> Who is gonna decide how the R&D money gets spent? What's their skin in the game and their feedback mechanism? Why will they do a better job picking what to research than current pharmaceutical companies?

Pharma companies are pretty terrible (e.g. pricing a cure for a kind of hepatitis just under a liver transplant, not because it costs that much, but because they can make the most money that way even though access is severely restricted). Getting rid of that market-driven terribleness may be a enough gain to justify the reform.

Personally, I'm so sick of the business-all-the-things approach and its well-known failure modes that I think society needs to put some effort into making other models work. Either straight up nationalization (with perhaps internal competition between research centers), or stricter oversight (e.g. putting government officials, patients, etc. on pharma company boards with enough power that the shareholders have to take a back seat).

Somehow the pharma industry still doesn't bring in that much money. There is a reason we aren't all in pharma funds.