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But the diagnoses had a lucrative side effect: They let the insurers collect more money from the federal government’s Medicare Advantage program.

Medicare Advantage, a private-sector alternative to traditional Medicare, was designed by Congress two decades ago to encourage health insurers to find innovative ways to provide better care at lower cost.

by next year, more than half of Medicare recipients will be in a private plan.

a New York Times review of dozens of fraud lawsuits, inspector general audits and investigations by watchdogs shows how major health insurers exploited the program to inflate their profits by billions of dollars.

The government pays Medicare Advantage insurers a set amount for each person who enrolls, with higher rates for sicker patients. And the insurers, among the largest and most prosperous American companies, have developed elaborate systems to make their patients appear as sick as possible, often without providing additional treatment, according to the lawsuits.

As a result, a program devised to help lower health care spending has instead become substantially more costly than the traditional government program it was meant to improve.

Eight of the 10 biggest Medicare Advantage insurers — representing more than two-thirds of the market — have submitted inflated bills, according to the federal audits. And four of the five largest players — UnitedHealth, Humana, Elevance and Kaiser — have faced federal lawsuits alleging that efforts to overdiagnose their customers crossed the line into fraud.

The government now spends nearly as much on Medicare Advantage’s 29 million beneficiaries as on the Army and Navy combined. It’s enough money that even a small increase in the average patient’s bill adds up: The additional diagnoses led to $12 billion in overpayments in 2020, according to an estimate from the group that advises Medicare on payment policies — enough to cover hearing and vision care for every American over 65.

Another estimate, from a former top government health official, suggested the overpayments in 2020 were double that, more than $25 billion.

The increased privatization has come as Medicare’s finances have been strained by the aging of baby boomers

Medicare Advantage plans can limit patients’ choice of doctors, and sometimes require jumping through more hoops before getting certain types of expensive care.

At conferences, companies pitched digital services to analyze insurers’ medical records and suggest additional codes. Such consultants were often paid on commission; the more money the analysis turned up, the more the companies kept.

they often have lower premiums or perks like dental benefits — extras that draw beneficiaries to the programs. The more the plans are overpaid by Medicare, the more generous to customers they can afford to be.

Many of the fraud lawsuits were initially brought by former employees under a federal whistle-blower law that allows them to get a percentage of any money repaid to the government if their suits prevail. But most have been joined by the Justice Department, a step the government takes only if it believes the fraud allegations have merit. Last year, the department’s civil division listed Medicare Advantage as one of its top areas of fraud recovery.

In contrast, regulators overseeing the plans at the Centers for Medicare and Medicaid Services, or C.M.S., have been less aggressive, even as the overpayments have been described in inspector general investigations, academic research, Government Accountability Office studies, MedPAC reports and numerous news articles,

Congress gave the agency the power to reduce the insurers’ rates in response to evidence of systematic overbilling, but C.M.S. has never chosen to do so. A regulation proposed in the Trump administration to force the plans to refund the government for more of the incorrect payments has not been finalized four years later. Several top officials have swapped jobs between the industry and the agency.

The popularity of Medicare Advantage plans has helped them avoid legislative reforms. The plans have become popular in urban areas, and have been increasingly embraced by Democrats as well as Republicans.

“You have a powerful insurance lobby, and their lobbyists have built strong support for this in Congress,”

Some critics say the lack of oversight has encouraged the industry to compete over who can most effectively game the system rather than who can provide the best care.

“Even when they’re playing the game legally, we are lining the pockets of very wealthy corporations that are not improving patient care,”

In theory, if the insurers could do better than traditional Medicare — by better managing patients’ care, or otherwise improving their health — their patients would cost less and the insurers would make more money.

But some insurers engaged in strategies — like locating their enrollment offices upstairs, or offering gym memberships — to entice only the healthiest seniors, who would require less care, to join. To deter such tactics, Congress decided to pay more for sicker patients.

Almost immediately, companies saw ways to exploit that system. The traditional Medicare program provided no financial incentive to doctors to document every diagnosis, so many records were incomplete

Under the new program, insurers began rigorously documenting all of a patient’s health conditions — say depression, or a long-ago stroke — even when they had nothing to do with the patient’s current medical care.

