In tough economic times, some people are making a fortune. It may surprise you to learn that some of those people work for a not-for-profit organization known as Blue Cross Blue Shield of North Carolina.

Blue Cross has been taking some heat lately for its most recent profit report, in which it disclosed that conservative estimates of its 2003 performance show that BCBS-NC earned $196 million in profits. In the wake of this stunning report, BCBS spokespersons have maintained that the insurer has no plans to give rebates to its customers.

On its face this is highly problematic; as the state's insurer of last resort, Blue Cross has a special responsibility to its community. Overcharging premiums has taken $200 million out of the state's economy and put it in the Blue Cross bank account, which makes no sense.

What's particularly outrageous, though, is what BCBS is doing with part of these record profits: passing them on to top executives.

A recent filing with the state's Department of Insurance shows that the top ten executives at Blue Cross all received huge raises in 2003. Leading the way was CEO Bob Greczyn, who earned a total of just over $2 million last year. That was a raise of more than $900,000 from his 2002 pay.

In all, BCBS-NC spent more than $9.5 million paying its top ten executives in 2003. That represents an increase of a staggering 94% over the prior year's pay level for those same positions.

Nobody can condemn BCBS-NC as an institution--its value to the community is too great. But with that value comes considerable obligation.

Blue Cross has tried to meet that obligation recently by pledging $2 million per year to the state's system of free health clinics for the next five years. That's a noble gesture, but it is tarnished considerably by the fact that that annual contribution is smaller than Bob Greczyn's compensation package. And although free clinics are a worthy cause that help provide access to health care, their efforts are dwarfed by the network of 70 or so community health centers that are the true backbone of the state's available health care for the poor.

Confronted with profit figures, a spokesperson for the profitable not-for-profit told the News and Observer last week that Blue Cross was going to sit on the $200 million in case there was a flu outbreak or a natural disaster. The only widespread sickness at this point, however, may occur among people who find out where too much of their BCBS premiums are going.

Last summer Blue Cross abandoned its questionable bid to convert to a for-profit corporation. The effort had prompted widespread speculation that at least part of the motive for conversion was to enrich the people at the top of the BCBS corporate ladder.

Now it's clear that that's happening anyway.