Which is a much more accurate calculation of overhead efficiency. By quoting “overhead as a percentage of total expenses” you are skewing the ratio to benefit Medicare because the average Medicare recipient generates approx 2X the healthcare expenditures relative to the healthier private insurance pop. The formula that gets used is : (total expenditures - claims paid = “overhead” / total expenditures. In other words, if you significantly increased the average claim expense for private insurance (to compare apples to apples) the “overhead ratio” for private insurance drops significantly. Using a ratio that calculates “Average overhead per insured” (Total overhead expense / total customers) is a much more accurate reflection of efficiency.

The WaPo article quotes one study that shows avg overhead per customer is actually higher for Medicare...but I’ve seen quite a few similar analyses out there.