Conversely, I'm not going to need to ration insulin in Argentina, Brazil, or India. Can't speak to the DPRK or Somalia as I haven't been.

If capital was allocated democratically rather than at the whim of companies (that end up chasing taxpayer subsidies anyways... SpaceX, Tesla, etc.) you wouldn't need to strictly enforce patent law. The risk is already being assumed mostly by the government for truly bleeding edge research. What we have in practice is a system where the cost is socialized and the benefit is privatized.