There are few better emblems of the failures of the US system of medical care than its inability to consistently provide insulin to Americans who need it. The FDA began to treat insulin as a biologic drug in 2020 — meaning it is made with living materials instead of combining chemicals like conventional pharmaceuticals — which comes with a different set of standards for generic versions, which are known as biosimilars, as well as manufacturing challenges given the precise conditions these products must be made in. Long-term trends toward privatization and the declining public trust in government’s ability to accomplish major projects, along with the mighty lobbying power of the drug industry, worked to discourage public officials from ideas as ambitious as the public production of a generic insulin