California’s healthcare industrial complex is booming. Guess who’s paying?

California’s hospitals recorded $11.3 billion in total net income in 2024 — 10% above pre-pandemic levels. The average hospital CEO in the state earns roughly $920,000 a year. And the largest union representing healthcare workers collected $114.5 million in dues in 2024 alone, according to its federal LM-2 filing — spending just 16 cents of every dues dollar on workplace representation.

Welcome to California’s healthcare industrial complex, where every institutional player prospers and the taxpayer picks up the tab.

Start with the hospitals. State data shows a 40% jump in net patient revenues from 2015 to 2022. By 2024, surging investment income pushed many “nonprofit” systems to record gains. Cedars-Sinai, Sutter, Kaiser — these are billion-dollar enterprises enjoying tax-exempt status while their executives collect compensation packages that would make Fortune 500 CEOs blush. The Cedars-Sinai CEO took home $5.7 million. UCLA’s Ronald Reagan Medical Center — a public hospital — paid its CEO $1.9 million. Nationally, HCA’s CEO earned $23.8 million, a 391-to-1 ratio over the median employee.

The Lown Institute has shown that high CEO pay doesn’t correlate with better community health outcomes. Many top-performing hospitals pay their leaders below the peer average. Lavish compensation is a symptom of an industry that adopted corporate culture without corporate accountability.

Then there’s the union side. SEIU positions itself as the righteous counterweight to hospital greed, championing the $25 healthcare minimum wage under SB 525 and pushing ballot measures to cap executive pay. Good politics. But SEIU Local 2015’s own 2024 federal LM-2 filing tells a different story. The union collected $114.5 million in dues from its 246,113 dues-paying members — an average of $465 per member. Of its total disbursements, $40.7 million went straight to SEIU’s national headquarters as per capita tax. Another $4.5 million went to political activities and lobbying, and $1.9 million to contributions and grants. The union’s president earned $306,000; one executive vice president earned $271,000; another earned $249,000. Meanwhile, only $18.3 million — 16% of dues revenue — was categorized as representational activities.

The most revealing piece is the unionization of In-Home Supportive Services workers. IHSS is a $28.5 billion program that pays caregivers — overwhelmingly family members — to look after their own elderly parents or disabled children at home. The state’s own budget documents note that providers are “oftentimes a family member or relative.” These are daughters bathing their mothers, parents feeding their disabled sons. They share no workplace. They have no shop floor. And they will never strike, because walking off the job means abandoning their own loved ones.

Yet SEIU Local 2015 claims to represent over 500,000 long-term care workers — though not all pay dues, according to its own filing. The rest were covered by union contracts but opted out of membership after the Supreme Court ruled they couldn’t be forced to pay. Still, the union is sitting on $142 million in cash and $168 million in total assets. The Court flagged this arrangement in Harris v. Quinn (2014), calling mandatory dues for these workers a “money-making scheme.” Despite that ruling, the default remains automatic withholding, and many caregivers — elderly, non-English-speaking, unfamiliar with opt-out procedures — keep paying.

Here’s the kicker: because SEIU dues are pegged to wages, every mandated raise automatically increases union revenue. Dues surged from $93.5 million in 2022 to $114.5 million in 2024. Higher wages mean higher dues, which fund more political spending, which produces more mandated raises. The cycle feeds itself.

None of this means caregivers don’t deserve fair pay — they absolutely do. But Californians should understand the full picture: hospitals banking billions, executives pocketing millions, and a union collecting $114.5 million from family members caring for their own relatives while devoting 84 cents of every dollar to something other than representing them. The health industrial complex is booming. The people financing it — patients, taxpayers, and the caregivers themselves — deserve to ask whether they’re getting their money’s worth.