> How do they even pay their executives' salaries?
I suspect less goes to executives than you think. Most of it is going to pay employees in the insurance industry.
The irony is that they are being paid to say "no." Perhaps if they instead went to work as service providers, we could get more services for what we spend.
Healthcare executive pay is pretty darn high, more money than any family needs to live comfortably.
Keep in mind this is just for Blue Shield California. There are executives of other health insurance systems in other states and regions who are making similar compensation.
However, I'll go ahead and say right now that I support the idea of these executives being paid these salaries, but on one condition: that we first achieve the goal of 100% of Americans having affordable access to healthcare. Once that goal is achieved, then we can start paying executives big bonuses and incentives. Deal? (Yeah, right...)
Below is a summary of the compensation paid in 2024 to Blue Shield of California’s President and Chief Executive Officer (CEO), Chief Financial Officer (CFO), and top three highest paid executives (other than the CEO and CFO) who were employed by Blue Shield of California at year-end.
Epic Systems is a private company, so there's no executive pay information, but the founder Judy Falkner's estimated net worth is $7.8 billion. Perhaps Epic could reduce the price of its very expensive software for providers to help ease healthcare costs and maybe Judy could give up some of those billions and not notice any difference in her quality of life?
BCBS CA revenue is approximately $25B. The total of above is $25.6M. That's 0.1%.
You may view those salaries as appropriate for leading companies of this size or immoral and outrageous. But either way executive comp is not the big problem with US healthcare costs.
$14,570 per person is our healthcare cost per capita.
For one thing, cutting out even that tiny 0.1%, that's a savings of $15 a year if I wasn't paying my insurance company's CEO. I would absolutely love to keep that $15. The idea that more than one dollar every single month from every single person is going to the CEOs of all our healthcare services is actually INSANE when you think about it.
That really means that out of my $14,570 yearly healthcare cost I could be paying something like $5/month just on executive salary. Who knows, maybe it's even more!
This is, again, insane. Why do Cleveland Clinic executives need to be paid $30 million/year?
This isn't administrative cost, like all the hard-working people who do the clerical work that keeps these systems operating. This is just the salaries of an extremely small group of people, less than 10 people per company.
All of these entities are allowed to make excess profit and/or have loose definitions of non-profit status, and pay CEOs dozens to hundreds of times the salary of their lowest paid employees. There isn't really a limit to the amount they can compensate top executives.
I think this summary is reductive, because it ignores the surprisingly dense layers of middle management in hospitals and clinics that are paid more than the medical professionals (and even that ignores external middle managers like PBMs etc).
Blue Shield of California has 4.5 million plan members, so all of these executive salaries combined add up to 49 cents per member per month. It's not a significant factor in premium costs.
Sweet. Let's charge 49 cents per million dollars of unrealized capital gains per month, it's not significant and less of a burden than 49 cents per month for healthcare.
I think that's highly significant. Keep in mind that that's only one provider in the system. You've also got to pay the executive salaries of your hospital system, your pharmacy chain, your drug company, medical equipment company, etc.
If we figure that every company involved in your $15k/year healthcare cost is paying 0.1-0.5% of their revenue to executive compensation (Cleveland Clinic as a random example pays 0.4% of revenue to the executives, $30 million) then we are talking about a small streaming video subscription worth of cost just which is allocated not on paying a productive group of administrators to keep the lights on, but instead paying excess incentives to an extremely small group of people.
In reality, if CEO compensation was capped to something reasonable like $500,000/year or 10x the pay of the lowest paid employee, there would still be CEOs and the quality of CEOs would not decline because it would still be the highest paid job on the market. Everyone involved in our economy would be just that much richer if the wealth wasn't getting unnecessarily concentrated.
$500,000 is a lot of money, I don't want to minimize that, but it would not be the highest paid job on the market. There's a number of roles in medicine, law, finance, and nowadays software that pay more for fewer managerial duties. There really isn't much room to argue for cutting executive pay without arguing that it's unimportant to get the best people in executive roles.
And that's an argument you can certainly have, but it seems strange to make it a precondition to fixing the healthcare system, when cutting executive pay would resolve only a small fraction of the problem.
That's pretty pathetic pay when we have run of the mill employees(ie non-founders) like Sundar and Satya becoming billionaires from their pay packages.
I suspect less goes to executives than you think. Most of it is going to pay employees in the insurance industry.
The irony is that they are being paid to say "no." Perhaps if they instead went to work as service providers, we could get more services for what we spend.