But the current system is not okay for people who need medications that exist and are cheap to manufacture (eg insulin) but can’t afford rates being charged
There is no patent protection on regular insulin, so it's some kind of ordinary monopoly problem, it appears.
I suspect a better set of regulations around generics would solve the problem with ordinary market forces. Probably there are quite a few policies that protect the existing drug companies that don't make any sense for generics.
IIRC the issue with insulin is that while "regular" insulin is not under patent, there are better insulin products on the market that are, and those are what everybody prefers.
Then, because most people do actually have insurance, the insurance pays for the more expensive version and so that's the only one anybody makes. The market for "regular" insulin is limited to people without insurance, which isn't a big enough market to justify all the regulatory work needed to manufacture it.
What's really needed there is to make it easier for generics manufacturers to get regulatory approval.
"What's really needed there is to make it easier for generics manufacturers to get regulatory approval."
That seems like a sensible solution to the extent the quality/safety itself is not compromised. For instance maybe there is difficulty importing from other countries, but there should be no problem importing regular insulin from Germany, for instance.