‘It’s a Scam From Top to Bottom’ — Mark Cuban Says Nobody Looks at Healthcare Economics and Thinks It’s Working

America spends trillions of dollars on healthcare, but high costs do not guarantee affordable treatment, easy access or better outcomes. Cost Plus Drugs co-founder Mark Cuban says the system’s financial incentives are broken, and the people paying the bills are the ones left dealing with the consequences.

"It’s a scam from top to bottom. Nobody looks at the economics of healthcare and says it’s working well," Cuban said on the "unPAUSED" podcast in October.

The Numbers Behind His Criticism

A May report from the Commonwealth Fund found that the United States spent 18% of its gross domestic product on healthcare in 2024, nearly twice the average among OECD countries. The U.S. also remained an outlier on access, with approximately 27 million people uninsured and patients more likely than those in peer countries to skip needed care because of cost. 

Americans also spend more than $400 per person annually out of pocket for prescription drugs, compared with less than $100 in France, according to the report. 

The disparity raises the question at the center of Cuban’s argument. If the country spends so much more than its peers, why does that spending still leave so many people struggling to afford care?

The Incentives That Keep Costs High

Cuban has criticized the role of intermediaries in healthcare, particularly when the incentives built into the system reward higher prices rather than better value.

"If it’s harder to get, you can price it more," Cuban said, describing how scarcity can become an opportunity to charge more instead of a reason to address supply problems.

He has also criticized the influence of pharmacy benefit managers and other middlemen, describing them as "too big to care." The concern is that organizations involved in negotiating, managing and processing healthcare payments can have financial incentives that do not necessarily align with what patients need.

Those incentives operate within a much larger system of insurance premiums, deductibles, hospital charges and administrative costs. Patients often have little visibility into how prices are set, and insurance does not always shield them from substantial bills.

The Commonwealth Fund’s international comparison found that Americans face higher out-of-pocket costs and greater financial barriers to care than people in many comparable countries. That does not mean every intermediary or healthcare expense is unnecessary. It does show that the system’s financial complexity has not made care consistently affordable.

A Question of Value

Cuban’s criticism is sweeping, but the underlying issue is measurable. Healthcare absorbs a larger share of the American economy than it does in peer nations, yet access remains uneven and cost continues to keep patients from getting treatment.

The challenge is not simply reducing spending. It is making sure the money spent produces meaningful value for patients, rather than rewarding a structure that can remain profitable even when care is unaffordable.

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