You can think of the Health Impact Fund as a mechanism that would keep the benefits and burdens of pharmaceutical innovation for the affluent roughly as they are while massively reducing the burdens presently imposed upon the poor. This sounds like magic. But it really works because the current system is not Pareto efficient. It's a system that generates hundreds of billions of dollars in litigation costs and deadweight losses that HIF-registered medicines would sidestep. By avoiding these losses, the HIF reform can bring improvements all around - including for pharmaceutical innovators.

The global financial crisis is a great opportunity to showcase and propagate both causal and moral institutional analysis. The crisis shows major flaws in the way the US financial system is regulated and, more importantly, in our political system, which is essentially a bazaar of legalized bribery where financial institutions can buy themselves the governmental regulations they want, along with the regulators who routinely receive lucrative jobs in the industry whose oversight had formerly been their responsibility, the so-called revolving-door practice.

By using general consumption PPPs, the World Bank is, in effect, saying to the poor: "Sure, you cannot buy as much food as the dollar value we attribute to your income would buy in the United States. But then you can buy much more by way of services than you could buy with this PPP equivalent in the United States." But what consolation is this? The poor do not buy services - they are services, on their luckier days.

We have the ability now to arrange global economic institutions so that poverty declines to a fraction of what it is now.

Governments and their hired negotiators are designing the supranational rules and pressing for their adoption and for compliance - and the US government first and foremost. These governments are elected by us, funded by us, acting on our behalf, sensitive to our will, and so, we are not mere bystanders observing the injustice.

There exist better models of decisionmaking, for the governance of states, corporations and other large organizations, for example in Germany. We need to study such models and promising pathways on which our existing decisionmaking procedures can be gradually reformed.

If the Health Impact Fund were to be instituted, a single company would be in charge of a medical product all the way from its conception to the health improvements realized by actual patients. The company would be paid for health impact, and it would have to arrange the entire pipeline in between - all the steps of invention, of clinical testing, of getting marketing approval in many different countries, of wholesalers and retailers and prescriptions and so on - in a holistically optimal way.