But for insurers that already dominate health care for workers, the program is strikingly lucrative: A study from the Kaiser Family Foundation, a research group unaffiliated with the insurer Kaiser, found the companies typically earn twice as much gross profit from their Medicare Advantage plans as from other types of insurance.

The insurers also began hiring agencies that sent doctors or nurses to patients’ homes, where they could diagnose them with more diseases.

Cigna hired firms to perform similar at-home assessments that generated billions in extra payments, according to a 2017 whistle-blower lawsuit, which was recently joined by the Justice Department. The firms told nurses to document new diagnoses without adjusting medications, treating patients or sending them to a specialist

Nurses were told to especially look for patients with a history of diabetes because it was not “curable,” even if the patient now had normal lab findings or had undergone surgery to treat the condition.

Adding the code for a single diagnosis could yield a substantial payoff. In a 2020 lawsuit, the government said Anthem instructed programmers to scour patient charts for “revenue-generating” codes. One patient was diagnosed with bipolar disorder, although no other doctor reported the condition, and Anthem received an additional $2,693.27, the lawsuit said. Another patient was said to have been coded for “active lung cancer,” despite no evidence of the disease in other records; Anthem was paid an additional $7,080.74. The case is continuing.

The most common allegation against the companies was that they did not correct potentially invalid diagnoses after becoming aware of them. At Anthem, for example, the Justice Department said “thousands” of inaccurate diagnoses were not deleted. According to the lawsuit, a finance executive calculated that eliminating the inaccurate diagnoses would reduce the company’s 2017 earnings from reviewing medical charts by $86 million, or 72 percent.

Some of the companies took steps to ensure the extra diagnoses didn’t lead to expensive care. In an October 2021 lawsuit, the Justice Department estimated that Kaiser earned $1 billion between 2009 and 2018 from additional diagnoses, including roughly 100,000 findings of aortic atherosclerosis, or hardening of the arteries. But the plan stopped automatically enrolling those patients in a heart attack prevention program because doctors would be forced to follow up on too many people, the lawsuit said.

Kaiser, which both runs a health plan and provides medical care, is often seen as a model system. But its control over providers gave it additional leverage to demand additional diagnoses from the doctors themselves, according to the lawsuit.

At meetings with supervisors, he was instructed to find additional conditions worth tens of millions of dollars. “It was an actual agenda item and how could we get this,” Dr. Taylor said.

Last year, the inspector general’s office noted that one company “stood out” for collecting 40 percent of all Medicare Advantage’s payments from chart reviews and home assessments despite serving only 22 percent of the program’s beneficiaries. It recommended Medicare pay extra attention to the company, which it did not name, but the enrollment figure matched UnitedHealth’s.

Even before the first lawsuits were filed, regulators and government watchdogs could see the number of profitable diagnoses escalating. But Medicare has done little to tamp down overcharging.

Several experts, including Medicare’s advisory commission, have recommended reducing all the plans’ payments.

Congress has ordered several rounds of cuts and gave C.M.S. the power to make additional reductions if the plans continued to overbill. The agency has not exercised that power.

The agency does periodically audit insurers by looking at a few hundred of their customers’ cases. But insurers are fined for billing mistakes found only in those specific patients. A rule proposed during the Trump administration to extrapolate the fines to the rest of the plan’s customers has not been finalized.

Ted Doolittle, who served as a senior official for the agency’s Center for Program Integrity from 2011 to 2014, said officials at Medicare seemed uninterested in confronting the industry over these practices. “It was clear that there was some resistance coming from inside” the agency, he said. “There was foot dragging.”

few analysts expect major legislative or regulatory changes to the program.

“Medicare Advantage overpayments are a political third rail,” said Dr. Richard Gilfillan, a former hospital and insurance executive and a former top regulator at Medicare, in an email. “The big health care plans know it’s wrong, and they know how to fix it, but they’re making too much money to stop. Their C.E.O.s should come to the table with Medicare as they did for the Affordable Care Act, end the coding frenzy, and let providers focus on better care, not more dollars for plans.”

this does not justify the atrocities committed by Hamas, which in any case has never countenanced any possibility for a peace treaty with Israel and has done everything in its power to sabotage the Oslo peace process.

irrespective of how much blame one ascribes to Israel, this does not explain the dysfunction of the state.

