We have frequently discussed the perverse incentives provided to the leaders of health care organizations. They almost never pay a penalty for presiding over organizational actions that are unethical, harmful to patients, or even criminal (e.g., see posts here and here for some very recent examples.) However, they often collect outrageously huge compensation disproportionate to any reasonable measure of their organizations' performance. (e.g., see posts here and here for relevant recent examples.)
Now two news articles, based in turn on research studies, further illuminate how hired managers and executives have become so wealthy and unaccountable.
The first news article was in the New York Times, and was in turn based on an accounting study. In summary,
Here are some of the major comparisons the report makes:
- Paid More than the GDP of Tajikistan
Again, note that all comparisons below refer only to these 2591 most highly paid executives of 483 companies, not all the companies' executives.
- Paid More than Audit Expenses
- Paid More than Income Taxes
- Pay Rises While Stock Prices Fall
- Paid a Substantial Fraction of Total Operating Revenue
The article used a health care example to illustrate this one:
Further details made this a particularly telling example of perverse incentives given to executives:
Parenthetically, some of the charges that affected Allergan's earnings were clearly due to a $375 million fine after a guilty plea to a federal misbranding charge and $225 million related civil penalties the company paid in 2010. As we noted in this post, the US Department of Justice alleged that Allergan paid kickbacks to promote a drug for unapproved uses. Thus, what cost the company a major piece of its revenues were costs related to unethical behavior including one federal misdemeanor, and allegedly paying kickbacks to doctors to promote a drug for unapproved uses. However, while this behavior caused a marked drop in earnings, the research above showed the impunity of the executives who presided over this behavior, whose compensation held steady or rose.
- Paid a Substantial Proportion of Research and Development Expenses
- Pay Equal to a Substantial Proportion of Market Capitalization
To put it a different way, for a few corporations, the pay of the top five executives was equal to at least one percent of the total value of the corporations as measured by the value of all stock shares outstanding.
In summary, the R. G. Associates' report suggests that the salaried executives, who the NY Times article reminded us are "hired hands," were generally paid amounts that seemed outrageously disproportionate to every metric used.
Furthermore, a second article in the Washington Post provided an even more astonishing comparison.
- Paid Enough to Become a Majority of the Richest Americans
Summary
So now it appears that the disproportionate compensation given to hired executives of large corporations, including health care corporations, have made them the majority of the very rich. Most of the very rich are thus hired corporate employees, not company owners, not entrepreneurs, not even those who inherited wealth, or who are sports stars or rock musicians. This transformation of the face of the very wealthy has occurred at a time when the other employees of those corporations have generally stagnant incomes, and when those who have invested in those corporations, including many in the middle-class who have invested their retirement savings, have barely made money.
So it turns out that in large corporations, including large health care corporations, it has become all about the top bosses. The top bosses are likely to be paid enough to make them some of the richest US citizens. Their pay likely comes off the top, so it has priority over profits and stock-holders gains, much less the pay of the lesser employees.
So it is clear that hired executives of large corporations have engineered perverse incentives for themselves that means never having to say they're sorry, never having to be accountable for anything the company does wrong. Hence, there should be no mystery why US health care is the most expensive in the world, and despite its expense, is not very accessible and not of good quality. The main culprit is a peculiar perversion of laissez faire capitalism in which the top managers have staged a coup, and have become the new oligarchs and plutocrats, and thus put their interests ahead of all others.
So to reform health care, we must reverse the managers' coup d'etat, and restore leadership of health care organizations that puts the mission, and the health of patients and the population first, and is accountable to corporate owners (when applicable) and to patients and the public. But that will mean now going up against those who have made themselves the richest and most powerful people in the country and the world, who will not lightly give up their oligarchy.
Now two news articles, based in turn on research studies, further illuminate how hired managers and executives have become so wealthy and unaccountable.
The first news article was in the New York Times, and was in turn based on an accounting study. In summary,
a recent, immensely detailed report in The Analyst’s Accounting Observer, a publication of R. G. Associates, an independent research firm in Baltimore. Jack Ciesielski, the firm’s president, and his colleague Melissa Herboldsheimer have examined proxy statements and financial filings for the companies in the Standard & Poor’s 500-stock index. In a report titled 'S.& P. 500 Executive Pay: Bigger Than ...Whatever You Think It Is,' they compare senior executives’ pay with other corporate costs and measures.
Here are some of the major comparisons the report makes:
- Paid More than the GDP of Tajikistan
Total executive pay increased by 13.9 percent in 2010 among the 483 companies where data was available for the analysis. The total pay for those companies’ 2,591 named executives, before taxes, was $14.3 billion.
That’s some pile of pay, right? But Mr. Ciesielski puts it into perspective by noting that the total is almost equal to the gross domestic product of Tajikistan, which has a population of more than 7 million.
Again, note that all comparisons below refer only to these 2591 most highly paid executives of 483 companies, not all the companies' executives.
