The NIH currently spends $33B a year on research. Not all of that is drug related

The top ~15 pharma companies spend over $70B a year on r&d, and VC funds $15B in the US alone

Even assuming government operates as efficiently as private industry, we are talking almost triple the NIH budget to accomplish that

> Even assuming government operates as efficiently as private industry, we are talking almost triple the NIH budget to accomplish that

So increase the budget? If we assume the government would operate as efficiently as private industry, then it would be cheaper overall. The other option is for private industry to recoup the costs plus profits from society at large.

Obviously increasing the budget is politically difficult, but let's not pretend the current method makes any real economic sense.

The NIH budget has declined 20% in the last 15 years. Not only is there a strong downward trend, but the movements in funding levels are gradual. I'd say that tripling the NIH budget is not just politically difficult, but politically impossible

Then just leave the drugs grandfathered. If we view something as a problem (i.e. the lack of formal drug approval processes on old drugs), but we are not willing to solve the problem right (i.e. providing funding to government agencies to do the research), then we shouldn't do anything at all. Continuing the status quo is also a reasonable action.

That would be the best thing to do IMO, but the problem is politics. Congress loves wasting money on toys that kill people, but when it comes to things that saves lives and advance science, all of a sudden budgets are tight or we need a new round of tax cuts.