There is much that can be changed within the sprawling thing we call "healthcare", without doing anything about Big Pharma.
In other words, one can actually take steps to improve access and efficiency without touching the drug companies.
Therefore, those peddling either/or scenarios centered around "Drug Companies", or "whole system down the tubes" analogies are deliberately misinforming folks.
If both Wyeth and Novartis have to consider that their next blockbuster drug is going to bring in less revenue, the probability that Drug X will be that blockbuster has to be higher in order to justify spending the money to find out. -AS, quoting the Drum-head
I'll suggest that this is a misunderstanding of the drug development market.
"Blockbuster drugs" are going to get developed, under almost any circumstances, even if almost all patent protection were removed. They are just too big and there is just too much money to be made.
The question then becomes about the marginal drug researched/produced.
Now, you can argue that patent protection, prescription-stabilized markets, handsome returns and large companies all militate against a Corporation taking risks on 'small market' drugs, speculative therapies, or very, very costly guesses on where basic science is headed. All of these things do not fit the most desired risk profile.
And, in fact, you see that reflected in the market. The marginal drugs are frequently researched by companies that finance and run like venture capital. The big companies that acquire these smaller, venture firms run them like that too, internally, in some cases, I think (I haven't looked in a while, but I think that's accurate). Otherwise, they are involved in buying "winners", picking up stage-II or stage-III prospects, pulling them into their Big Pharma marketing machines, etc. [In fact, if one wants to drag the AIDS period into it, which is probably not constructive, big pharma are historically poor at things like vaccine development, where liabilities are enormous and understandably so - perhaps even rightfully so.]
Marginal drugs are unlikely to be deeply jeopardized, therefore, if some strides are made to ... restructure the way(s) profits are taken on big-time research drugs. An initial patent protections period that recoups a drug's development cost in 5-7 years (that's a guesstimate of the shelf life of some therapies), and then a tradeoff between cost-reduction and extended patent protection (until some better idea comes up).
Again, all this could take place separately from changes to the system to provide improvements in access and an end to the "Nanny Corporation".
