The government is the worst tool for this job, because they would need to hire external experts to assess which disease should be studied, and those experts would be already in bed with the industry for a long time. You would just be diverting tax-payer money in a different way.
There's no need to "hire external experts". They could have their own pool.
So it's not unsurmountable, just badly done...
Even so,
https://www.iam-media.com/article/switzerland-once-again-nam....
This is true to some extent (not all drugs approved require more than just superiority vs placebo), but that reads like throwing the baby out with the water. There's a ton of great drugs developed every year that are clearly very innovative in terms of mode of action, and by far and large those come from the US.
Innovation comes mostly from the public sector, not private sector. This applies equally to technology.
Private-led innovation is hyped by these industries PR departments. DARPA, NASA, NIH don't have a PR department.
References: 1/ Overall, NIH funding contributed to research associated with every new drug approved from 2010-2019, totaling $187 billion." (https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3731819) Search Mariana Mazzucato talks, books on innovation, example: https://www.noemamag.com/big-pharma-is-hurting-drug-innovati...
2/ "Apple Didn’t Build Your iPhone; Your Taxes Did": https://www.pbs.org/newshour/economy/the-entrepreneurial-sta...
3/ 97%-99% of Astrazenneca covid vaccine research was public+charity funded( ref https://pubmed.ncbi.nlm.nih.gov/34937701/ )
You don't pay for the cost of the ingredients in pharmaceutical products (otherwise the cost of most drugs would be 1/10th of what they are or even less), but for the IP behind it. You need clinical trials to demonstrate that something works for a specific condition, and this is what gets an approved stamp by the FDA and integration with the reimbursement system, along with a negotiation on pricing.
If there were no such incentives, then nobody would do any kind of clinical trial for compounds that are already widely available in OTC form, and the only thing you would have is anecdotal evidence (i.e. noise) to know what works or not.
Whether this is the right way to incentivize research and development is a valid topic to discuss, however.