Healthcare and Security: Why Some Industries Cannot Functionally Be For-Profit

When we examine the fundamental structure of certain industries, we encounter a peculiar characteristic that distinguishes them from conventional commercial enterprises. Healthcare and security, unlike manufacturing or retail, possess an inverse relationship between success and economic activity—a relationship that creates tension when these functions are organized according to profit-seeking imperatives.

Consider what success actually means in these domains. A genuinely successful healthcare system produces populations whose baseline health requires minimal medical intervention. A genuinely successful security apparatus creates conditions where the need for response diminishes toward insignificance. In both cases, achievement of the stated purpose necessarily entails reduction of activity. The healthier a population becomes, the less healthcare it requires. The safer a community becomes, the less security intervention it necessitates.

This characteristic alone does not present a problem—until we reorganize these maintenance functions according to market logic designed for production and exchange. Markets function effectively when success and activity align—when producing more, selling more, and doing more all serve the stated purpose. A successful manufacturer benefits from increased production. A successful retailer thrives on expanded transactions. Growth and purpose move in the same direction.

But when we apply this same organizational logic to functions where success means reduced need for service, we create a structural contradiction. If revenue depends on treating disease, then the elimination of disease threatens the economic foundation of the enterprise. If budgets justify themselves through crime rates, then the creation of genuinely safe communities directly undermines institutional stability.

The result is not difficult to predict. Healthcare reorganizes itself around the management of chronic conditions rather than their resolution. Patients become long-term customers rather than people to be healed and released from dependence on medical intervention. Security apparatus expands in response to crime rather than investing primarily in the conditions that would prevent crime from emerging in the first place.

This transformation does not require malicious intent from individual actors. Most physicians genuinely wish to heal. Most officers of the law do not desire the perpetuation of crime. But the structure within which they operate rewards different behavior than the stated purpose would suggest. The physician who successfully cures a patient has eliminated a source of ongoing revenue. The physician who manages a chronic condition through regular appointments, ongoing prescriptions, and periodic interventions has created a stable stream of income. One approach serves the patient's wellbeing. The other serves the economic logic of the institution. When these two imperatives come into conflict—and within a for-profit structure, they inevitably do—the economic imperative tends to prevail, not through conscious malevolence, but through the simple mechanics of institutional survival and growth.

Similarly, a police department that successfully prevents crime through addressing root causes may find itself facing budget reductions due to decreased reported incidents. Even when these institutions are technically public, they operate under a market-mimicry logic, where “success” is measured by the volume of processed cases and the expansion of departmental infrastructure rather than the contraction of the problem itself. A department that responds to high crime rates with expanded enforcement can justify increased funding, additional personnel, and enhanced infrastructure. The incentive structure rewards visible intervention over pre-emptive prevention, and crisis response over the creation of conditions where crises do not arise in the first place.

This dynamic transcends the distinction between private and public sectors. Whether the goal is shareholder profit or departmental budget maximization, the logic of growth remains the same. A security apparatus—private or public—that successfully eliminates the root causes of crime faces the “threat” of becoming obsolete. Consequently, the system evolves to prioritize visible intervention over prevention. It seeks a “steady state” of manageable crisis that justifies its continued existence or expansion.

We might recognize this pattern more clearly if we considered an analogy from a different domain. Imagine a building superintendent whose compensation and job security depended not on maintaining systems in good working order, but on responding to emergencies. Under such an arrangement, the superintendent who prevents pipes from bursting, who maintains electrical systems before they fail, who ensures that routine maintenance forestalls crisis—this superintendent would be economically disadvantaged compared to one who allows systems to deteriorate until dramatic failures occur, generating billable emergencies.

No one would design building maintenance this way intentionally. We would recognize immediately that the incentive structure contradicts the function's purpose. Yet this is precisely how we have structured healthcare and security—the domains whose purpose is the maintenance of human safety and wellbeing.

The Ideology of Universal Marketization

The question then becomes: why has this persisted? Why have we continued to organize these functions—essential to our wellbeing and survival—according to logic that guarantees their corruption?

