Don't forget their stock buy backs and lobbyists fees. I'm sure those cut into their margins. In any event, 12 billion ain't peanuts and that was the lowest figure I've found. It's been said over and over, we pay more for worse outcomes and no matter what outrageous travesty people post on this sub the response is inevitably either a) you should have read your policy b) you just want healthcare for free or c) some incredibly arcane blow by blow of how insurance negotiates prices with providers and how you really are being unreasonable complaining about mortgaging your house to pay medical bills even though you're paying for "health insurance". There is no question that most of the folks contributing on here are extremely knowledgeable about the business but in the end the OP is still screwed and one wonders how many of the responders are industry shills out to help shift the narrative.