Other countries take a different tack. They decide what they are willing to pay for a given drug based on how strong that drug’s clinical benefit is, or whether it is cost-effective compared with similar medications already being sold. As a result, some new drugs aren’t covered in those countries — but those that are covered are generally effective and affordable. This approach acknowledges that innovation is useful only if people can afford the resulting products.

In America, nearly one in four people who take prescription drugs have trouble paying for them, and patients are roughly six times more likely to skip or ration essential medications, compared with patients in other countries. The consequences of such rationing are often dire.

Opponents of Ms. Pelosi’s bill have warned that any such changes to the American system will result in a “nuclear winter” for drug innovation. But these fatal predictions ignore some obvious facts. First, innovation is already being thwarted under the current system, which skews heavily toward some types of drug development and away from others. For example, there are huge incentives to bring certain new cancer drugs to market, even when those drugs have little impact on survival rates, but comparatively few incentives to develop antibiotics or treatments for diseases that predominantly affect low-income communities — both of which are urgently needed.

Second, drug companies that are concerned about their research budgets dwindling have options. They might consider trimming the generally outsize amount of money they spend on advertising. Or they could look to the generous tax breaks they have secured in recent years — as Axios and others have reported, much of the pharmaceutical industry’s 2017 windfall went to stock dividends and share buybacks, not research and development. Even the Health and Human Services secretary, Alex Azar, a former pharmaceutical executive, has called the drug industry’s projections of innovation loss “mathematically unbelievable.”