More than 10 percent of Americans are living with diagnosed or undiagnosed diabetes, and millions of them need insulin to survive.

Unfortunately, because they live in the United States, they are at the mercy of profiteering pharmaceutical companies that have been jacking up insulin prices at an exponential rate in recent years. “One vial of Humalog (insulin lispro), which used to cost $21 in 1999, costs $332 in 2019, reflecting a price increase of more than 1000%,” noted a 2020 commentary on drug costs from the Mayo Clinic. “In contrast, insulin prices in other developed countries, including neighboring Canada, have stayed the same.”

Insulin prices aren’t rising because of research and development costs. The medication has been available for more than a century, and it’s cheaply produced. So what, then, has contributed to the increase in cost? According to Dr. S. Vincent Rajkumar, the physician who authored the Mayo assessment, “The manufacturers of insulin know that patients who need it will spend whatever it takes to acquire it, regardless of price. It is a matter of life and death.”

While drug prices in general are outrageous, price gouging on insulin has become such a scandal that the notoriously slow-to-act US Congress has finally begun to entertain the notion of intervening. Last Thursday, the House of Representatives voted 232-193 for the Affordable Insulin Now Act, which would cap insurance co-pays for insulin at $35 a month. Under a provision of the legislation, the cost could go even lower if insurance companies negotiated lower prices. The logic behind the measure, which still faces hurdles in the Senate, was summed up by one of its sponsors, Representative Dan Kildee (D-Mich.), during the House debate.

“As a father of a type 1 diabetic, I have seen firsthand how the high price of prescription drugs like insulin can harm patients and harm families. When my daughter turned 26 and got her own health insurance, there were months where she spent a third of her take-home pay—because she’s diabetic—on staying alive,” said Kildee. “No one should have to choose between taking their medication as prescribed and putting food on the table or a roof over their head.”

Who could disagree?

The answer to that question is instructive. While every Democrat who voted on the bill was a “yes,” only 12 members of the House Republican Caucus joined them in moving to address a dismal circumstance where, as House Speaker Nancy Pelosi (D-Calif.) noted, “One in four Americans who rely on insulin have been forced to ration or skip their dose, a practice that can be dangerous and even deadly.”

Most House Republicans, 193 out of 210, were on the other side of the debate. Ninety-two percent of the chamber’s GOP caucus voted “no.”

Those “no” votes included House minority leader Kevin McCarthy, the California Republican who could replace Pelosi as speaker of the House if his party prevails in this fall’s midterm election. And Cathy McMorris Rodgers, the Washington State Republican who, as her party’s ranking member on the House Energy and Commerce Committee, would be the key player on drug-pricing issues in a GOP-controlled House. Other notables included House minority whip Steve Scalise of Louisiana and Republicans as distinct as Illinois’s Adam Kinzinger, who has broken with former President Trump and his party to serve as a thoughtful member of the January 6 committee, and Marjorie Taylor Greene, the Trump-defending, insurrectionist-coddling extremist from Georgia.

What was their excuse? Some members of the caucus echoed the fantasy that capping drug prices could lead pharmaceutical companies to do less research—a silly notion, considering that these companies operate in other countries that regulate profiteering. Top House Republicans defaulted to the traditional GOP stance of defending the right of greedy capitalists to be greedy capitalists. Rodgers warned that tackling price-gouging on prescription drugs could set the United States on a path that would undermine the free-market system. “Today, it’s the government fixing the price on insulin,” she speculated during the House debate. “What’s next? Gas? Food?”

This, of course, is the cruel calculus of corporate-friendly Republicans who are disinclined to disappoint their reliable campaign donors.

For a clearer picture of where the Republicans are coming from, however, check out Representative Matt Gaetz. Instead of blaming Big Pharma for charging astronomically inflated prices for life-saving medications, the Florida Republican blamed people with diabetes. Claiming that the legislation “victimizes insulin payees as people with an uncontrollable disease that are being taken advantage of and need Big Brother to throw them a raft,” Gaetz said the real problem is overweight Americans. “Arbitrary price controls are no substitute for individual weight control,” the congressman argued. “Since 2000, the number of diabetes cases in the U.S. has nearly doubled. The demand for insulin has increased and the requisite price increase has followed suit. In other words, the price of insulin increases as waistlines increase.”

In one statement, Gaetz revealed his ignorance about complex metabolic disorders as well as basic economics—not to mention the grotesque disparities that are on display in the food and health care systems of the United States. He also confirmed that he, and his Republican colleagues, are heartless bastards.