$30B is trivial, people don’t grasp the scale of investment in these areas. Total research investment alone in the US is 10x that. There was a time when the US government was a major contributor to this R&D but that was half a century ago. Private investment dwarfs government investment at every stage with only a few exceptions.
Some of the most productive areas of US government biomedical research have not come from NIH but from DoD. Most people do not realize that virtually all modern trauma medicine was invented by US military research as a very active ongoing program. If you get in a bad automobile accident, most things that happen will be the product of US military research. But interestingly, these programs have very sparse research budgets, literally just single millions of dollars in many cases. But that is trauma medicine, not drug development.
Drug trials in particular are extremely expensive. People like to pretend these don’t exist. A few million in research costs doesn’t write off billions of dollars in development costs. There is no mathematical way to argue otherwise.
According to CBO pharma spends ~$90B on R&D (https://www.cbo.gov/publication/57126) so $30B I would not call trivial or a rounding area, but your points still stands that it is the minor share.
> A few million in research costs doesn’t write off billions of dollars in development costs. There is no mathematical way to argue otherwise.
There could be an important distinction between infra R&D and last mile R&D. The cost of developing a drug in our current system might be $3B today on average, but if you also had to replace all the infra R&D USG invested in over decades (GenBank, PubMed, and all the other databases from NCBI and the like) that these efforts depend on, it might be much higher. So I could still see an argument that the government pays for the research needed by all the drugs, then private sectors builds on that and pay for the last mile for each one.
However, I think you've put forward strong points against the argument "the research is done using public funds, and then privatized and commercialized later".
> Drug trials in particular are extremely expensive. People like to pretend these don’t exist.
I think in general people are frustrated because for all the money going into pharma people have not been getting healthier in the USA, in fact, in the median case, the opposite. So some big things are going wrong. I think you've shown that the problem is not that government is paying for high drug development costs and industry is coasting.
Some of the most productive areas of US government biomedical research have not come from NIH but from DoD. Most people do not realize that virtually all modern trauma medicine was invented by US military research as a very active ongoing program. If you get in a bad automobile accident, most things that happen will be the product of US military research. But interestingly, these programs have very sparse research budgets, literally just single millions of dollars in many cases. But that is trauma medicine, not drug development.
Drug trials in particular are extremely expensive. People like to pretend these don’t exist. A few million in research costs doesn’t write off billions of dollars in development costs. There is no mathematical way to argue otherwise.