The persistence of these arrangements is rarely a matter of conscious design, but rather the result of a specific ideological inheritance. We are living within the terminal stages of an accounting paradigm honed within British imperial administration and later universalized through American financial hegemony—the assumption that market mechanisms optimize all domains of human activity. According to this framework, competition ensures efficiency, profit motive ensures quality, and private enterprise inevitably outperforms public administration. These principles, gradually and unconsciously, became elevated to the status of universal truths applicable to every sphere of social organization.

But markets do not optimize everything. They optimize what they are structured to optimize—and when the organization contains a structural contradiction between its stated purpose and economic incentive, this “market optimization” produces perverse outcomes. A healthcare market optimized for profit does not produce health. It produces the most profitable relationship to disease. A security market optimized for revenue does not produce safety. It produces the most profitable relationship to crime.

The distinction is not subtle, yet it remains largely invisible within contemporary discourse. We debate healthcare reform as if the problem were simply how to manage the system—never examining whether the fundamental organizational logic itself can produce the outcomes we claim to desire. We discuss criminal justice reform as if the problem were one of police training, sentencing guidelines, or procedural fairness—rarely acknowledging that the entire apparatus depends economically on the continuation of the phenomenon it ostensibly exists to eliminate.

The ideology that enables these perversions serves a function beyond its claims about efficiency. It provides justification for the conversion of human needs into profit opportunities. When every domain of life can be reconceptualized as a market, every human vulnerability becomes a potential revenue stream.

The Observable Consequences

The consequences of this misapplication manifest throughout both industries in patterns so pervasive they have become invisible through familiarity. In healthcare, we observe the steady expansion of chronic disease management at the expense of cure and prevention. Pharmaceutical companies develop medications that require lifelong administration rather than treatments that resolve conditions. Medical practices optimize for volume of patient visits rather than reduction of patient need. Insurance structures reward procedure codes rather than health outcomes.

The financial incentives operate at every level. Hospitals profit from occupied beds, not from populations that remain well enough to avoid hospitalization. Pharmaceutical companies generate revenue from ongoing prescriptions, not from patients who recover and require no further medication. In a for-profit structure, a cure is a market-exit event; a treatment is a recurring revenue stream. Device manufacturers benefit from conditions that require technological intervention, not from bodily systems that function without assistance.

None of this requires conspiracy. It requires only that actors within the system respond rationally to the incentives before them. A hospital administrator seeking survival within the institution will pursue strategies that generate revenue. A pharmaceutical executive responsible to shareholders will inevitably prioritize treatments that create recurring income. A physician working within a system that rewards throughput—the rapid processing of patients—is incentivized to see more patients for shorter periods rather than fewer patients for longer, more thorough care.

The same pattern repeats in security. Police departments measure success through arrest statistics rather than crime reduction. Private security firms grow in response to the increase in perceived threats rather than demonstrably safe communities. Prison systems expand to accommodate communities whose incarceration generates profit for private operators.

The result is two systems that perpetuate the problems they ostensibly exist to solve. Not through active malice—though malice can certainly exist in some cases—but through structural logic that makes perpetuation economically rational and permanent resolution economically threatening.

Consider the treatment of metabolic diseases like diabetes, obesity, or cardiovascular conditions. These represent some of the most prevalent and costly health challenges in modern industrial societies. They are also largely preventable and, in many cases, reversible through changes in diet, activity, and lifestyle. Yet the healthcare system generates minimal revenue from prevention and reversal. It generates enormous revenue from ongoing management—medications, monitoring devices, specialist consultations, eventual surgical interventions, and treatment of complications.

A rational actor within this system will focus their resources where they generate returns. Prevention programs may be offered, but often receive a fraction of the investment directed toward management technologies and pharmaceuticals. The economic logic is clear, even as it contradicts the stated purpose of promoting health.

