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This is worth a few minutes of your time, whether you are sick and in need of care or RX or you work in healthcare or you're concerned about how insurance and receiving and paying for care works in the USA, this is the best discussion I've seen in a while. As per usual, Mark Cuban kicking ass and being a conscious capitalist. Love this guy.
Healthcare AI+Innovation | ER Doc@TPMG | Offcall & MDCalc Founder
"We’ve turned hospitals and doctors into subprime lenders without assets." In one sentence, Mark Cuban cuts straight to the heart of what’s broken in American healthcare, and this 4 minute video clip will summarize everything that’s wrong. Mark is a brilliant communicator, and perfectly captures the hidden consequences of what is ultimately a moral victory: 𝘥𝘰𝘤𝘵𝘰𝘳𝘴 𝘢𝘯𝘥 𝘩𝘰𝘴𝘱𝘪𝘵𝘢𝘭𝘴 𝘵𝘳𝘦𝘢𝘵 𝘱𝘢𝘵𝘪𝘦𝘯𝘵𝘴 𝘧𝘪𝘳𝘴𝘵, 𝘢𝘯𝘥 𝘢𝘴𝘬 𝘧𝘰𝘳 𝘱𝘢𝘺𝘮𝘦𝘯𝘵 𝘭𝘢𝘵𝘦𝘳. And as an ER doctor, much of this comes from EMTALA, the law that says we don’t let people just die on the streets. In the ER, we’ll see you no matter what. But because EMTALA is an “unfunded mandate” — meaning the government won’t pick up the tab if you can’t pay — doctors and hospitals have to just take on a ton of “subprime” risk (and debt). And how do hospitals balance their books if a third of the time their services are essentially free? 𝗧𝗵𝗲𝘆 𝗷𝗮𝗰𝗸 𝘂𝗽 𝗽𝗿𝗶𝗰𝗲𝘀. Then Cuban exposes the vicious cycle between payors and hospitals: 🏥 Hospitals Inflate Prices: To offset unpaid bills, hospitals charge inflated prices to insurers who they know will pay. An MRI might cost $450 for cash-pay patients, but if billed to insurance? $2,000. 🏦 Insurance Companies Benefit: Thanks to the Affordable Care Act (ACA), insurers must spend 85% of premiums on healthcare costs. Higher hospital prices mean insurers can justify higher premiums—and take a larger profit. 🤒 Patients Lose Twice: Patients face inflated bills they can’t pay, leading to bankruptcies. Meanwhile, cash prices are often cheaper than insured prices, making the system feel completely 𝗿𝗶𝗴𝗴𝗲𝗱. I will say this until I’m blue in the face: honestly at least a third of ALL the healthcare spending in the US is just to counter, pivot, and adapt to the fundamentally broken system. Payors do this? Insurers do that. Doctors do this? Pharma does that. The rules of the game clash with the values of our people—and this friction leaves everyone, from patients to providers, deeply unhappy with what we’ve built.
Patrick G.
2d
This is old news. Nothing ground breaking in the assessment. Mark should focus more on the solution not the problem.
Anne Cantera
1w
Waiting for him to start a health insurance company.
.Joel Barr.
1w
That pharmacy thing he has working is smart shit.
This is why private practices are accepting insurance less and less. Doctors get paid in full as patients are taking on financial burdens for OOP costs WHILE still paying insurance premiums. The flow for patients to submit these OOP/OON claims to United Health is awful. Accessibility issues, basic form validation is lacking, data pass through injects errors, it's terrible. I'd love to get in contact with the product owner of that experience bc I'm not entirely sure how it's legal as it exists today.
Everyone from provider in the medical World and subscriber to the medical ins plan knows that the system is messed up. There is enough talk and chatter in social media but no action. Unfortunately people like Luigi Mangione took the extreme action which is never called for. The insidious problem is medical ins cos should not be played by the stock market. As we all know, upto 20% of return is expected by investors. So the middle man (which does not provide medical care but manage it) the ins co is going to take it out from the low hanging fruit...the patient. The Hospital and Ins cos are in it together. Hospitals charges more, so Ins cos raises premium rates citing increase in the cost. In the end the patient is the looser, and who represents the patient...their local Gov representatives...who are governened by deep pocket special interest lobbyist. So the patient..in reality, has no representation. Yes, the medical system needs a serious operation.
I really appreciate Cuban's ability to articulate some of these very complex problems in a way that's accessible to so many people. Also based on this photo I'd but his chances of having ADHD at greater than 90%
Trust the US to strip previously well-earning people into the credit space. Talk about one job being enough for a decent quality of life. We might have to talk abour guard-rails more in the future. The free market economics have been implemented enough and the evidence is in. Without regulations, more honest, hard-working people will get exploited.
Definitely a problem that can only be solved through a systemic redesign where not one actor is easy to blame (well except the insurance business model itself). Living in Japan, it’s been eye opening to see how the system here is able to accomplish delivering care that’s both affordable and high quality.
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1wIs it gaming the system if the system is designed to be gamed and all the players (except maybe the patients) know it? This isn’t Conscious Captalism, Thomas. It’s No-Conscience Captalism or Unconscionable Capitalism, take your pick.