[lotsofpulp]

> but it's much less obvious that we should have zero handouts to narrow interests when it's "please spend $10000 per life saved via rare-disease research and treatment, I don't care how little the general public is aware of and cares about it and would generally prefer lower taxes"

In reality, this turns into we should have billion dollar handouts to narrow interests because rather than use taxpayer funds to R&D cures into the public domain using the existing world class university system, the narrow interests would prefer being able to benefit from patented medicines:

https://www.wsj.com/articles/drug-prices-reach-new-highin-th...

> Since August, U.S. or European health regulators have approved four new products intended as one-time treatments for rare genetic diseases that carry list prices of at least $2 million a patient, including two from Bluebird Bio Inc.

[ThrustVectoring]

Okay, make the hypothetical be malaria nets or insulin then. The exact specifics don't matter all that much, it's just an illustration that you can't use issue-by-issue majoritarianism to generate a coalition that can pass a broadly popular group of policies that lacks individual plank-by-plank popularity. There's no enforcement mechanism to coordinate a "you vote for my pet issue and I'll vote for yours".