From my own personal view I looked long and hard at a couple of academic medicine appointments. One of the major selling points is the pension (with the director of the Oregon health sciences system retiring with a 72K/month pension). You make less than the private sector, but if you put in your 20-30 years the pension benefits can nearly make up some of the difference depending on some factors.
So I took a deep dive into some of these state pension plans and thought they were not sustainable. I don't know how they get fixed but I'm sure high earners will be first on the chopping block. Some of my friends in academics save extra on top of their pension for retirement because they're nervous and they should be.
Hell, I work for tOSU and most PhD professors with a decade or less of experience make over $100K annually. Not bad for such a cushy job.
I haven't quite figured out how that works for the MD Professors who see patients at the medical center and appear to work pretty much like any other physicians at a non-academic medical center. Do they get to bill insurances of the patients they see and earn revenue or are they only allowed their pay from the University?