Earlier quoted context omitted.
I'm not trying to be rude, but I can't fathom how you can think running a public utility like water treatment and capital intensive research and development are in anyway comparable to each other.
Water works represent an enormous public investment in R&D over hundreds of years. They didn't and don't invent themselves. It's an engineering triumph that they feel so routine.
FWIW unlike 90% of this thread, this suggestion doesn't sound insane to me. We could look at the number of people with a disease, and the QALY swing caused by the treatment, and then pay the team which designed the drug for the patent for (expected number of treatments) * (expected gains in QALYs).
This would allow the drugs to be any price the government liked once created, but still convince financially motivated smart people to work in medicine. Bonus points if the solution included ever-rising-prices for long untreated diseases (kind of like an auction).