The Inner Monologue

I. The Industry of Suffering

Imagine, for a moment, a society where the right to breathe was privatized. Where a corporation owned the air, and your ability to inhale depended on your insurance premium. Outrageous, right? Yet that is precisely what we have allowed with the pharmaceutical industry in America. The right to live without pain, the right to survive disease, the right to treat a child’s illness — all have been captured and commodified by an industry that exists not to heal, but to profit from the hope of healing.

In a nation that prides itself on moral leadership, we have tolerated an economic model that monetizes human suffering. It is the ultimate contradiction of capitalism — when profit no longer flows from service or innovation, but from the continued existence of sickness. The modern drug company is not rewarded for curing, but for managing; not for ending disease, but for indefinitely leasing relief.

The simple truth is this: investors should never profit from the pain of others.

II. Public Risk, Private Reward

Defenders of the pharmaceutical status quo love to recite the mantra: “We need profits to fund research.” It’s a tidy justification, but an incomplete one — and deliberately so. The reality is that much of the foundational science behind the world’s most important drugs is publicly funded. The American taxpayer foots the bill through the National Institutes of Health, university grants, and defense medical research programs.

Take mRNA vaccines — the technology that saved millions of lives during the COVID-19 pandemic. The breakthrough science was not the product of Wall Street speculation; it was built over decades in publicly funded laboratories. Or consider cancer immunotherapies, HIV treatments, and countless antibiotics — all resting on NIH-funded discoveries that corporations later commercialized.

This is the great sleight of hand: the public takes the risk, and private shareholders take the reward. The American people fund the seed, but never share in the harvest. And that harvest is rich — pharmaceutical companies regularly post profit margins double those of most other industries. Nearly 95% of their profits are paid out as dividends or stock buybacks, enriching shareholders while patients ration insulin and seniors split pills in half to survive another month.

If all pharmaceutical firms were nonprofit, the billions now siphoned off as profit would flow back into research, affordability programs, and public health infrastructure. The argument isn’t about destroying innovation — it’s about reclaiming ownership of what we already pay for.

III. The Myth of Profit-Driven Innovation

Pharmaceutical executives often warn that eliminating profit would end innovation. But this is a myth carefully cultivated by those who benefit from it. History tells another story. Penicillin was discovered without a profit motive. The polio vaccine was given freely to the world. Insulin was sold for one dollar so that no one would die without it. Jonas Salk, when asked who owned the patent to his vaccine, replied, “Well, the people, I would say. There is no patent. Could you patent the sun?”

The most profound medical breakthroughs have come not from greed, but from curiosity, collaboration, and compassion. The pursuit of profit has, in fact, distorted innovation — driving pharmaceutical companies to focus on “me-too” drugs (slight variations on existing treatments) that extend patents rather than cure disease. The system rewards predictability, not risk; revenue, not revelation.

A nonprofit model would free science from this distortion. It would allow research to target the diseases that truly matter — not just the ones that pay.

IV. The Moral Contradiction of Profit in Medicine

There is something morally corrosive about the idea that a company can celebrate record profits while people die for lack of access to their product. It is a moral contradiction dressed in the language of free markets.

The act of healing is not an industry. It is a social covenant. Doctors swear an oath to do no harm. Pharmacists are trained to serve the community. Yet the corporations that manufacture the very tools of healing operate under no such ethical restraint. They are obligated by law not to heal, but to maximize shareholder value.

When the corporate mission is profit, then pain becomes profitable. The longer the illness, the higher the return. The sicker the society, the stronger the stock. Every incentive is inverted. And that is not capitalism — it is cannibalism.

V. The Structural Inefficiency of Profit

The defenders of this model will argue that competition and profit drive efficiency. But in pharmaceuticals, the opposite is true. The profit motive adds layer upon layer of inefficiency: marketing budgets that exceed research budgets; armies of lobbyists to preserve monopolies; patent extensions designed not to innovate but to exclude.

Each of these is a cost that adds nothing to human health — yet all are passed along to the consumer. The result is an average American paying two to three times more for medication than citizens of any other developed nation.

Analysts estimate that if pharmaceutical manufacturers alone adopted a nonprofit model, retail drug prices could fall by roughly 20–30%. Applied to high-cost drugs — those $100 prescriptions that burden households — the savings could exceed 25% per drug. For the most expensive therapies, the savings reach into the millions per patient. The math is clear: profit is the most expensive ingredient in American medicine.

VI. Reclaiming the Social Contract

America does not need to destroy capitalism to protect morality — it simply needs to decide where capitalism ends and civilization begins. We already operate nonprofit hospitals, nonprofit blood banks, nonprofit credit unions, and nonprofit utilities. These sectors recognize a basic principle: when a product is essential to life, it should not be governed by profit.

Medicine belongs in that category.

Nonprofit pharmaceutical institutions would still pay competitive wages. They would still compete for scientific talent. They would still fund R&D — in fact, they might fund it more efficiently, free from the pressure to deliver quarterly returns. But their measure of success would change. It would not be the stock price or the dividend yield; it would be the number of lives improved, the diseases eradicated, and the accessibility of their treatments.

The goal would no longer be to win the market, but to heal the people.

VII. The National Interest

A profit-driven pharmaceutical system is not only immoral — it is strategically dangerous. Supply chains for essential drugs are global and fragile, and the pursuit of profit often leads to consolidation, offshoring, and dependence on foreign manufacturers. During the COVID-19 pandemic, the United States witnessed the consequences firsthand when basic medicines and medical supplies became scarce.

A nonprofit pharmaceutical sector would treat national health security as a public good, not a line item. It would prioritize resilience over margin, domestic manufacturing over dividends, and collective preparedness over corporate gain. In an era of global instability, such an approach is not only moral — it is patriotic.

VIII. The Ethical Imperative

The time has come to ask a difficult question: Should anyone have the right to profit from another’s pain?

In most moral frameworks — religious, philosophical, or civic — the answer is no. Yet our current pharmaceutical system depends entirely on that transaction. We have normalized the notion that investors can profit from the misery of the sick. It is the final frontier of ethical capitalism — and it must be crossed.

Requiring U.S. drug companies to operate as nonprofits would not end medicine. It would redeem it. It would restore trust, refocus innovation, and reaffirm the idea that in America, life itself is not a commodity.

There will always be a place for profit — in entertainment, in technology, in consumer goods. But not in insulin. Not in chemotherapy. Not in antidepressants, or antivirals, or antibiotics. The human right to health should never be traded on an exchange.

IX. Conclusion: Profit or Compassion

We are a nation defined by what we choose to protect. We protect property, we protect patents, we protect markets. Perhaps it is time we protect people.

To insist that drug companies be nonprofit is not a rejection of capitalism; it is a reaffirmation of conscience. It is the belief that there are some things too sacred to sell — that compassion, like clean air, belongs to everyone.

When investors profit from pain, society loses its soul. It is time to reclaim it.