Somewhere last week I read someone say that “removing the profit motive” would fix the problems with our health care, because someone’s prosthetic arm had been taken away. Meanwhile, in countries where the profit motive has been removed, governments are looking for ways to block general care from people who are too old or don’t eat well.

We cannot remove the profit motive from health care. It will always be there. The question is only who the customer is, because wherever the profit comes from that’s who the customer is. Resources will always cost something, and if we try to pretend it doesn’t all we’ll end up doing is moving the costs into bribes or under the control of people who don’t care about patients.

We can either move costs closer to the patient or move them away into inaccessible layers of bureaucracy. Today, the profit motive is between a doctor and an insurance company or HMO, and between the insurance company/HMO and an employer. If tomorrow it ends up being between an HMO and a government bureaucracy, that’s not going to be better.

We need a system where the profit motive for doctors comes from helping patients; where medical equipment makers such as those who make prosthetics fight for business from the patient, who wants to shop for quality rather than the insurance company which doesn’t. We need to see prosthetic limbs and other medical care drop in price and rise in quality the same way that products do in any other free market.

“Remove the profit motive” is an easy thing to say in today’s world of overregulated, government-distanced HMOs, but it’s wrong because it misses the point that the profit motive has already been removed from the patient. Profit comes from the customer. When the customer is not the patient, profit comes from cutting patient benefits. When the customer is an insurance company, an HMO, an employer, or the government, the patient doesn’t matter from a profit perspective. What matters is attracting employers and government agencies, and that means cutting benefits.

Eric Simpson’s problem was a result of “removing” the profit motive from health care; removing it even further away from patients won’t help. If we want a system where the patient matters, we want one where health care providers profit directly from patients, one where the actual benefits come under free market forces. We won’t need less expensive HMOs if we have less expensive treatment.