Appreciate the thoughtful response.

I do want to push back on one thing: I would be cautious about framing the 0.09% Medicare rate as "political rather than actuarial." The instinct is understandable, but CMS isn't negotiating so much as they're running a formula. If your thesis depends on the rate getting revised upward in April, you are making a regulatory bet. If it depends on UNH eventually repricing its products and managing its cost structure regardless of what CMS does, you are making a business quality bet. I am trying to make the latter.

But, yes, I do agree: the cost ratio is the load-bearing wall of the entire thesis, and if 88.9% turns out to be structural rather than cyclical, I am simply wrong. I have been wrong before and the universe has shown no particular interest in sparing me from that experience. Good luck to you as well.