For those of you with an interest in improving our healthcare system, I highly recommend either Eric Topol’s Ground Truths Podcast with Mark Cuban or the transcription of their discussion. Both can be found here: Mark Cuban: A Master Disrupter for American Healthcare
Mark Cuban describes the expansion of his generic pharmacy business Cost Plus Drugs. But the main focus is on other aspects of healthcare like pharmacy benefits managers, insurance companies and improving patient access.
“So a big part of my time these days is going to CEOs and sitting with them and explaining to them that you’re getting ripped off on both your pharmacy and your healthcare side….”
“Because when you see stories like we’ve all seen in news of a big healthcare, a BUCA healthcare (Blue Cross Blue Shield (BCBS), UnitedHealth, Cigna, and Aetna/CVS) plan with all the pre-authorizations and denials, typically they’re not even taking the insurance risk. They’re acting as the TPA (third party administrator) as the claims processor effectively for whoever hired them. And it goes back again, just like I talked about before. And as long as CMS hires or allows or accepts these BUCAs with these plans for Medicare for the ACA (Affordable care Act), whatever it may be, it’s not going to work. As long as self-insured employers and the 50 million lives they cover hire these BUCAs to act as the TPAs, not as insurance companies and give them leeway on what to approve and what to authorize and what not to authorize. The system’s going to be a mess, and that’s where we are today.”
In response to a post by Elon Musk that Americans are not getting a good deal with their healthcare expenditures, Mark Cuban posted the following:
“Because we’re cutting out all those ancillary costs and credit risk, I want Medicare pricing. Now the initial response is, well, Medicare prices, that’s awful. We can’t do it. Well, when you really think about the cost and operating costs of a hospital, it’s not the doctors, it’s not the facilities, it’s all the administration that cost all the money. It’s all the credit risks that cost all the money. And so, if you remove that credit risk and all the administration, all those people, all that real estate, all those benefits and overhead associated with them, now all of a sudden selling at a Medicare price for that hip replacement is really profitable.”
He also describes how his employees pay premiums but no additional costs and how to get to universal health coverage. “Why do we need insurance companies if they’re not even truly acting as insurance companies?“
Related blog posts:
gutsandgrowth 
Peter Attia’s podcast also did one recently that really covers the subject pretty well also: https://peterattiamd.com/saumsutaria/
I got to experience healthcare in Switzerland while living there for several years almost a decade ago. I think it is a great example of how a private system can be made to work–and how it clearly is NOT working in the US. We didn’t experience any serious illnesses when there, but after having 1 baby at Northside Hospital and the 2nd one at the Fribourg Cantonal hospital, it was a real eye opener for us for how healthcare could be.
There is a mandate there that everyone MUST purchase health insurance to the minimum level of “Swiss Basic” with standard of care that is highly regulated. It is a free market system, but employers are required to not be involved. Every insurance company must offer a policy rate to anyone who asks for one–and the only questions they ask is your age and if you smoke.
A decade ago, when a cup of Swiss coffee was ~$8 US, we paid $2500 (~2700 CHF per QUARTER) and I just had Co-pays. Being self-employed, I now pay $2600 per MONTH with no help until a $14K max out of pocket (that I will now hit in March).