There's also a lot of anger and frustration which can be reflected in how we talk about it. Unfortunately sometimes that can sometimes get in the way of having the constructive conversations we need to move forward.
As for choice made by the US as a whole, I don't agree that's the case, at least not directly. The lack of transparency into relationships between regulators and the industry makes it difficult for the citizenry to make informed choices. We might get bits and pieces, but lack of trust in both each other and sources can make any discussion devolve into a "he said/she said" argument. Indirectly we've made this choice (as a populace over time), in that we've allowed things to get this far.
And yeah, direct incentives in the case of health care research would be much more transparent and likely less susceptible to abuse. That said, I freely admit I'm not a public policy expert. Like anything else, there are differences in how things operate when the scale changes.
I've found this article useful as providing more ideas on how to think about the health care situation:
http://www.theatlantic.com/magazine/archive/2009/09/how-amer...
I'm glad we're seeing more articles in this area, and more discussions. Thanks for being a part of it!
The idea that "indirect incentives" would seriously be suggested is a great example. Of course indirect incentives will provide a great opportunity to indirectly exploit the system. You want innovation? Pay direct bounties for innovations, contingent on reasonable cost-plus access to the innovation. You want basic research? Pay for it directly.