Motivated by profit through scale and efficiency, Berkshire Hathaway, Amazon and JPMorgan Chase, with a combined market worth of $1.62 trillion, plan to form a new, streamlined health care company for their U.S. employees. Each will contribute to lower the cost of care and improve earnings for shareholders through advancements in health care delivery, but is this to the benefit or detriment of their employees?

There is no question that the U.S. health care system is sicker than many patients it seeks to treat. At nearly 18 percent of gross domestic product, the per capita cost of care is roughly twice that of other modern industrial societies that cover everyone. Even at such high cost, U.S. health care covers less than 90 percent of the population, and outcomes are not stellar. Obamacare has cut the number of uninsured in half, but under the current administration, which has hamstrung Obamacare since it could not repeal it, roughly 3 million people have lost their newfound access. Costs remain high because of myriad inefficiencies, an abundance of middlemen and a plethora of highly expensive yet impressively effective biomedical technologies for which the ability of payers to negotiate on pricing is constrained.

The costs of health care are so high that U.S. companies may be hard-pressed to compete in the global marketplace, which benefits from lower labor costs in part because of universal access in other nations. Berkshire Hathaway, Amazon and JPMorgan Chase are already members of the Health Transformation Alliance, a consortium of 46 self-insured companies which began by cutting a deal for lower drug costs with UnitedHealth and CVS.

Such activity has put pressure on the nation’s three largest pharmacy benefit managers: Express Scripts Holding, CVS Health and Walgreens Boots Alliance, which control north of 70 percent of all dispensed pharmaceuticals. In contrast, Medicare is prohibited from negotiating on drug prices. This private-sector initiative is also putting pressure on the large conventional insurers such as Cigna, Anthem and Aetna.

How will Berkshire Hathaway, Amazon and JPMorgan Chase draw from success in their core businesses as they design their own health system? Will they bet on slashing bureaucracy while implementing artificial intelligence and telemedicine? Amazon engineered a massive disruption in the retail and technology sector, removing layers of product sales and distribution, by redesigning work flows and implementing evermore sophisticated gadgetry. Many of the 12.4 million workers in the health care industry might need to look elsewhere for employment. With such scale, also watch for vertical integration. Why not acquire or create a new insurance company and/or become a pharmacy benefit manager replete with an online pharmacy and drone delivery? Expect increased automation in laboratory tests and imaging, also.

But do lower costs and greater efficiencies translate into quality of care as much as they bolster shareholder earnings?

Caveat emptor. In truth, society has crossed over from the age of information technology to the age of data. Data on our interests, activities, movements and communications are now collected wholesale and routinely used to profile and drive human behavior. We are made to feel free through advertising if we buy the right smartphone, drive the cool car, sport certain garments and date the stereotype du jour.

How will this affect the sacred art of medicine? Will the crucial doctor-patient relationship become a quaint relic of days gone by? Will psychotherapy even be delivered by artificial intelligence?

If the new Fortune 500 health care gains broad-based traction and begins to care for a large portion of the population, what crumbs of care will be left to those covered by Medicare and Medicaid in what will become a two-tiered system?

Warren Buffett has called the current costly U.S. health care system “a hungry tapeworm on the American economy,” but will this new private health care system be delivered with a tapeworm so voracious that it will seek to consume the soul of medicine and, with it, freedom itself?