Mark Cuban has an idea for how to stop the runaway train — the $38 trillion national debt — and it has a lot to do with the online pharmacy company he founded. January 2022. On Christmas Eve, billionaire investors Posted on X On his dissatisfaction with the insurance market.
We could pay off the national debt by fining insurance companies and health care providers $100 every time they overbilled, incorrectly denied care, or misrepresented the number of patients who paid out-of-pocket.
They exploit the fear and information asymmetries that exist in health care
Separate them. Make… https://t.co/yc83T2tHs6
— Mark Cuban (@mcuban) December 24, 2025
Cuban said insurance companies and health care providers “have taken advantage of the fear and information asymmetries that exist in health care.” He advocated breaking them up in order to “make the market efficient again.”
While Cuban’s proposal focuses on imposing $100 fines on insurance companies that overcharge or deny care, the broader thrust of his argument is to do away with opaque middlemen and mandate transparent pricing (as he did with cost-plus drug pharmacies), which could help alleviate one of the biggest drivers of America’s fiscal strain.
The U.S. national debt soared to $38 trillion in October, rising by about $1 trillion in just over two months to 2025, twice the typical growth rate since 2000. According to the Peter G. Peterson Foundation, a leading fiscal watchdog. Interest payments, already about $1 trillion a year, could total as much as $14 trillion over the next decade, a trajectory regulators warned was “unfit for a great country like the United States to manage its finances.” A closer look at health insurance and overbilling doesn’t exactly reveal that fixing the problem will solve the debt or deficit, but Cuban is right, there are definitely problems in this area.
How cost-plus drugs fit in
Cost Plus Drugs sells drugs at the drug’s manufacturing cost, plus a fixed markup of 15%, a small pharmacy fee and posted shipping charges. The company eliminates traditional pharmacy benefit managers and negotiates directly with manufacturers, publishing procurement costs and formulas so customers can see exactly how their prices are set.
wealth and other media reports that cost-plus drugs can slash the price of some generic drugs from thousands of dollars per month to double digits, especially for patients who are uninsured or face high deductibles. Cuban believes that if similar transparency and direct-to-consumer models were applied across health care, along with rules like making cash prices count toward insurance deductibles, the country could eliminate layers of waste that burden households and even public budgets.
As a direct-to-consumer company, Cost Plus eliminates the pharmacy benefit managers (PBMs) who negotiate prices with drugmakers on behalf of health insurance companies. The industry has been criticized by others outside Cuba, such as former Federal Trade Commission chairwoman Lina Khan, who led an aggressive, years-long crackdown that she called “prescription drug middlemen“. Federal Trade Commission’s Section 6(b) investigations into the PBM industry require the field’s largest companies to turn over reams of data and documents about their business practices, and a January 2025 FTC interim report claimed that PBMs were driving drug prices by $7.3 billion above their procurement costs. While this number is substantial, even if the PBM’s overcharge estimate is larger, it is a far cry from the $38 trillion national debt.
When contacted by email, Cuban agreed “of course” the national debt is so huge that even fixing billions in inefficiencies would be just the beginning. “Obviously, those who are fined will change their behavior,” he added, but said he believed the abuse in the system was “well over $7.3 billion.”
Cuban said as an example that if brand-name drugs moved to net pricing, millions of insurance plan holders would pay the net price during the deductible phase instead of the full retail price they currently pay. “Can you imagine if a Pringles distributor paid full retail for the Pringles and then sold them to grocery stores for full retail, and then the grocery store had to wait for a rebate, which may or may not cover their cost to buy the Pringles? That’s how drug stores work. It doesn’t make sense.” He argued this would save patients tens of billions of dollars a year in specialty and brand-name drug costs.
Khan’s public criticism of PBM was “janitor“This gave the company grounds that she was biased and should recuse herself from the investigation. During Khan’s tenure as chairman, the FTC filed lawsuits against several prominent PBMs, and those lawsuits remain pending even though Khan is no longer with the agency.”
Heading into the critical 2026 midterm elections, millions of Americans are facing skyrocketing insurance costs caused by federal government policies following the Republican defeat in the 2025 elections on the theme of “affordability.” Insurance subsidies under the Affordable Care Act expired in December, and many Americans are choosing not to enroll. new york times report. (The Affordable Care Act’s mandate requiring people to buy health insurance has remained constitutional in multiple Supreme Court rulings, but fines were reduced to $0 during Trump’s first term because Part of the 2019 Tax Cut Act.)
The economy has been a top concern for voters ahead of the midterm elections, but that could include health insurance costs because “cost of living“Health care” is often cited as the main economic issue, with health care often ranking second, according to a November 2025 AP Voter Poll. October 2025 U.S. Household Poll The Hart Research Associates study found that health care costs are the top concern among American voters, with 43% saying lowering costs is the most important issue for Congress and the president to address, ahead of housing, jobs, immigration and crime.
Economists and health policy experts counter that even significant savings on prescription drug and billing reforms would only partially address part of the $38 trillion in debt created by structural deficits, rising interest costs and political gridlock. They say Cuban’s pharmacies are a powerful example of how to lower prices and expose middlemen, but warn it is unlikely to be a panacea for debt problems stemming from a wider range of tax and spending choices.
“Right now,” Cuban told wealth“The biggest players in health care, the insurance companies, the PBMs they own…are too big for %pp care.”
This story was originally published on wealth network