In security, we observe similar dynamics. Community programs that address underlying conditions—poverty, lack of opportunity, social fragmentation—require long-term investment with diffuse returns. They do not generate immediate measurable outputs that justify expanded budgets. Enforcement and incarceration, by contrast, produce quantifiable metrics—arrests made, sentences served, facilities occupied. These outputs justify institutional expansion regardless of their effectiveness at creating genuinely safer communities.

The question of effectiveness itself becomes secondary to the question of institutional survival. Mass incarceration persists despite clear evidence of its ineffectiveness because it generates revenue for private prison operators, justifies law enforcement budgets, and provides political theater for officials seeking to appear "tough on crime." The stated purpose—public safety—becomes subordinate to the economic and political purposes served by maintaining high incarceration rates.

Historical and Civilizational Context

This reorganization of essential functions according to profit imperatives did not emerge from careful consideration of what organizational structure would best serve human wellbeing. It emerged from the systematic extension of market logic into domains previously organized through other principles—commons-based arrangements, collective responsibility, professional obligation untethered from profit maximization—structured around meeting shared needs rather than extracting revenue.

The transformation accelerated over the past three centuries alongside the expansion of industrial capitalism and the political systems that supported it. Healthcare, which had operated through various models including charitable provision, professional guild structures, and family-based care, became progressively commodified. Security, traditionally understood as a collective responsibility administered through community structures and public office, became increasingly privatized and commercialized.

This extension was not accidental—it served specific interests. The transformation of healthcare into an industry created investment opportunities, revenue streams, and mechanisms of capital accumulation where none had existed before. The same pattern repeated in security, whose very nature resists profitable organization yet whose reorganization according to market principles generated enormous wealth for those positioned to capture it.

We might observe that other civilizational models organized these functions differently. Medical knowledge and practice often operated as collective endeavors, with practitioners trained and supported through institutional mechanisms that did not depend on extracting profit from the sick. The goal was healing as a professional and communal obligation, not wealth generation through disease management.

These alternative models demonstrate that the current arrangement is not inevitable, not “natural,” and not the only possible way to organize essential human functions. We have made choices—or more accurately, those with power to structure social organization have made choices—and those choices have produced the world we now inhabit.

The ideology that justifies these choices—the assumption that markets optimize everything—conceals the category error at their foundation. It prevents us from asking whether an organizational logic optimized for increased production and exchange might be fundamentally unsuited to systems whose ultimate goal is to make themselves unnecessary. It normalizes arrangements that, examined clearly, prove absurd: paying people to perpetuate problems rather than solve them, rewarding institutions for the persistence of conditions they claim to eliminate.

Why This Persists

The persistence of these arrangements, despite their obvious dysfunction, points to another structural reality: those with the power to reorganize these systems benefit from their current structure. Not necessarily the individual practitioners—the doctors and nurses, the officers and administrators—but those who control capital, who direct institutional policy, and who shape the structures within which these functions operate.

For those strategically positioned to benefit, the translation of human need into market opportunity registers as a successful business model rather than a structural mistake. The sick and the insecure generate predictable revenue streams. Their conditions, managed rather than resolved, provide stable returns on investment. The language of care and protection obscures the underlying extraction, allowing accumulation to proceed under humanitarian cover.

This creates resistance to structural change—one that operates at multiple levels. Economically, existing arrangements that generate profit would disappear under alternative structures. Politically, institutions entrenched within current models defend their territory and resist reorganization. Ideologically, the framework that normalizes these arrangements—the belief in universal market optimization—prevents alternatives from being seriously considered.

Reform efforts—most of which fail to address this structural foundation—inevitably produce limited results. Adjusting regulations, improving oversight, training personnel more thoroughly—these interventions may reduce excesses, but they cannot resolve the fundamental contradiction between structural incentive and ultimate purpose. The structure itself generates the problem. Refinements to the structure leave the problem intact.

We see this clearly in healthcare reform debates. Proposals often focus on insurance mechanisms, expansion of coverage, controlling costs—yet never questioning whether a for-profit insurance industry makes sense for a domain where the functional goal is the reduced need for service. We tinker with payment models, reimbursement structures, and regulatory frameworks, assuming that the right configuration will somehow resolve the inherent contradiction between healing people and profiting from their sickness.

