> Then why do the 7 publicly listed health insurers have shitty shareholder returns?

CNC is up 90% YoY. That's far more than any of the largest tech companies. Alphabet is the highest of the tech stocks, and it's up 38% in the same period. When we look at the performance of the seven large U.S. publicly traded health insurers, their returns were extraordinary in the decade following the ACA.