- Paid More than Audit Expenses
158 companies paid more in cash compensation to their top guys and gals last year than they paid in audit fees to their accounting firms.
- Paid More than Income Taxes
Thirty-two companies paid their top executives more in 2010 than they paid in cash income taxes.
- Pay Rises While Stock Prices Fall
The report calculated that at 179 companies in the study, the average value of stockholders’ stakes fell between 2008 and 2010 while the top executives at those companies received raises.
- Paid a Substantial Fraction of Total Operating Revenue
It identified 24 companies where cash compensation last year amounted to 2 percent or more of the company’s net income from continuing operations.
The article used a health care example to illustrate this one:
Topping this list is Allergan Inc., the health care concern whose top executives received, after taxes, an estimated $2.6 million in salaries last year. That amounted to 50 percent of what the company earned from continuing operations, the report said.
Further details made this a particularly telling example of perverse incentives given to executives:
Caroline Van Hove, an Allergan spokeswoman, said that the salaries were large when compared with net income in 2010 because one-time charges reduced earnings significantly that year; in previous years, she noted, earnings were far higher than executives’ pay. She also said the company’s C.E.O. had not received an increase in salary over the past three years.
Parenthetically, some of the charges that affected Allergan's earnings were clearly due to a $375 million fine after a guilty plea to a federal misbranding charge and $225 million related civil penalties the company paid in 2010. As we noted in this post, the US Department of Justice alleged that Allergan paid kickbacks to promote a drug for unapproved uses. Thus, what cost the company a major piece of its revenues were costs related to unethical behavior including one federal misdemeanor, and allegedly paying kickbacks to doctors to promote a drug for unapproved uses. However, while this behavior caused a marked drop in earnings, the research above showed the impunity of the executives who presided over this behavior, whose compensation held steady or rose.
- Paid a Substantial Proportion of Research and Development Expenses
Moving on to R.& D. costs, the report examined the 62 technology companies in its sampling that reported such an expense, excluding certain costs associated with acquisitions.
Mr. Ciesielski found that the median level of executive pay was equal to 5.3 percent of these companies’ R.& D. expenditures.
- Pay Equal to a Substantial Proportion of Market Capitalization
Finally, there’s the comparison of executive pay with market capitalization. As Mr. Ciesielski noted, this calculation provides the biggest shock value.
Eleven companies analyzed in the report gave top executives a combined pay package amounting to 1 percent or more of the companies’ average market value over the course of the year.
To put it a different way, for a few corporations, the pay of the top five executives was equal to at least one percent of the total value of the corporations as measured by the value of all stock shares outstanding.
In summary, the R. G. Associates' report suggests that the salaried executives, who the NY Times article reminded us are "hired hands," were generally paid amounts that seemed outrageously disproportionate to every metric used.
Furthermore, a second article in the Washington Post provided an even more astonishing comparison.
- Paid Enough to Become a Majority of the Richest Americans
The largest single chunk of the highest-income earners, it turns out, are executives and other managers in firms, according to a landmark analysis of tax returns by economists Jon Bakija, Adam Cole and Bradley T. Heim. These are not just executives from Wall Street, either, but from companies in even relatively mundane fields such as the milk business.
The top 0.1 percent of earners make about $1.7 million or more, including capital gains. Of those, 41 percent were executives, managers and supervisors at non-financial companies, according to the analysis, with nearly half of them deriving most of their income from their ownership in privately-held firms. An additional 18 percent were managers at financial firms or financial professionals at any sort of firm. In all, nearly 60 percent fell into one of those two categories.
Summary
So now it appears that the disproportionate compensation given to hired executives of large corporations, including health care corporations, have made them the majority of the very rich. Most of the very rich are thus hired corporate employees, not company owners, not entrepreneurs, not even those who inherited wealth, or who are sports stars or rock musicians. This transformation of the face of the very wealthy has occurred at a time when the other employees of those corporations have generally stagnant incomes, and when those who have invested in those corporations, including many in the middle-class who have invested their retirement savings, have barely made money.
So it turns out that in large corporations, including large health care corporations, it has become all about the top bosses. The top bosses are likely to be paid enough to make them some of the richest US citizens. Their pay likely comes off the top, so it has priority over profits and stock-holders gains, much less the pay of the lesser employees.
So it is clear that hired executives of large corporations have engineered perverse incentives for themselves that means never having to say they're sorry, never having to be accountable for anything the company does wrong. Hence, there should be no mystery why US health care is the most expensive in the world, and despite its expense, is not very accessible and not of good quality. The main culprit is a peculiar perversion of laissez faire capitalism in which the top managers have staged a coup, and have become the new oligarchs and plutocrats, and thus put their interests ahead of all others.
So to reform health care, we must reverse the managers' coup d'etat, and restore leadership of health care organizations that puts the mission, and the health of patients and the population first, and is accountable to corporate owners (when applicable) and to patients and the public. But that will mean now going up against those who have made themselves the richest and most powerful people in the country and the world, who will not lightly give up their oligarchy.
