Elon Musk isn’t known for mincing words, and when he recently took to X (formerly Twitter) to ask why the U.S. can’t afford healthcare, he got an answer he may not have expected. Billionaire entrepreneur Mark Cuban didn’t just respond — he laid out a scathing critique of the system and pinpointed seven major reasons why healthcare costs are out of control.
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Musk’s original question, “Shouldn’t the American people be getting their money’s worth?” cuts to the heart of the issue. It reflects a growing sentiment that Americans are paying exorbitant healthcare costs but not receiving adequate value.
But Cuban — ever the problem-solver — didn’t stop there. He’s also presented a bold solution that could upend the pharmaceutical industry and force real change. The billionaire broke down where the system is failing and how he plans to fix it.
Instead of pointing fingers at the government or the system at large, Cuban argued that self-insured companies are part of the problem because of the contracts they sign with insurers and pharmacy benefit managers (PBMs). These deals, he claims, lock businesses into an overpriced system that benefits everyone — except the patients and the companies footing the bill.
Here’s the reality check Cuban dropped on business leaders:
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When businesses sign with big PBMs, they give up access to their own claims data, meaning they can’t even see where their money is really going. No data means no power to negotiate better deals.
PBMs — not the companies paying the bill — decide which drugs employees can access. This often means prioritizing expensive medications over more effective, cheaper alternatives.
Cuban called out one of the biggest rip-offs in healthcare — so-called “specialty drugs” that aren’t actually special. PBMs mark up the price, forcing employers to pay more, even when identical alternatives exist at a fraction of the cost.
PBMs structure rebates so that the sickest and oldest employees end up shouldering the highest costs, leading to higher deductibles, bigger co-pays and worse health outcomes.
PBM contracts reimburse independent pharmacies at rates lower than their actual costs, forcing them out of business. Fewer pharmacies mean less competition — which means higher prices and less access for consumers.
