In 1923, the University of Toronto sold the patent for insulin to Eli Lilly for the symbolic sum of $1. The discoverers—Banting, Best, Collip, and Macleod—deliberately refused to profit from a molecule that keeps people alive. They understood insulin as a social product: the cumulative labor of generations of scientific workers, the metabolic necessity of millions. They wanted it cheap and accessible.
One hundred years later, Eli Lilly charges $600–$1,000 per vial for insulin analogs like Humalog. The production cost? Industry analysts and whistleblowers estimate $3–$6 per vial. That is not a price. That is a contradiction. And in a system driven by the accumulation of capital, contradictions kill.
The Innovation Myth: A Century of Patented Honesty
Pharmaceutical capital justifies monopoly pricing by invoking a sacred term: innovation. We are told that high prices are the necessary reward for research risk, the fuel for the next breakthrough. This is ideology in its purest form—a justification of the present by distorting the past.
Insulin is 100 years old. The biological mechanism was mapped before the Great Depression. The first recombinant human insulin (Humulin, 1982) was a genuine scientific advance, but it emerged from publicly funded university research and was licensed to Lilly, not invented in its labs. The "new" insulins—Humalog, Novolog, Lantus—are incremental tweaks to delivery timing, not fundamental discoveries. They are what Marxists call formal rather than real subsumption: the form of innovation (a new patent) without the substance (a new cure).
The patent system, originally intended to reward disclosure and spur progress, has been captured as an instrument of rent extraction. By filing ever-narrower patents on molecular variants, delivery devices, and even injection techniques, pharmaceutical capital builds a thicket around insulin that blocks generic competition for decades. The result is not innovation but artificial scarcity—a deliberate restriction of supply to maintain monopoly prices.
The uninsured patient paying $1,000 a month for insulin is not paying for research. She is paying for the legal infrastructure of enclosure.
The Reserve Army of Consumers
Marx observed that capitalism maintains a "reserve army of labor"—the unemployed who discipline the employed by their very existence. Pharmaceutical capital has discovered a new formation: the reserve army of consumers. In 2022, the United States accounted for 15% of global insulin volume but 50% of global insulin revenue. The rest of the world—including Canada, the UK, and much of Europe—pays a fraction. Why? Because their states impose price controls or operate public health systems. The US market is uniquely deregulated for capital.
This is not a bug. It is a feature. The uninsured and underinsured in America function as a captive market that can be charged whatever the traffic will bear—and what it bears is death. Studies show that 1 in 4 diabetics ration insulin, skipping doses or diluting vials to make them last longer. The direct result is ketoacidosis, kidney failure, amputations, and death. These are not side effects. They are cost externalities—morbidities shifted from the corporate balance sheet onto the bodies of the working class.
When Eli Lilly spent $18 billion on stock buybacks between 2017 and 2022—cash returned to shareholders rather than invested in lower prices—it declared, in the only language capital understands, that the lives of insulin-dependent patients are less valuable than shareholder yield.
Rationing as a Crisis of Legitimacy
Every system of exploitation requires a legitimating ideology. For pharmaceutical capital, that ideology has been: "Profits save lives." But insulin rationing, now so widespread that it has entered the national conversation, cracks the facade. When a person dies because they could not afford a drug developed in 1921, the contradiction becomes too naked to conceal. The public begins to ask a dangerous question: Why does a for-profit corporation control the means of survival?
The US legal apparatus has answered that question consistently. Through the Hatch-Waxman Act, through patent evergreening, through the prohibition on Medicare negotiating drug prices (a ban lifted only partially in 2022, and still contested), the state has functioned as the executive committee of the pharmaceutical bourgeoisie. Law does not protect life. Law protects property—specifically, the intellectual property that converts a century-old molecule into a $20 billion annual revenue stream.
This is not a market failure. A market failure implies an accident. This is a structural imperative: capital must expand, or it dies. And if expansion requires that the uninsured serve as a human sacrifice to the profit rate, the system will offer them up.
Steel-Man Counterargument: What About R&D?
The defender of the current order will say: Without high prices on existing drugs, there is no pool of capital to fund research into new insulins—ultra-rapid analogs, glucose-responsive "smart" insulins, even curative therapies. If you cap prices, you kill the golden goose.
There is a kernel of truth here, deliberately distorted. The profit motive does direct capital toward research—but it directs it toward patentable, high-margin research. That means incremental analogs that can be patented, not cures that cannot. That means investment in lifestyle drugs for wealthy markets, not treatments for neglected diseases of the poor. The profit motive incentivizes the wrong innovation, or no innovation at all, where the need is greatest.
Moreover, the fundamental science behind virtually every major drug advance of the last 50 years—including recombinant insulin—was funded by public money: the NIH, the MRC, the Wellcome Trust, university endowments. The private sector then swoops in, patents the last 5% of the discovery, and appropriates 100% of the surplus. This is the privatization of socialized risk. The public pays for the research, and capital collects the rent.
A Marxist analysis does not oppose research. It demands that the social product of research be returned to society—through public ownership of drug patents, compulsory licensing, or a directly socialized pharmaceutical sector. The question is not whether to fund science. The question is for whom.
Synthesis: The Contradiction Must Break
The insulin crisis reveals a deeper truth about late capitalism: it can no longer reproduce the material conditions of its own survival. A system that cannot affordably provide a substance discovered a century ago—a substance whose synthesis requires no rare earths, no exotic physics, no unknowable secret—has exhausted its historical warrant. The contradiction between socialized production (insulin is easy to make, cheap, and universally necessary) and private appropriation (patent monopolies extract billions) is unsustainable.
The response cannot be charity or voluntary price cuts, which leave the structure intact. The response must be decommodification: removing insulin—and by extension all essential medicines—from the market entirely. This means public ownership of patents, price controls backed by the threat of compulsory licensing, and ultimately a health system that treats medical care not as a commodity but as a social right.
The billionaires will not surrender their rents willingly. But the reserve army of consumers is waking up. Each death from rationed insulin is a fresh indictment. Each protest, each class-action suit, each legislative push is a skirmish in a larger war. The question is whether the working class will recognize that insulin is not a charity case but a weapon in the struggle to dismantle the patent-state itself.
Until that day, the vial sits on the pharmacy shelf—worth $600 to a dying man, worth $6 in the labor that made it, and worth exactly $1 to the scientists who gave it away.
Cross-reference: The Political Economy of Patent Evergreening, Banting's Gift: How Insulin Was Meant to Be Free, Rationing as Systemic Violence: The US Healthcare Crisis.
