“The Great Reckoning” is a phrase that conjures a decisive moment—a juncture when accountability can no longer be deferred, and the record of promise and performance stands exposed. In literature and in life, this reckoning often signifies the moment when justice, clarity, and consequence converge, forcing institutions and individuals alike to confront the uncomfortable truth. Nowhere does this ring truer today than in American healthcare.
The political pundits and media personalities remain largely silent as this moment of reckoning approaches. When the experts are proven wrong, admissions are few and far between. They have been wrong, time and again, about COVID-19 mitigation and treatment strategies. They were wrong about the grand promises of the Affordable Care Act (ACA), or “Obamacare,” as it’s commonly known.
Remember the assurances? “If you like your doctor, you can keep your doctor. If you like your plan, you can keep your plan.” The hallmarks advertised—access, quality, and care—have proved elusive for millions. These slogans, so confidently proclaimed, have not stood up to the realities faced in doctor’s offices, hospital corridors, and, most of all, in the homes of patients who depend on the system.
Today, those on the frontline—doctors, nurses, technicians, and their patients—are awakening to the fact that both the quality and the cost of care are moving rapidly in the wrong direction. Where is the promised improvement? Why are wait times for cardiology or oncology stretching into weeks, even for patients urgently needing follow-up after major treatments? Why do cancer survivors in cities like Boise, Idaho, wait a month for critical mammogram results, just a year after chemotherapy? Access to timely care has become a universal problem—not just for Medicaid recipients but for working families across the nation, many of whom will face an average 26% increase in health insurance premiums this year alone. That burden will fall on both businesses and families who already pay dearly to insure themselves.
Yet, while patients struggle with access, cost, and uncertainty, health insurers and corporate executives in hospital systems have never had it so good. Take the facts: Since the enactment of Obamacare, the value of major health insurer stocks has soared by a staggering 1,000%, and the industry is now buoyed by more than a trillion dollars a year in public subsidies. According to recent reporting, the CEOs of the nation’s ten largest health insurers raked in a combined $134 million in compensation in 2024 alone—a 27% jump over previous years—while the average CEO salary among major insurers now hovers near $20 million, encompassing salary, bonuses, stock, and other perks. Hospital CEOs, even at so-called nonprofits, have also benefitted from inflated paydays: from 2009 to 2023, the average hospital chief’s earnings rose by 27.5%, outpacing the mere 9.8% growth for average hospital employees. At the biggest integrated health systems, individual CEO compensation routinely tops $10 million per year.
This surge in executive pay has dramatically outpaced workforce wage growth and even general inflation. The driver is clear: industry consolidation, soaring profitability, and incentive compensation tied to system size and revenues. In effect, the ACA era, rather than reducing executive excess, has coincided with a gilded age for corporate health leaders.
And the money does not stop with executives. In the shadowy corridors where politics meets profit, campaign cash flows freely. During the last presidential cycle, health insurers gave five times more to Kamala Harris than to Donald Trump. Blue Shield of California handed $500,000 and UnitedHealth another $75,000 to Governor Gavin Newsom’s proposition efforts—measures that helped secure additional congressional seats for Democrats, raising the stakes for future legislative giveaways. It’s a pay-to-play system: billions in subsidies flow to corporations, and some of those billions are quietly recycled into the campaign coffers of politicians who keep the wheels spinning.
In Idaho—like elsewhere—the political class, from both parties, has proved susceptible to the advances of “corporate medicine.” Campaign contributions from hospital systems and insurance giants flow into statehouses just as they do at the federal level, further entangling the interests of politicians with those of the industry. Just as major developers and financiers hold sway in municipal politics, the levers of state government are now routinely greased by the largesse of healthcare corporations.
So, who is serving whom? Who is the supplicant, and who is the benefactor? At this moment of reckoning, these are the questions the American public must ask—again and again—until we get honest answers. The scale and duplicity of the current system are only possible at the intersection of corporate cronyism and a bloated federal budget. When politics follows the money, and the money never stops, real accountability—real justice—becomes the only remedy left.