He has repeatedly preferred his personal interests over the national interest and has built his career on dividing the nation against itself. He has appointed people to key positions based on loyalty more than qualifications, took credit for every success while never taking responsibility for failures, and seemed to give little importance to either telling or hearing the truth.

The real explanation for Israel’s dysfunction is populism rather than any alleged immorality. For many years, Israel has been governed by a populist strongman, Benjamin Netanyahu, who is a public-relations genius but an incompetent prime minister

The coalition Netanyahu established in December 2022 has been by far the worst. It is an alliance of messianic zealots and shameless opportunists, who ignored Israel’s many problems — including the deteriorating security situation — and focused instead on grabbing unlimited power for themselves. In pursuit of this goal, they adopted extremely divisive policies, spread outrageous conspiracy theories about state institutions that oppose their policies, and labeled the country’s serving elites as “deep state” traitors.

the way populism corroded the Israeli state should serve as a warning to other democracies all over the world.

There is much to criticize about Israel’s past behavior. The past cannot be changed, but hopefully once victory over Hamas is secured, Israelis will not only hold our current government to account, but will also abandon populist conspiracies and messianic fantasies — and make an honest effort to realize Israel’s founding ideals of democracy at home and peace abroad.

even after the 7 October massacre had stirred memories of the bleakest chapters of the Jewish past – and prompted a surge in antisemitism across the world – Jews were being told exactly how they can and cannot speak about their pain. We’re not to mention the Holocaust, one scholar advised, because that would be “weaponising” it. Historical context about the Nakba, the 1948 dispossession of the Palestinians, is – rightly – deemed essential. But mention the Nazi murder of 6 million Jews – the event that finally secured near-universal agreement among the Jewish people, and the United Nations in 1947, that Jews needed a state of their own – and you’ve broken the rules. Because it’s impossible that both sides might have suffered historic pain.

Instead, a shift is under way that has been starkly revealed during these past three weeks. It squeezes the Israel-Palestine conflict into a “decolonisation” frame it doesn’t quite fit, with all Israelis – not just those in the occupied West Bank – defined as the footsoldiers of “settler colonialism”, no different from, say, the French in Algeria

They have been framed as the modern world’s ultimate evildoer: the coloniser.

That matters because, in this conception, justice can only be done once the colonisers are gone

What’s more, such a framing brands all Israelis – not just West Bank settlers – as guilty of the sin of colonialism. Perhaps that explains why those letter writers could not full-throatedly condemn the 7 October killing of innocent Israeli civilians. Because they do not see any Israeli, even a child, as wholly innocent.

the late Israeli novelist and peace activist Amos Oz was never wiser than when he described the Israel/Palestine conflict as something infinitely more tragic: a clash of right v right. Two peoples with deep wounds, howling with grief, fated to share the same small piece of land.

I had gone to graduate school in Lebanon, then moved back there in an attempt to better understand how Hezbollah had evolved into Israel’s most capable foe. My research revealed as much about Israeli missteps and weaknesses as it did about Hezbollah’s strengths.

If Israel is going to have any strategic success against Hamas, it needs to do three things differently from conflicts past.

Hezbollah took everything Israel could throw at it for a month and was still standing.

As noted earlier, Israel has an unfortunate tendency to lay out maximalist goals—very often for domestic consumption—that it then fails to meet

In 2006, for example, Israel’s then–prime minister, Ehud Olmert, told the country he was going to destroy Hezbollah, return the bodies of two Israeli prisoners, and end the rocket attacks on Israel.

Israel did none of the three. And although Lebanon was devastated, and Hezbollah’s leader, Hassan Nasrallah, publicly apologized for the raid that started the conflict, most observers had little doubt about who had won the conflict.

Strategic Humility

Hezbollah clearly does not want to enter this conflict in any meaningful way. It knows that the pressure will grow to do so if Israel has any real success in Gaza, but for the moment, it doubts that Israel will accomplish any such thing.

Nasrallah addressed the Arabic-speaking world for the first time since the start of this conflict on Friday. Significantly, he declared that although fighting still rages, Hamas became the conflict’s winner as soon as Israel claimed that it would destroy the militant group, which he confidently predicted it would not.

