I don't really think this is true in non-charity work. Half of American hospitals are nonprofit and many of the insurance conglomerates are too, like Kaiser. The executives make plenty of money. Kaiser is a massive nonprofit shell for profitmaking entities owned by physicians or whatever, not all that dissimilar to the OpenAI shell idea. Healthcare worked out this way because it was seen as a good model to have doctors either reporting to a nonprofit or owning their own operations, not reporting to shareholders. That's just tradition though. At this point plenty of healthcare operations are just normal corporations controlled by shareholders.