Mark Cuban has an idea for how to stop the $38 trillion national debt runaway train, and it has a lot to do with the online pharmacy company he founded in January 2022. On Christmas Eve, the billionaire investor posted on X about his frustrations with the insurance market.
Insurers and providers, according to Cuban, “play on the fear and information asymmetry that exists in health care.” He argued that they should be broken down to “make markets efficient again”.
While Cuban’s proposal focused on $100 fines for insurers who overbill or deny care, the broader thrust of his argument is that dismantling opaque middlemen and forcing transparent pricing — as he is doing with his pharmacy Cost Plus Drugs — could help tame one of the biggest drivers of America’s fiscal strain.
America’s national debt grew by more than $38 trillion in October, adding about $1 trillion in just over two months in 2025 — twice the typical growth rate since 2000, according to the Peter G. Peterson Foundation, a leading fiscal watchdog. Annual interest payments are already around $1 trillion and could reach $14 trillion over the next decade, a trajectory the watchdog warns is “no way for a large nation like America to manage its finances.” A closer look at health insurance and overbilling doesn’t find that fixing the problem would solve the debt or the deficit, but Cuban is right that something is definitely not right in this space.
Cost Plus Drugs sells drugs at their manufacturing cost, plus a fixed 15% markup, a small pharmacy fee and an advertised shipping fee. The company cuts out traditional pharmacy benefit administrators and negotiates directly with manufacturers, publishing acquisition costs and formularies so customers can see exactly how their prices are built.
wealth and other outlets have reported that Cost Plus drugs can reduce the price of generic drugs from thousands of dollars a month to double digits, especially for patients who are uninsured or have high deductibles. Cuban argues that if similar transparency and direct-to-consumer models were applied to health care — combined with rules like letting cash prices count toward insurance deductibles — the country could shed layers of waste that burden both families and, ultimately, public budgets.
As a direct-to-consumer company, Cost Plus does away with pharmacy benefit managers, or PBMs, who negotiate prices with drug manufacturers on behalf of health insurance companies. That sector has come under fire from players beyond Cuban, such as former Federal Trade Commission Chairman Lina Khan, who has led an aggressive, years-long crackdown on what she called “prescription drug middlemen.” The FTC’s Section 6(b) investigation into the PBM industry ordered the biggest firms in the space to turn over extensive data and documents about their business practices, and a January 2025 FTC interim report claimed that PBMs had marked up drugs by $7.3 billion above their acquisition costs. While this is substantial, even a much higher estimate of the overburden by PBMs would be a far cry from the $38 trillion national debt.
When reached by email, Cuban agreed that “of course” the national debt is so gigantic that even billions in fixed inefficiencies are just the beginning. “And obviously those who are fined would change their behavior,” he added, but said he believed the abuse in the system was “well over $7.3 billion.”
If brand-name drugs switched to net price, Cuban offered as an example, then millions of insurance plan holders would pay the net price during their deductible phase, rather than the full retail price they currently pay. “Can you imagine if a Pringles distributor paid full retail for Pringles and then sold to grocery stores for full retail, and then the grocery stores had to wait for a discount that may or may not cover their cost to buy Pringles? That’s how pharmacy works. It doesn’t make sense.” He argued that this would save patients tens of billions a year on specialty and brand-name drugs.
Khan’s public criticism of PBMs as “watchdogs” has given the companies ammunition to claim she is biased and should recuse herself from the inquiry. The FTC filed lawsuits against several prominent PBMs while Khan was chairman, and those are still pending, even though Khan no longer works at the agency.
Heading into the 2026 midterm elections and following a Republican rout in the 2025 elections that rallied around the theme of “affordability,” millions of Americans face rising insurance costs as a result of federal government policy. Insurance subsidies under the Affordable Care Act expired in December, and many Americans are choosing not to be insured, The New York Times reported. (The mandate to require people to buy health insurance under the ACA has survived several Supreme Court rulings as constitutional, but the penalty was reduced to $0 in Trump’s first term as part of the 2019 tax cut law.)
The economy consistently polls as voters’ top concern heading into the midterms, but that may include health insurance costs, as the “cost of living” is regularly cited as the top economic concern, with health care typically a close second, according to a November 2025 AP poll. Lowering costs was the top issue for Congress and the President to address, above housing, jobs, immigration and criminality.
Economists and health experts counter that even aggressive prescription drug savings and billing reform would only touch a fraction of what’s driving a $38 trillion debt built on structural deficits, rising interest costs and political gridlock. They say the Cuban pharmacy is a strong example of how to lower prices and expose middlemen, but warn that it is unlikely to be the view of a debt problem fueled by much broader tax and spending options.
“Right now,” Cuban said wealth“the biggest players in healthcare, the insurance companies, the PBMs they own… they’re all Too Big %pp Care.”
This story was originally featured on Fortune.com