As Eliot Cohen has pointed out, the other side also has maximalist goals. Hamas and Hezbollah want nothing less than the destruction of Israel. But they are in no rush.

that Israel will destroy Hamas. That just isn’t going to happen, especially because no one has any idea who, or what, should replace Hamas in Gaza. So tell the world what will happen—and how it will make Israel and the region safer.

Communications Discipline

One of the things that struck me was the almost profane way in which Israeli military spokespeople would often speak, to international audiences no less, about non-Israeli civilians

“Now we are at the stage in which we are firing into the villages in order to cause damage to property … The aim is to create a situation in which the residents will leave the villages and go north.”

The callousness with which Israeli spokespeople too often describe the human suffering on the other side of the conflict, the blunt way in which they described what many Americans would consider war crimes, never fails to offend international audiences not predisposed to have sympathy with Israeli war aims.

much like right-wing American politicians, who sometimes use inflammatory rhetoric about real or perceived U.S. enemies, Israeli officials often resort to language about adversaries and military operations that can be exceptionally difficult for their allies to defend on the international stage:

One minister casually muses about using nuclear weapons on Gaza; another claims that the Palestinians are a fictional people. One can safely assume that people will continue accusing the Israeli government of including genocidal maniacs when they can point to officials in that government talking like, well, genocidal maniacs.

Israel needs to develop a clear communications plan for its conflicts and to sharply police the kind of language that doesn’t go over as well in Johannesburg or Jordan as it does in Jerusalem.

Focus on Iran

Few people have any interest in a regional war. The economic consequences alone would be dire. But had I been in Israel’s position on October 8, I might have been sorely tempted to largely ignore Gaza—where even the best-trained military would struggle to dislodge Hamas without killing tens of thousands of innocent civilians—and focus my efforts much farther east

Israel nevertheless needs to find a way to change Iran’s strategic calculus. Otherwise, Hamas and Hezbollah will only grow stronger.

This is triggering a U.S.-China cold war, mass migrations from south to north and an America that has become more unreliable than indispensable.

that’s not the half of it. Because now that advanced military technologies like drones are readily available, smaller players can wield much more power and project it more widely than ever before, enabling even their bad choices to shake the world

This is why I referred to Russia’s invasion of Ukraine as our first true world war, and why I feel that Hamas’s war with Israel is in some ways our second true world war.

They are being fought on both physical battlefields and digital ones, with huge global reach and implications.

Indeed, in today’s tightly wired world, it is possible that the war over the Gaza Strip — which is roughly twice the size of Washington, D.C. — could decide the next president in Washington, D.C., as some young Democrats abandon President Biden because of his support for Israel.

before we become too pessimistic, let us remember that these choices are just that: choices. There was nothing inevitable or foreordained about them

Gorbachev, Deng, Anwar el-Sadat, Menachem Begin, George H.W. Bush and Volodymyr Zelensky, to name but a few, faced excruciating choices, but they chose forks in the road that led to a safer and more prosperous world, at least for a time

What is the essential ingredient that Dubai has and Gaza lacks? Because both began, in one sense, as the convergence of sand and seawater at crucial intersections of the world.

The short answer is visionary leadership.Dubai has benefited from two generations of monarchs in the United Arab Emirates who had a powerful vision of how the U.A.E. in general and the emirate of Dubai in particular could choose to be Arab, modern, pluralistic, globalized and embracing of a moderate interpretation of Islam

Their formula incorporates a radical openness to the world, an emphasis on free markets and education, a ban on extremist political Islam, relatively little corruption, a strong rule of law promulgated from the top down and a relentless commitment to economic diversification, talent recruitment and development.

Any of Dubai’s neighbors — Kuwait, Qatar, Oman, Bahrain, Iran and Saudi Arabia — could have done the same with their similar coastlines, but it was the U.A.E. that pulled it off by making the choices it made.

Compare that with Gaza, where the role models today are Hamas martyrs in its endless war with Israel.

Among the most ignorant and vile things that have been said about this Gaza war is that Hamas had no choice — that its wars with Israel, culminating on Oct. 7 with a murderous rampage, the kidnappings of Israelis as young as 10 months and as old as 86 and the rape of Israeli women, could somehow be excused as a justifiable jailbreak by pent-up males.

