Academia already does much of the fundamental research.
It's mostly the "D" part of the "R&D" that is expensive, and shapes the pharma industry. Some of this could be addressed by making clinical trials cheaper to operate and initialize, but it's always going to be quite expensive.
I agree that most fundamental (chemistry, biology) research is done in academia. But fundamental research doesn't deliver new drugs, it only supports discovery.
About 24% of new drugs are discovered in academia.[1] The remainder come from industry. I think offloading all discovery to academia, plus the "D" part of R&D would be something academia would struggle with.
Sure, a lot of discovery is done in industry too (and, as you note, is supported by academic outputs). But that's not the expensive part which is what I was trying to say -- obviously not clearly enough.
Reforming the current system would be difficult, no doubt. And perhaps it's unworkable. Big pharma also owns academia. Much of the peer-reviewed literature for many drugs has been ghostwritten by industry-funded consultants. Sometimes the authors don't even read their manuscripts, and in some cases haven't been informed of them. Some journals have been addressing this, but it's pervasive.
In any case, the current system isn't working. Incentives for fraud far outweigh those for improving public health. And there is virtually no accountability.
It's mostly the "D" part of the "R&D" that is expensive, and shapes the pharma industry. Some of this could be addressed by making clinical trials cheaper to operate and initialize, but it's always going to be quite expensive.