With such competition, the FDA might devise a ratings system ("general use," "medical guidance suggested," "patients strongly cautioned," or something like that), and drug packages would carry that information. We'd know that the government was evaluating new drugs, but government wouldn't stand between lifesaving treatments and us. Most of us, most of the time, would take the government's advice, but because it would be our choice, we could try new or risky drugs when nothing government-approved was available.
We could try a system where the FDA would review all drugs, but its approval wouldn't be needed for a drug to be sold. Private organizations might go into competition with the FDA even if its review remained mandatory. If a new drug is going to be "not yet rated" by the government for 15 years, the endorsement of an independent evaluator -- even one not quite as strict as the FDA -- that can deliver its opinion in three years would be valuable. Under today's FDA rule, consumers assume big government takes care of the whole issue, so we become less vigilant. The consumer is encouraged to stay asleep: Don't ask questions; just take what Big Brother approves. Yet, knowing what we know about the incompetence of government monopolies, there's little doubt that competing private groups would do the testing better, cheaper and quicker.
Any kind of FDA has its price. If all drugs have to be reviewed -- even if they can be sold while under review -- the cost in money and energy will keep some drugs off the market. But getting rid of the FDA's power to forbid us to try something would be a big improvement: It would mean Americans would no longer be forced to wait, and die while their government passes judgment on innovations that could save them.