Yes but when you talk about system-wide decisions, it's not really clear which one will save the most lives. If drug companies are made to sell drug x cheaper,

Yes but when you talk about system-wide decisions, it's not really clear which one will save the most lives. If drug companies are made to sell drug x cheaper, maybe they end up charging more for drug y, or now they can no longer afford to invent drug z. So we can look at someone dying for lack of $800 and say that's clearly a big mistake, but it's not clear what trade-offs and adjustments would make the system solve this problem without also making even worse mistakes elsewhere. To measure our system, the best you can probably do is population-wide stats, like life expectancy, infant mortality, maybe average height (healthier populations being taller). On those metrics, we're making tremendous progress.