(The Center Square) - Mark Cuban and State Rep. James Talarico (D-TX) have identified real public frustration: American health care too often fails patients on affordability, transparency and choice. But breaking up health care companies will not create one. Putting patients in control would.
Cuban and Talarico recently argued that consolidation among insurers, pharmacy benefit managers (PBMs), pharmacies, and providers drives up costs. Talarico described how when he was diagnosed with Type 1 diabetes, he would pay $684 for a 30-day supply of insulin. That affordability problem is real. The disagreement is over the solution.
Talarico has embraced the bipartisan Break Up Big Medicine Act, which would restrict certain health care companies from owning medical providers. Cuban has also criticized vertical integration among insurers, PBMs, pharmacies and providers.
But Cuban is not entering this debate without a political or commercial history. He previously backed Kamala Harris over President Donald Trump and is now joining Democrat Talarico in calling for federal action against health-care consolidation. That raises a fair policy question: Would giving Washington more power to determine how health-care companies may organize actually increase competition and patient choice, or simply replace market decisions with political ones?
Those concerns deserve scrutiny. But Washington deciding how companies may organize does not address the deeper problem: patients control too little of their health care money.
Decades of public policy have built a third-party payment system dominated by employers, insurers, PBMs, hospitals, and government programs. The person receiving care often cannot see a meaningful price or directly control the dollars paying it. That weakens the price signals and consumer choices that make markets work.
Cuban’s health-care crusade also comes with a commercial interest worth considering. He is not merely criticizing the prescription-drug marketplace; he co-founded a company that competes in it. That raises another question: Should an entrepreneur competing against established health-care companies also urge Washington to restructure those competitors by law? Or should his business model compete for patients and prove its value on the merits?
Cuban’s own Cost Plus Drugs offers a useful contrast. It operates through a limited cash-pay model that offers posted prices for certain medicines. That can be a useful option for some consumers, but it is not a complete replacement for the coverage, pharmacy access, specialty-drug services, clinical support, and benefit integration many patients depend on. Its existence nevertheless makes an important point: companies can enter the market and compete without Washington forcing rivals to restructure.
The real test of Cuban’s confidence in Cost Plus Drugs is simple: compete for patients. A business model that truly delivers better value should not require a political campaign to restructure its competitors by statute. If Cuban’s model is as superior as he claims, it does not need Talarico and Washington bureaucrats to tilt the playing field. It should compete, win customers, and prove its value without a government-designed breakup of its rivals.
That is the lesson policymakers should apply across health care.
My Empower Patients Initiative with Dr. Deane Waldman would move health care dollars and decisions toward patients. A central reform is No-Limit Health Savings Accounts, which would give Americans much greater freedom to save and spend their own money on care.
Combine that with portable health care dollars, direct primary care, transparent cash prices, catastrophic insurance, and fewer barriers to providers entering markets. Then businesses have to compete for consumers instead of lobbying government over how the industry should be structured.
The same principle applies to PBMs. As I explained in recent Texas legislative testimony, PBMs deserve scrutiny, and fraud or anticompetitive conduct should be punished. But regulating one middleman more aggressively can simply move costs and bargaining power elsewhere.
Lower prices, transparency, and patient choice are worthy goals. But Washington won't achieve them by deciding which healthcare businesses may exist, which relationships may survive, and which business model political insiders prefer.
The better path is to give patients, not politicians, and not corporate bureaucracies, more control over their healthcare dollars. Expand choices and provide clear prices. Punish fraud and genuinely anticompetitive conduct. Let new entrants compete on the merits, without using government to restructure their rivals.
Texans do not need the government to redesign the already government-dominated healthcare system around Cuban’s business interests or Talarico’s progressive agenda. They need the freedom and financial control to choose the care, coverage, pharmacy, and doctor that work for them.
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