By NextBestFitKeep private R&D for most drugs; public funds fill gaps
Public funds go only to areas private R&D neglects (antibiotics, rare diseases).
Draft decision:RejectedConfidence: medium · not yet reviewed
Public R&D expanded beyond gap-filling.
Review ledgerHow this path connects
This path
Keep private R&D for most drugs; public funds fill gaps
Creates or worsens
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Fund only neglected areas publicly
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
What it fixes
- Government chooses which research gets funded
Limiting public research funding to neglected areas such as antibiotics and rare diseases narrows government’s role and targets gaps left by private research.
What it creates or worsens
- U.S. prices are far higher than in other countries
Restricting public funding to neglected research areas leaves reliance on high prices elsewhere.
7 paths soften this
All-payer rate settingU.S. prices are far higher than in other countriesChosenCap commercial prices at a multiple of MedicareU.S. prices are far higher than in other countriesChosenRestore competition and leave prices to marketsU.S. prices are far higher than in other countriesRejectedGlobal budgets for hospitalsU.S. prices are far higher than in other countriesChosenFee-for-service at public fee scheduleU.S. prices are far higher than in other countriesChosenCapitation for primary care and integrated systemsU.S. prices are far higher than in other countriesChosenSingle public payer for everyoneTens of millions of people have no coverageChosen - Depends on uncertain evidence or judgments
Identifying the research gaps that qualify for public funding is difficult.
Who's affected
Who gains
- Medical researchers and research institutions
- Government chooses which research gets funded: Government priorities may leave risky or politically disfavored research unfunded.
- People with ongoing or specialist care needs
- Government chooses which research gets funded: People with rare conditions can lose research support for needed treatments.
- Hospitals and specialist groups with high private prices
- U.S. prices are far higher than in other countries: Providers with pricing power earn more per service.
- Drug and device makers
- U.S. prices are far higher than in other countries: U.S. prices are well above those in peer countries.
Who loses
- Medical researchers and research institutions
- Government chooses which research gets funded: Well-connected institutions can benefit from politically influenced research funding.
- People with employer coverage
- U.S. prices are far higher than in other countries: Private plans pay the highest prices, passed on through premiums.
- Taxpayers and public budgets
- U.S. prices are far higher than in other countries: Public programs pay more than peer countries too.
Where it has been tried
- CARB-X: Public-private antibiotic accelerator.
- United States: A 2026 CARB-X evaluation reports over US$1 billion committed through 2028 and 77 funded applications among the 2016–2019 application cohort, whose outcomes were assessed through February 2024.Sources: Health Affairs Scholar (2024)