The former should be public, while the latter should be commercially driven as much as possible.I think there's a recipe for consensus building here. Granted that you'll never be able to pay for universal health care by eliminating public research grants, but there's got to be some lobby money coming from medical R&D for policies like this.
As for Marx and Smith, the statement is not just about efficiency, but also oppression. Forceful intervention into an economy is oppressive and inefficient. Impoverished workers operating in unsafe conditions are both oppressed and unproductive. These are obviously blanket statements that require nuance for specific situations, but that's basically what I was getting at.
I'd personally like to see an environment where initial risk is taken on by the capitalist, and as a venture matures, ownership gradually passes to labor. When you think about it, it's not too far off from what we have now with the Seed -> VC -> IPO cycle.