I'm a lawyer and accountant and until early 2021, for more than a quarter century I represented large hospital systems--both non-profit and for-profit--regarding payment for services, both from individuals and from insurers, including the second-largest for-profit chain in the U.S. and the second-largest non-profit chain in North Texas.
The FACT is that for more than 15 years, MOST hospitals have been HEMORRHAGING cash.
Liability insurers ROUTINELY claim massive overcharging and knock off about 50%. If the patient has a lawyer, the lawyer's fee is normally 40% of the TOTAL recovery.
MEDICAID PAYS 10-15 PERCENT. THAT'S LIKE A COMPANY HIRING YOU AT $20 PER HOUR AND THEN ONLY PAYING YOU **THREE**, "disallowing" the balance and DENYING ALL APPEALS.
HEALTH insurers CONTRACT to pay a discounted rate--AND THEN they send the bills to "slasher" "independent" auditors that KNOCK OFF 40%, so the insurers only pay the DISCOUNTED rate on the REDUCED amount--saying their "auditor" told them the going rate in that area.
And, like Medicare, if the hospital appeals, the health insurers deny all appeals.
The RESULT has been hospital systems REPEATEDLY joining up with some NON-PROFIT system--even though they already ARE a non-profit--then a few years later a group of the hospitals in that chain switches over to some other chain, etc.
And regarding MANAGERS, many of the CEO's and CFO's basically play "musical chairs"--
"Hey--they just decided on the new CEO. He's starting in January."
"Great! I hope HE'LL be able to get things straight around here. Not like THIS guy!"
Fast forward 6 months in ...
"Well, he's making a bunch of changes that, hopefully, will help."
New guy, 18 months later ...
"You know, changes take time. He's cleaning up the mess from the last guy. ...
Hey, did you hear? The CFO is leaving."
CEO about 3-and-a-half-years in ...
"I better start looking for a new job. That will take about a year. I can't keep relying on 'I'm fixing my predecessor's screw-ups."
Around 4-and-a-half-years, finds a new job, gives something like 6 months notice.
Keep in mind there is also a new CFO, who is also going through the same scenario.
THAT is THE NORM in the U.S. healthcare system. NOT "raking in the bucks for rich investors."