Illustration: Rebecca Zisser/Axios

The chief executives of 177 health care companies collectively made $2.6 billion in 2018 — roughly $700 million more than what the National Institutes of Health spent researching Alzheimer's disease last year, according to a new Axios analysis of financial filings.

Why it matters: The pay packages reveal the health care system's real incentives: finding ways to boost revenue and stock value by raising prices, filling more hospital beds, and selling more drugs and devices.

By the numbers: The median pay of a health care CEO in 2018 was $7.7 million. Fourteen CEOs made more than $46 million each.

  • The figures were calculated by using actual realized gains of stock options and awards, which are in the annual proxy disclosures companies file with the Securities and Exchange Commission.

The highest-paid health care CEO last year was Regeneron Pharmaceuticals’ Leonard Schleifer, who made $118 million. A spokesperson said Schleifer "has built Regeneron from a start-up into a leading innovative biopharmaceutical company" and that he "generally holds his option awards until nearly the end of the full 10-year option term."

  • Pharmaceutical CEOs represented 11 of the 25 highest compensation amounts last year.
  • Executives of medical device and equipment companies that don't attract as much attention — such as Intuitive Surgical, Masimo, Hill-Rom and Exact Sciences — also were sitting at the top.

Between the lines: A vast majority of CEO pay comes from exercised and vested shares of stock. Salaries are almost an afterthought.

  • But health care executives routinely earned millions of dollars in cash bonuses, based on factors like revenue goals and financial metrics that experts say can be manipulated.
  • Quality of care is either not a factor at all in CEOs' bonuses, or a marginal one.

Details: McKesson CEO John Hammergren received a $4 million bonus for hitting financial targets last year, just as the company was facing a slew of lawsuits over its role in the opioid crisis. McKesson did not immediately respond to questions.

  • Community Health Systems CEO Wayne Smith recorded a $3.3 million bonus even though his hospital chain continued to hemorrhage money. His bonus was heavily weighted by an adjusted metric that made CHS look profitable, and none of his bonus was tied to patient outcomes. CHS did not respond.

Worth noting: The analysis does not include compensation from not-for-profit hospital systems, because their 2018 tax filings have not been released yet.

Go deeper: The entire analysis

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Justice Department sues Google over alleged search monopoly

Illustration: Lazaro Gamio/Axios

The Justice Department and 11 states Tuesday filed an antitrust lawsuit against Google, accusing the company of using anticompetitive tactics to illegally monopolize the online search and search advertising markets.

Why it matters: The long-awaited suit is Washington's first major blow against the tech giants that many on both the right and left argue have grown too large and powerful. Still, this is just step one in what could be a lengthy and messy court battle.

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Illustration: Aïda Amer/Axios

  1. Politics: Americans feel Trump's sickness makes him harder to trustFlorida breaks record for in-person early voting.
  2. Health: The next wave is gaining steam.
  3. Education: Schools haven't become hotspots.
  4. World: Ireland moving back into lockdown — Argentina becomes 5th country to report 5 million infections.

In photos: Florida breaks record for in-person early voting

Voters wait in line at John F. Kennedy Public Library in Hialeah, Florida on Oct. 19. Photo: Eva Marie Uzcategui/AFP via Getty Images

More Floridians cast early ballots for the 2020 election on Monday than in the first day of in-person early voting in 2016, shattering the previous record by over 50,000 votes, Politico reports.

The big picture: Voters have already cast over 31 million ballots in early voting states as of Tuesday, per the U.S. Elections Project database by Michael McDonald, an elections expert at the University of Florida.

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