One major impediment... is the grant system itself. It has become a sort of jobs program, a way to keep research laboratories going year after year with the understanding that the focus will be on small projects unlikely to take significant steps....
it should also be recognized that whether or not congress or a federal department intends this as a strategy, grant systems can become jobs programs within research institutions because many administrators, scientists, and support staff within the institutions guide the system to the result (i.e. there is a non-linear relationship). It's not just limited to healthcare research, e.g. look at the DOE national lab system and research related to nuclear waste or 'alternative' energy projects.
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