Those are mostly solved, unevolving problems, meaning their R&D spend is a small fraction of the total budget.

For example: in 2016, of the total FY2016 federal budget of $4T, only $145B is committed to R&D (3%) [1]. Compare that to the pharmaceutical industry average of 18% [2].

[1] https://www.aaas.org/fy16budget/federal-rd-fy-2016-budget-ov...

[2] https://www.investopedia.com/ask/answers/060115/how-much-dru...

Those people have to live, eat, and see my family do well. Those people can decide to go do something else, most people are not financially independent.

The money has to come from somewhere, always.

There are many western countries without a single-payer (socialized) system. E.g. Germany, Belgium, the Netherlands, France, Austria, Denmark, Ireland, Greece. That said, almost all of them have national price setting, almost all of them have a mandate, and almost all of them are much more generous to the poor who cannot afford insurance.

Can you defend the huge marketing budgets of the pharma companies? I have to imagine any new-drug-awareness or training for physician roles covered currently by marketing could be filled adequately at pennies on the dollar compared to current marketing spend. Advertising and marketing are largely zero-sum so we should be able to trim quite a bit of fat there without impacting health outcomes (although cable companies and other advertising platforms would take a hit).

>> we would not have nearly as much innovation in medicine without a profit motive

> Most economists? That feels like a claim in need of a citation

The usual best place for finding out what economists think is the IGM Economics Experts Panel[1]. I mention it because it's a great resource to be aware of, but they haven't addressed this question, though it's covered in textbooks. I checked the Mankiw textbook on Principles of Microeconomics[2], which if I'm not mistaken is the world's most popular one. In the introduction, it says that people tend to supply things when the returns are high:

"Incentives are crucial to analyzing how markets work. For example, when the price of an apple rises, people decide to eat fewer apples. At the same time, apple orchards decide to hire more workers and harvest more apples. In other words, a higher price in a market provides an incentive for buyers to consume less and an incentive for sellers to produce more. As we will see, the influence of prices on the behavior of consumers and producers is crucial for how a market economy allocates scarce resources."

That becomes a background assumption for discussion of incentives in the rest of the book. For example, when talking about externalities, it notes that the patent system increases the incentive to innovate:

"Research into new technologies provides a positive externality because it creates knowledge that other people can use. Because inventors cannot capture the full benefits of their inventions, they tend to devote too few resources to research. The federal government addresses this problem partially through the patent system, which gives inventors exclusive use of their inventions for a limited time."

[1] http://www.igmchicago.org/igm-economic-experts-panel

[2] https://en.wikipedia.org/wiki/Greg_Mankiw#Textbooks

The fact that Cuba managed to do a thing isn't the same thing as proving equivalence between for-profit and non-profit healthcare systems re: innovation.

Because they benefit from the massive amount spent on medical innovation in the U.S.

Dr. Howard Florey and Ernst Chain deserve most of the credit for the development of Penicillin. They received the Nobel with Flemming and did most of the work in getting Penicillin out of the lab.

I don't think relying on wonderful accidents is a practical way to go about medical innovation.