Indeed administrators make obscene profits. Discovery Health makes a 40% profit on their scheme administration. That is way above what margins most companies make on the JSE. Discovery Medical scheme trustees are failing, in that they are not asking why they are overpaying to such an extent. Their previous KPMG report checked whether they get value for money, but apparently did not question whether they should be paying less, in fact. Having multiple schemes leads to competition and innovation. If you only have one or two, that aspect falls away, which is bad for everyone. One can have a virtual pooling of risk in a Risk Equalisation Fund without physical pooling in one or two schemes.  All the positives of pooling, along with competition still happening to drive innovation. One does need change to keep the industry sustainable, but radically reducing funds to one or two is not the way to go. Fewer schemes is fine, but one or two is too few. Restructuring options is another way to help