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.

Large companies are very good at solving extremely complex problems in a globally optimal way.

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.

The fact that oppressive and corrupt regimes can borrow money in the name of the whole country means that the country's future generations will be weighed down by interest and repayment burdens, even if the money has been frittered away in some frivolous way, embezzled or used for weapons to suppress the country's population.

Companies are actually much better than governments and other bureaucracies at organizing in a holistically efficient way the extremely complex path from the examination of molecules all the way to the delivery of medicines to patients. Already in the conception and selection of research projects, companies would anticipate all the challenges down the line that they will need to overcome in order to achieve actual health impact. Bureaucratic organizations, by contrast, are notoriously bad at this sort of optimizing.

With the Health Impact Fund, the innovation is paid for separately, through publicly funded health impact rewards, and the product is sold at the cost of production to all. Here, the cruel injustice of preventing the poor from buying at cost - evidenced by today's suppression of the trade in generic versions of patented medicines - would no longer be needed.

Economists operate with this image of the homo economicus, the rational economic agent, and while such agents are rare in the wider world, they are common in economics departments. Exemplifying the homo economicus paradigm, economists typically choose their research projects and hypotheses so as to promote their own careers, to maximize their lifetime income. This explains the astonishing pressures toward conformity in academic economics: how deviant views (except those by a few who have already achieved stardom) get crushed by an army of conformists.