Of all the things we might do to improve our health care system, the one reform that is more important than any other is almost never discussed.

It is ignored by Republicans. By Democrats. By the experts. By the think tanks. And by just about everybody who has an opinion on health policy.

Here it is: If we want the system to work well, we must make it profitable to take care of sick people.

Profitable to whom? Profitable to everyone whose services are needed. To doctors. To hospitals. And most important of all, to the “third party payers”: insurance companies, employers and government agencies – the entities that initially control all the money.

The idea is not new. Almost 250 years ago, Adam Smith observed that the reason the free market works so well is that each of us has a financial self-interest in meeting other people’s needs. The more needs we meet, the more income we earn; the wealthier we become. It’s as simple as that.

But in health care, we have done everything possible to suppress normal market processes – year after year, decade after decade.