Let’s go to the videotape: In September 2005, Ariel Sharon completed a unilateral withdrawal of all Israeli forces and settlements from Gaza, which Israel occupied in the 1967 war. In short order, Hamas began attacking the crossing points between Gaza and Israel to show that even if Israel was gone, the resistance movement wasn’t over; these crossing points were a lifeline for commerce and jobs, and Israel eventually reduced the number of crossings from six to two.

In January 2006, the Palestinians held elections hoping to give the Palestinian Authority legitimacy to run Gaza and the West Bank. There was a debate among Israeli, Palestinian and Bush administration officials over whether Hamas should be allowed to run in the elections — because it had rejected the Oslo peace accords with Israel.

Yossi Beilin, one of the Israeli architects of Oslo, told me that he and others argued that Hamas should not be allowed to run, as did many members of Fatah, Arafat’s group, who had embraced Oslo and recognized Israel. But the Bush team insisted that Hamas be permitted to run without embracing Oslo, hoping that it would lose and this would be its ultimate refutation.

Fatah ran unrealistically high numbers of candidates in many districts, dividing the vote, while the more disciplined Hamas ran carefully targeted slates and managed to win the parliamentary majority.

Hamas then faced a critical choice: Now that it controlled the Palestinian parliament, it could work within the Oslo Accords and the Paris protocol that governed economic ties between Israel, Gaza and the West Bank — or not.

Hamas chose not to — making a clash between Hamas and Fatah, which supported Oslo, inevitable

That led to the first Israeli economic blockade of Gaza — and what would be 22 years of on-and-off Hamas rocket attacks, Israeli checkpoint openings and closings, wars and cease-fires, all culminating on Oct. 7.

These were fateful choices. Once Sharon pulled Israel out of Gaza, Palestinians were left, for the first time ever, with total control over a piece of land. Yes, it was an impoverished slice of sand and coastal seawater, with some agricultural areas. And it was not the ancestral home of most of its residents. But it was theirs to build anything they wanted.

Hamas had a choice: to replicate Dubai in 2023 or replicate Hanoi in 1968. It chose to replicate Hanoi, whose Củ Chi tunnel network served as the launchpad for the ’68 Tet offensive.

Hamas is not simply engaged in some pure-as-the-driven-snow anticolonial struggle against Israel. Only Hamas’s useful idiots on U.S. college campuses would believe that.

Hamas is engaged in a raw power struggle with Fatah over who will control Gaza and the West Bank, and it’s engaged in a power struggle in the region — alongside other pro-Muslim Brotherhood parties and regimes (like Turkey and Qatar) — against pro-Western monarchies like Saudi Arabia, Jordan, Kuwait and the U.A.E. and military-led regimes like Egypt’s.

In that struggle, Hamas wanted Gaza isolated and in conflict with Israel because that allowed Hamas to maintain its iron-fisted political and Islamist grip over the strip, foregoing elections and controlling all the smuggling routes in and out, which funded its tunnels and war machine and the lifestyle of its leaders and loyalists

The only exit from this mutually assured destruction is to bring in some transformed version of the Palestinian Authority in the West Bank — or a whole new P.L.O.-appointed government of Palestinian technocrats — in partnership with moderate Arab states like Egypt, Jordan and Saudi Arabia. But when I raise that with many Israelis right now, they tell me, “Tom, it’s not the time. No one wants to hear it.”

please, spare me the Harvard Yard nonsense that this war is all about the innocent, colonized oppressed and the evil, colonizing oppressors; that Israel alone was responsible for the isolation of Gaza; and that the only choice Hamas had for years was to create an underground “skyline” of tunnels up to 230 feet deep (contra Dubai) and that its only choice on Oct. 7 was martyrdom.

But our story about agency and choices does not stop there. Benjamin Netanyahu, Israel’s longest-serving prime minister — 16 years — also made choices. And even before this war, he made terrible ones — for Israel and for Jews all over the world.

Before this war, Netanyahu actively worked to keep the Palestinians divided and weak by strengthening Hamas in Gaza with billions of dollars from Qatar, while simultaneously working to discredit and delegitimize the more moderate Palestinian Authority in Ramallah, committed to Oslo and nonviolence in the West Bank.

