Mark Cuban isn't buying the idea that healthcare is broken. He thinks it's working exactly as designed—for the people cashing in. And in his words, "they are too big to care."

In a post on X, the Cost Plus Drugs co-founder unloaded on the system he says is engineered to enrich hospitals and insurers by quietly jacking up costs. "Want another reason why healthcare costs are insane? Hospitals will not only charge a facility fee and other random costs," Cuban wrote, "but also, if they believe the insurance company is willing to pay more than what was on the patient bill, they will increase the bill to the insurance company." That inflated total doesn't just vanish—it gets passed on to self-insured employers.

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According to Cuban, this isn't abuse of the system. It is the system. "Our healthcare has become a game of who can rip off who and get away with it," he wrote. His fix? Break them up. "They are so big they set the rules," he said. "They control it top to bottom."

He's calling for mandatory divestitures of non-insurance assets to open the field for entrepreneurs to compete, drawing a direct line to the 1984 AT&T breakup. "Make them divest non-insurance assets, then we entrepreneurs can actually compete," he wrote. "It's like breaking up AT&T in 1984. Look how it opened up the internet 10 years later."

Cuban's deeper point is about vertical integration. The same companies often control the insurance provider, the pharmacy benefit manager, and the healthcare facility itself. That kind of setup doesn't just obscure costs—it builds a system that rewards complexity, overbilling, and market lockout.

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He's been just as blunt about pharmacy benefit managers, or PBMs. "I'm all for PBM reform," Cuban wrote earlier this month. "But realize that the biggest PBMs are owned by the biggest insurance companies. Right now they use the PBMs as a cash cow. But they aren't stupid. They will move those dollars wherever they need to compensate for any PBM legislation. They are too big to care."

Many who responded to his thread echoed the frustration. "Children's hospital charged me over $500 for ankle x-ray for my son! It wasn't even the main hospital, it was a satellite!" one person replied. Another pointed to the army of administrators ballooning costs behind the scenes: "Doctors and nurses are great, but they rarely ever meet with patients about costs or negotiate them… eliminating admin is getting rid of the middle man."

Cuban sees that "middle man" not as excess—but as the engine of profit. And when the cost of a scan can swing from $250 to $2,500 depending on the building you walk into, patients are left guessing, even with coverage.

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U.S. healthcare spending is now over $5 trillion a year, with administrative overhead far higher than in other developed nations. Despite the sky-high costs, outcomes often lag. Meanwhile, small employers with self-funded plans are stuck footing bills they didn't authorize, for services they couldn't negotiate, from systems they don't control.

Cuban's approach isn't to fine-tune the mess. It's to smash it. His Cost Plus Drugs platform, which cuts out PBMs and sets transparent prices, is one example of how he's trying to build around the entrenched giants rather than work within their system.

Whether Congress takes up his call to break apart healthcare conglomerates the way it once did AT&T is still uncertain. But Cuban's message—like the bills many Americans receive—isn't subtle.

And if you're one of those people trying to make sense of rising premiums, surprise charges, or employer health plans that still leave you with big out-of-pocket costs, it might be time to talk to a financial adviser before the next invoice lands on your desk.

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