For a startup, however, patents can still have value in at least the following ways:
1. Patents on improvements can discourage established competitors who are using the same or similar improvements from suing the startup for infringing the competitors' patents.
2. A potential acquirer may want to acquire the company for its patents. The acquirer may be an established competitor who does have the resources to assert the patents against other competitors.
3. Patents encourage investors who see patents as residual assets that would be liquidated if the company fails.
There are very few places in law where you can legally stake a claim within someone else's territory and exploit it for profit.
Without patents pharmaceutical industry would be nearly impossible, i.e. it's very hard to come up with a compound but very easy to synthesize it as soon as it's known.
Long story short, there are enough sick people to provide medicine to and have a profitable business through a high volume of care, and governments are much better at providing long term financial stability than private corporations to burden the necessarily regulatory costs.
https://www.ftc.gov/news-events/topics/competition-enforceme...
https://www.justice.gov/opa/pr/pharmaceutical-companies-pay-...
https://www.justice.gov/usao-edpa/pr/three-generic-pharmaceu...
Take FDM 3D printers for example. Stratasys figured out and patented the first one almost 35 years ago and then proceeded to do fuck all with it, selling mediocre garbage for sky high prices. After it expired in 2009 3D printing rapidly became a whole industry with dirt cheap hardware, enabling millions to make things never before thought possible. We could've reached that point in the early 90s if it weren't for patents.
Sure one might say, it also forces the patentee to disclose the inns and outs of the invention, but frankly those patent descriptions are often as bare bones as possible and you'd get there reverse engineering any product far sooner than 20 years.
For small companies patents are basically worthless, a big company can just play legal ropeadope until they run out of money.