The nurse and the man who sells the nurse her insurance are not paid according to how much good they do, and everyone knows it. Service and income run on separate rails.
That doesn't cancel the connection between them. It makes it indirect. Serving people well builds something that pays out unevenly and late — a reputation, a phone call three years from now, the person who recommends you without being asked.
Two ledgers are being kept. Only one is denominated in money, and the other tends to outlast it.