I think comparison to Kaiser is very telling on the pros and cons. I have options for united and Kaiser at work. Kaiser is slightly cheaper but comes with major pros and cons. Cons are major internal gatekeeping for drugs and procedures. Pros are no getting stuck between provider insurer billing disputes, and most of your data under one roof.

Kaiser works well for people willing to fight their doctors to get the care they want.

United works well for people willing to fight their insurance billing department. It also works for people planning to hit their maximum annual out of pocket limit.

Let's say I'm legally required to use 80% of my salary on cupcakes. My wife makes a cupcake, and I purchase it for $100k. Do we think this was the likely intended result of the legislation?

You’re using hypotheticals when we have actual numbers. (And more-consolidated competitors with higher customer satisfaction rates.)

You have a solid hypothesis. The cross ownership exists. But the hypothesised effect—margin expansion—isn’t observed. The best we can say is they tried to juice margins but failed to, which is neither here nor there, and pins administrative incompetence—not greed—as the culprit.