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As a result we end up with the most bizarre health-insurance system imaginable: One ever better designed to avoid sick people.

America’s giant health insurers are now busily consolidating into ever-larger behemoths.

In reality, they’re becoming huge to get more bargaining leverage over everyone they do business with — hospitals, doctors, employers, the government and consumers. That way they make even bigger profits.

researchers found, for example, that after Aetna merged with Prudential HealthCare in 1999, premiums rose 7 percent higher than had the merger not occurred.

The real choice in the future is either a hugely expensive for-profit oligopoly with the market power to charge high prices even to healthy people and stop insuring sick people.

Or else a government-run single payer system — such as is in place in almost every other advanced economy — dedicated to lower premiums and better care for everyone.

It doesn’t help that the Trump administration is rapidly stripping away as many regulations as it can, promising to repeal two for every new one implemented — an ultra-wealthy administration’s attempt to formalize the plutocratic free-for-all that has followed decades of growing corporate power, defined by massive income inequality, regulatory capture, a revolving door between agencies and the industries they oversee, and steadily eroding consumer rights. The empowered consumer is a figment of our imagination.

Experiences that used to be standardized are being divided into tiers denoting various rights, access and costs. The result is to both pit consumers against one another — as they compete for a limited pool of guaranteed seats on an airplane, for example — and to extract more money out of better-heeled customers.

If we violate any of the strictures of the contract we’ve implicitly signed by buying a ticket, then the airline — backed with the imprimatur of state authority, perhaps even with the help of local police — has every right to remove us from the plane without apology.

Survey the economic landscape and you’re likely to find similarly scrambled power relationships. During the foreclosure crisis, banks acted like arms of the state, with local sheriffs becoming the banking industry’s eviction force. Health insurers dictate access to health care for millions while a small coterie of chief executives reaps huge payouts. The telecommunications industry has consolidated into a handful of industry behemoths that maintain regional monopolies

The result is a lack of competition and slow, pricey service

Increasingly we’re not just paying more for less; we are sacrificing our privacy rights in the process, as personal data has become a huge driver of the digital economy

Those are the economic costs of this arrangement. The social and cultural costs are harder to define but no less important. As Sandel explains, common experiences become increasingly fragmented and subjected to the vicissitudes of the market: “At a time of rising inequality, the marketization of everything means that people of affluence and people of modest means lead increasingly separate lives. We live and work and shop and play in different places. Our children go to different schools.”

traditionally guaranteed rights become more contingent and benefits accrue to the wealthy.

We get what we pay for, which increasingly means whatever a company like United decides.

in 2001, the top 10 websites accounted for 31 percent of all U.S. page views, but, by 2010, they accounted for 75 percent of them.

The Internet has created a long tail, but almost all the revenue and power is among the small elite at the head.

Advances in artificial intelligence will accelerate this centralizing trend. That’s because A.I. companies will be able to reap the rewards of network effects. The bigger their network and the more data they collect, the more effective and attractive they become.

As a result, our A.I. future is likely to be ruled by an oligarchy of two or three large, general-purpose cloud-based commercial intelligences.”

engineers at a few gigantic companies will have vast-though-hidden power to shape how data are collected and framed, to harvest huge amounts of information, to build the frameworks through which the rest of us make decisions and to steer our choices. If you think this power will be used for entirely benign ends, then you have not read enough history.

The second implication is philosophical. A.I. will redefine what it means to be human. Our identity as humans is shaped by what machines and other animals can’t do

On the other hand, machines cannot beat us at the things we do without conscious thinking: developing tastes and affections, mimicking each other and building emotional attachments, experiencing imaginative breakthroughs, forming moral sentiments.

For the last few centuries, reason was seen as the ultimate human faculty. But now machines are better at many of the tasks we associate with thinking — like playing chess, winning at Jeopardy, and doing math.

In the age of smart machines, we’re not human because we have big brains. We’re human because we have social skills, emotional capacities and moral intuitions.

I could paint two divergent A.I. futures, one deeply humanistic, and one soullessly utilitarian.

In the cold, utilitarian future, on the other hand, people become less idiosyncratic. If the choice architecture behind many decisions is based on big data from vast crowds, everybody follows the prompts and chooses to be like each other. The machine prompts us to consume what is popular, the things that are easy and mentally undemanding.

In this future, there is increasing emphasis on personal and moral faculties: being likable, industrious, trustworthy and affectionate. People are evaluated more on these traits, which supplement machine thinking, and not the rote ones that duplicate it

In the humanistic one, machines liberate us from mental drudgery so we can focus on higher and happier things. In this future, differences in innate I.Q. are less important. Everybody has Google on their phones so having a great memory or the ability to calculate with big numbers doesn’t help as much.

In the current issue of Wired, the technology writer Kevin Kelly says that we had all better get used to this level of predictive prowess. Kelly argues that the age of artificial intelligence is finally at hand.