Netanyahu’s goal has always been to destroy the Oslo option once and for all. In that, Bibi and Hamas have always needed each other: Bibi to tell the United States and Israelis that he had no choice, and Hamas to tell Gazans and its new and naïve supporters around the world that the Palestinians’ only choice was armed struggle led by Hamas.

This is now a common strategy for consolidating and holding power forever by a single political faction and disguising it with an ideology of resistance. It’s no wonder they all support one another.

Don’t they get it? Netanyahu’s greatest political achievement has been to persuade Israelis and the world that it’s never the right time to talk about the morally corrosive occupation and how to help build a credible Palestinian partner to take it off Israel’s hands.

He and the settlers wore everyone down. When I covered the State Department in the early 1990s, West Bank settlements were routinely described by U.S. officials as “obstacles to peace.” But that phrase was gradually dropped. The Trump administration even decided to stop calling the West Bank “occupied” territory.

Israel is being surrounded by what I call Iran’s landcraft carriers (as opposed to our aircraft carriers): Hamas, Hezbollah, the Houthis and Shiite militias in Iraq. Iran is squeezing Israel into a multifront war with its proxies. I truly worry for Israel.

But Israel will have neither the sympathy of the world that it needs nor the multiple allies it needs to confront this Iranian octopus, nor the Palestinian partners it needs to govern any post-Hamas Gaza, nor the lasting support of its best friend in the world, Joe Biden, unless it is ready to choose a long-term pathway for separating from the Palestinians with an improved, legitimate Palestinian partner.

For all these reasons, if Netanyahu keeps refusing because, once again, politically, the time is not right for him, Biden will have to choose, too — between America’s interests and Netanyahu’s.

In sum, this war is so ugly, deadly and painful, it is no wonder that so many Palestinians and Israelis want to just focus on survival and not on any of the choices that got them here

The Haaretz writer Dahlia Scheindlin put it beautifully in a recent essay:The situation today is so terrible that people run from reality as they run from rockets — and hide in the shelter of their blind spots. It’s pointless to wag fingers. The only thing left to do is try and change that reality.

“It’s symbolic — all of these thoughts and choices have gone into that piece,” she said. “It’s making fashion out of something that’s already existed. It’s saying there’s value in something that’s been discarded.”

“It’s not like we use every ounce of fabric. There are fabrics that we have to sell back off. But in every choice that we make, we just try.”

Biden, as part of the 2022 Inflation Reduction Act, largely resolved these problems, reducing maximum premium payments (net of subsidies) and eliminating the cliff at 400 percent. The result is to make health insurance coverage substantially more affordable, especially for middle-income Americans who previously earned too much to be eligible for subsidies. Hence the surge in marketplace enrollments.

Bowman also indulged a penchant—again shared broadly on the anti-Israel, anti-Zionist left—for performative and self-righteous politics.

For weeks, prominent left-wing organizers on social media slammed Latimer, a centrist liberal, as a reactionary white man backed by billionaires. The New York City chapter of the Democratic Socialists of America, which endorsed Bowman, decried Latimer as an AIPAC-picked, MAGA-bought racist.

using the term genocide has become de rigueur for candidates seeking an endorsement from DSA and Justice Democrats. Bowman obliged, repeatedly.

Bowman’s rhetoric was undisciplined and incendiary, while Latimer was a popular local politician whose internal polls showed him leading by double digits before AIPAC spent anything.

“The Paranoid Style in American Politics.” A modern left-wing update might be titled “The Infantile Style in American Politics”—as the conspiratorial mixes with obstinacy and braggadocio.

The Bronx rally offered a glimpse, too, of the sectarianism that routinely afflicts the left. Pro-Palestine protesters from Within Our Lifetime showed up and beat drums and chanted throughout the rally, doing their best to disrupt the proceedings. They denounced Bowman, Ocasio-Cortez, and Sanders as “Zionists” who backed “Genocide Joe” for president.

victories coexist with a growing shrillness and insistence by many on the left upon political purity. So longtime liberal Democratic politicians find themselves denounced as pro-genocide for supporting Israel and Biden’s position on the Gaza conflict.

Many mainstream Democrats seem less and less patient with the activist left. Hakeem Jeffries, the House minority leader and possible future speaker, would have none of the Bowman camp’s talk of martyrdom.

