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“Unfortunately, in rich-world health, innovation is both your friend and your enemy. Innovation is inventing organ replacement, joint replacement. We're inventing ways of doing new things that cost $300,000 and take people in their 70s and, on average, give them an extra, say, two or three years of life. And then you have to say, given finite resources, should we fire two or three teachers to do this operation?”

“Most innovations, unfortunately, actually increase the net costs of the healthcare system. There's a few, particularly having to do with chronic diseases, that are an exception. If you could cure Alzheimer's, if you could avoid diabetes - those are gigantic in terms of saving money. But the incentive regime doesn't favor them.”

“Is it not manifest that our academic institutions should have a wider scope; that they should not be timid and keep the ruts of the last generation, but that wise men thinking for themselves and heartily seeking the good of mankind, and counting the cost of innovation, should dare to arouse the young to a just and heroic life; that the moral nature should be addressed in the school-room, and children should be treated as the high-born candidates of truth and virtue?”

“Setting an aggressive enough carbon-reduction goal will result in an appropriate price for carbon and will help many a renewable technology. Consumer education will help. Most importantly, though, will be the continually declining cost trajectory of the real breakthrough in clean-technology costs driven by research and innovation. In the end, private capital is the real barometer of change.”

“When you take a look at the transition from server software to Azure, what's going on in terms of cloud infrastructure, the company is absolutely the No. 1 company serving enterprise backbone needs, which is fantastic. It's making the migration to cloud. We started a good thing with Azure, and the company has made well more than two years of progress in terms of being able to compete with the right cost profile, margin structure, and innovation versus Amazon.”

“The trouble is that the risks that are being hedged very well by new financial securities are financial risks. And it appears to me that the real things you want to hedge are real risks, for example, risks in innovation. The fact is that you'd like companies to be able to take bigger chances. Presumably one obstacle to successful R&D, particularly when the costs are large, are the risks involved.”

“It is irrational to charge high prices for socially valuable innovations as this guarantees that they will be underutilized. It is much better to sell them at cost and then to reward the innovator in some other way. This is not always possible, because in some cases the value of an innovation is in the eye of the beholder; it's very difficult to value how much a new Madonna song is worth, for example. But in the case of medicines, green technologies and seeds in agriculture, such an alternative reward mechanism is fairly straightforward.”

“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.”

“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.”