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greed. the patent was donated to the public domain back when synthisis was discoverd but since the manufacturers have taken up tweaking it patenting that tweak then charging more and more. other countries dont have this problem with insulin. thats why you hear about people going to Canada and Mexico to get meds cheap.

If the old insulin works just as well, and is basically free, why is everyone paying through the nose for the newly patented stuff?

"old insulin" pre-~1980 was made from grinding up animal (cow, pig) pancreas and extracting a tiny amount of pure insulin through a chemical extraction process. Wikipedia posts a ratio of 2 tons of animal matter to 8 oz of insulin. It was "easy" but didn't scale up very well.

because they dont make it anymore

They do, you can still buy it for cheap. It's not the same though, the new stuff works much faster.

because they don’t make it anymore

They do, you can buy it at Walmart cheaply.

Nobody has used that type of insulin for decades.

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