Jeffries took a noticeably removed and dispassionate view of that loss. “The results speak for themselves. The voters have spoken,” he said, sounding less than distraught. A senior Jeffries adviser later noted on social media that the minority leader has now supported six candidates challenged by DSA, and his candidates have won all six races.

People bemoan a perceived rise in bad dating etiquette such as “ghosting” and the sending of unsolicited sexual messages, and blame the way online romance makes it easier to discard potential partners at a touch of a button. “Hacks,” or tricks designed to game the apps for better dates, abound, demonstrating the shortcomings of their designs. 

the companies’ growing emphasis on pricier premium services is giving users new reasons to scrutinize the algorithmically driven path to romance.

Bumble made its name as a free app that only let women make the first move, for example. But since 2016, it has charged for advantages such as unlimited “swipes” to connect with prospects. The most expensive plan today costs $80 a month

“This is not a new phenomenon, and I think that dating apps have crystallized and brought those concerns to the fore, primarily because the prior institutions that were responsible for connecting individuals—such as family, friends, churches, other homes of worship—were not able to assume blame in the same way,” said Jess Carbino, a sociologist who has worked as a consultant for Bumble and Tinder.

Unlike apps such as Tinder and Bumble, the League requires profile approval to join. On the app, users get three to five prospects a day unless they upgrade to become a paying member, which runs $99 a week or $399 for a three-month subscription. Once a match is made in the app, users have 14 days to initiate a conversation before the matches expire. 

That willingness is not reassuring. For example, it is not far-fetched to imagine insurers wanting to get their hands on this type of medical information in order to hike premiums. Data brokers of all kinds will be similarly keen to obtain people’s real-time health-chat records. Altman made a point to say that this theoretical product would not trick people into sharing information.

. Neither Altman nor Huffington had an answer to my most basic question—What would the product actually look like? Would it be a smartwatch app, a chatbot? A Siri-like audio assistant?—but Huffington suggested that Thrive’s AI platform would be “available through every possible mode,” that “it could be through your workplace, like Microsoft Teams or Slack.

This led me to propose a hypothetical scenario in which a company collects this information and stores it inappropriately or uses it against employees. What safeguards might the company apply then? Altman’s rebuttal was philosophical. “Maybe society will decide there’s some version of AI privilege,” he said. “When you talk to a doctor or a lawyer, there’s medical privileges, legal privileges. There’s no current concept of that when you talk to an AI, but maybe there should be.”

So much seems to come down to: How much do you want to believe in a future mediated by intelligent machines that act like humans? And: Do you trust these people?

A fundamental question has loomed over the world of AI since the concept cohered in the 1950s: How do you talk about a technology whose most consequential effects are always just on the horizon, never in the present? Whatever is built today is judged partially on its own merits, but also—perhaps even more important—on what it might presage about what is coming next.

the models “just want to learn”—a quote attributed to the OpenAI co-founder Ilya Sutskever that means, essentially, that if you throw enough money, computing power, and raw data into these networks, the models will become capable of making ever more impressive inferences. True believers argue that this is a path toward creating actual intelligence (many others strongly disagree). In this framework, the AI people become something like evangelists for a technology rooted in faith: Judge us not by what you see, but by what we imagine.

I found it outlandish to invoke America’s expensive, inequitable, and inarguably broken health-care infrastructure when hyping a for-profit product that is so nonexistent that its founders could not tell me whether it would be an app or not.

Thrive AI Health is profoundly emblematic of this AI moment precisely because it is nothing, yet it demands that we entertain it as something profound.

you don’t have to get apocalyptic to see the way that AI’s potential is always muddying people’s ability to evaluate its present. For the past two years, shortcomings in generative-AI products—hallucinations; slow, wonky interfaces; stilted prose; images that showed too many teeth or couldn’t render fingers; chatbots going rogue—have been dismissed by AI companies as kinks that will eventually be worked out

Faith is not a bad thing. We need faith as a powerful motivating force for progress and a way to expand our vision of what is possible. But faith, in the wrong context, is dangerous, especially when it is blind. An industry powered by blind faith seems particularly troubling.

The greatest trick of a faith-based industry is that it effortlessly and constantly moves the goal posts, resisting evaluation and sidestepping criticism. The promise of something glorious, just out of reach, continues to string unwitting people along. All while half-baked visions promise salvation that may never come.