms.

The only compelling messages they hear are coming from the right–something about building a wall and standing up to China in order to restore their previous way of life. The unions have withered, and in any case they didn’t prevent the merciless monopolization of their economies.

Fetterman should be on the ground in Western Pennsylvania talking to folks who have to drive thirty miles to get a prescription filled at a UPMC approved pharmacy. He should be talking to the pharmacists that are being driven out of business. He should then take that same message to all the other business owners who’ve gone under, or who soon will. And he should talk to their customers who valued those personalized services and tax base they provided.

And then he should partner up with some Republicans (most of these communities nationwide are now represented by Republicans), and write some legislation that puts real teeth into antitrust enforcement. To begin with, they can focus on how people are getting fucked by Express Scripts and put an end to it.

No doubt, most Republicans will take the big donor money and blame something else (Hunter’s laptop, Nicaraguan caravans) for the loss of private pharmacies. But this is a real enough problem that if a politician takes it on he or she can win folks to their side. In fact, this is one of the best possible ways to convince these folks that a Democrat can be on their side.

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