FWIW, 6% is clearly "Hollywood accounting," just look at the stock chart. No business with six percent margins has stock performance like UNH.
https://www.ftc.gov/news-events/news/press-releases/2024/09/...
> The FTC’s administrative complaint alleges that CVS Health’s Caremark, Cigna’s ESI, and United Health Group’s Optum, and their respective GPOs—Zinc Health Services, Ascent Health Services, and Emisar Pharma Services—have abused their economic power by rigging pharmaceutical supply chain competition in their favor, forcing patients to pay more for life-saving medication. According to the complaint, these PBMs, known as the Big Three, together administer about 80% of all prescriptions in the United States.
The better comparison would be with other insurance carriers.