The same pattern appears in criminal justice reform. Proposals focus on sentencing reform, police training, community policing initiatives, rehabilitation programs—all potentially valuable interventions, but all operating within a framework where the security apparatus economically depends on the continuation of crime. Until we reorganize security functions such that genuine success—the substantial reduction or elimination of crime—becomes economically sustainable rather than institutionally threatening, reform will continue to produce marginal improvements while the fundamental dysfunction persists.

On a logical and architectural level, these arrangements are internally contradictory. The contradiction is primarily structural, not administrative. No amount of regulatory sophistication can align incentives that point in opposite directions. A for-profit healthcare system will always organize itself around profitable disease management because that is what for-profit systems do—they pursue profit. If genuine health threatens profit, then the system will resist genuine health.

What Genuine Success Would Require

If healthcare is to produce health rather than manage disease profitably, it must be reorganized according to principles that align economic incentive with genuine success in its field. This does not mean eliminating all market mechanisms or rejecting every principle of economic efficiency. It means recognizing that certain functions—especially ones where success means decreased activity—require a different set of organizational logic than those focused on production and increased activity.

A healthcare system structured to promote health rather than profit from sickness would reward reduction of disease burden, not expansion of treatment volume. It would invest heavily in cures, restoration, and prevention because they serve the purpose of societal wellbeing as a primary incentive, even if it generates less immediate revenue. It would prioritize cure over management wherever possible, resolution over perpetuation, and the elimination of dependence rather than its cultivation.

Such a system might operate through various mechanisms. The specific organizational form matters less than the alignment of incentive with purpose—to be clear about our aims and to measure our success by it. Ultimately, we must build a model with structural coherence and lack of internal contradiction. If those responsible for health benefit economically from creating healthy populations, they are more likely to work toward that end. We arrive at our goal. If they benefit economically from managing sick populations, they will optimize for sickness management instead. In this case, the problem is embedded.

Security operates according to the same principle. An apparatus genuinely structured to create safe communities would invest primarily in the conditions that prevent crime from emerging—economic opportunity, social cohesion, educational access, mental health support. It would measure success not through arrest statistics but through reduction in the occurrence of harm. It would orient itself toward its own obsolescence rather than its perpetual expansion.

This inversion of current logic appears radical only because current arrangements have become so thoroughly normalized. The idea that security institutions should work to eliminate the need for their own services seems strange in a context where institutions universally seek to expand their reach and justify their budgets through the problems they claim to address. Yet this is precisely what alignment with purpose would require—institutions that celebrate reduced need for their intervention as evidence of success rather than treating it as a threat to their existence.

The Path Forward

The choice before us is not complicated, even if implementing it proves challenging. We can continue organizing these functions according to market logic, knowing this guarantees their corruption. Or we can reorganize them according to logic appropriate to their nature—logic that aligns economic incentive with genuine success, that rewards resolution rather than perpetuation, that serves the stated purpose rather than using it as cover for extraction.

The challenge we face is not a lack of technical capacity, but a crisis of structural design. We have tasked our most essential institutions with an impossible mission: to eliminate the very problems that provide their sustenance.

On a purely architectural level, this is a recipe for perpetual failure. No amount of administrative oversight or moral appeals to the “good hearts” of practitioners can overcome a structure that rewards its own inefficiency. A system that profits from the management of a problem will eventually find reasons to ensure that problem is never solved.

We must eventually confront the reality that healthcare and security are not markets to be “optimized,” but common goods to be maintained. Success in these fields should be measured by the quietness of the hospital and the silence of the sirens—not by the volume of their activity. Until we align our economic incentives with this reality, we will continue to pay a premium for the very crises we claim we want to end. We can have a system that serves the patient and the citizen, or a system that serves the balance sheet. We cannot, as a matter of simple logic, have both.