Mark Cuban has an idea for how to stop the runaway train that is the $38 trillion national debt, 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.
If we fined insurers and providers $100 every time they over-billed, incorrectly denied care or misrepresented any amount of patient out of pocket, we could pay of the national debt
— Mark Cuban (@mcuban) December 24, 2025
They play on the fear and information asymmetry that exists in healthcare
Break them up. Make… https://t.co/yc83T2tHs6
Insurers and providers, according to Cuban, “play on the fear and information asymmetry that exists in healthcare.” He advocated for them to be broken up, so as to “make the markets efficient again.”
While Cuban’s proposal focused on $100 fines for insurers that over-bill or deny care, the broader thrust of his argument is dismantling opaque middlemen and forcing transparent pricing—as he does with his Cost Plus Drugs pharmacy—could help tame one of the biggest drivers of America’s fiscal strain.
America’s national debt surged past $38 trillion in October, adding roughly $1 trillion in just over two months in 2025—twice the pace of typical growth since 2000, according to the Peter G. Peterson Foundation, a leading fiscal watchdog. Annual interest payments are already around $1 trillion and could total as much as $14 trillion over the coming decade, a trajectory the watchdog warns is “no way for a great nation like America to run its finances.” A closer look at health insurance and over-billing doesn’t exactly find fixing the issue would fix the debt or deficit, but Cuban is right that something is definitely off in this space.
How Cost Plus Drugs fits in
Cost Plus Drugs sells medications at their manufacturing cost, plus a flat 15% markup, a small pharmacy fee, and a posted shipping charge. The company cuts out traditional pharmacy benefit managers and negotiates directly with manufacturers, publishing acquisition costs and formulas so customers can see exactly how their prices are built.
Fortune and other outlets have reported Cost Plus Drugs can slash the price of some generics from thousands of dollars a month to double‑digit sums, especially for patients who are uninsured or stuck with high deductibles. Cuban argues if similar transparency and direct‑to‑consumer models were applied across health care—combined with rules like letting cash prices count toward insurance deductibles—the country could strip out layers of waste that burden both families and, ultimately, public budgets.
As a direct-to-consumer company, Cost Plus cuts out the pharmacy benefit managers, or PBMs, who negotiate prices with drug-makers on behalf of health insurance companies. This sector has come under criticism from players far beyond Cuban, such as former Federal Trade Commission Chair Lina Khan, who led an aggressive, multi-year crackdown on what she called “prescription drug middlemen.” The FTC’s Section 6(b) inquiry into the PBM industry ordered the largest firms in the space to turn over extensive data and documents about their business practices, and a January 2025 interim report from the FTC claimed that PBMs marked up drugs by $7.3 billion in excess of their acquisition costs. While that’s substantial, even a much larger overcharging estimate on the part of PBMs would be a far cry from the $38 trillion national debt.
When contacted by email, Cuban agreed that “of course” the national debt is so gigantic that even billions of inefficiencies being fixed are just the start. “And obviously those being fined would change their behavior,” he added, but he said he thinks abuse in the system is “far more than $7.3 billion.”
If brand medication moved to net pricing, 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 to Pringles and then sold to grocery stores for full retail, and then the grocery stores had to wait for a rebate that may or may not cover their cost to buy the Pringles? That’s how pharmacy works. It makes no sense.” He argued this would save patients tens of billions a year across specialty and brand medications.
Khan’s public criticisms of PBMs as “gatekeepers” gave the companies ammunition to argue she was biased and should recuse herself from the investigation. The FTC filed lawsuits against several prominent PBMs while Khan was chair and those are still pending, even though Khan is no longer serving at the agency.
Heading into crunch midterm elections in 2026, and following a rout of Republicans in 2025 elections that unified around the theme of “affordability,” millions of Americans are dealing with a spike in their insurance costs as a result of federal government policy. Subsidies for insurance under the Affordable Care Act expired in December, and many Americans are choosing to go uninsured, 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 the first Trump term, as part of the 2019 tax cut law.)
The economy consistently polls at voters’ top concern heading into the midterms, but that may include health insurance costs, as “cost of living” is regularly cited as a main economic concern, with health care typically coming in second, per an AP voter poll in November 2025. An October 2025 poll for Families USA conducted by Hart Research Associates found health care costs were the top priority for American voters, with 43% saying that lowering costs was the most important issue for Congress and the President to address, above housing, jobs, immigration and crime.
Economists and health‑policy experts counter that even aggressive savings in prescription drugs and billing reform would only touch part of what is driving a $38 trillion debt built on structural deficits, rising interest costs and political gridlock. They say Cuban’s pharmacy is a powerful example of how to lower prices and expose middlemen, but warn it is unlikely to be the silver bullet for a debt problem fueled by far broader tax and spending choices.
“Right now,” Cuban told Fortune, “the biggest players in healthcare, the insurance companies, the PBMs they own … are all Too Big [to] Care.”
