He thinks Rick Scott is serious about healthcare? The same Rick Scott whose company was cited for one of the biggest Medicare/medicaid frauds in our history? Do tell.
Kudos to Cuban for his Cost Plus Drugs. But not so much for his
But I'm confused by his invocation of transparency, which he seems to equate to price-setting rather than price-taking. Yes, price setting is central for affordable health. But Cuban's pitch for transparency won't get us there if, as he says, government or his version of cost plus organizations should set standards, but not prices. Medicare (at the federal level) and Medicaid (on a state-by-state basis) set prices, which is the advantage they have over private pools (insured or self-insured). Medicaid payments are are as much as 30% less than private payments for the same procedures, Medicare is in between the two. But the price-controlled advantages they have lead to shifts in cost to private-pay patients, especially individuals and small groups. And both Medicare and Medicaid regularly do battle with the drug companies in Congress and in statehouses, so the drug companies are not exactly passive recipients of the prices that even governments set.
So Kudos to Cuban for leveraging his group's buying power to counter the cost shifting and middle man markups for this one segment of health care for people who are otherwise on the lowest rung of pricing power in the system.
Still, price setting -- not just transparency, not just jawboning -- is the key to cost controls in the system overall, as every state Medicaid administrator knows. But price setters need price takers to agree to their pricing, which leads to where the power resides in the system, from PBMs to insurance companies to hospitals and health care systems.
Anyone can design a better system (easy) and try to get there incrementally (smart, though still not easy), but it will require paying less to lots of power centers in the health care economy which refuse to be price takers (and that's the hardest part of all, financially and politically).
Bernie Sanders' pitch for Medicare for All has been focused on political will, but he has done a disservice by not admitting that, first, it's not free (Medicare has an income-based system of premiums for all of its recipients, despite the fact that we all pay to support it via our paychecks) as well as price controls that many in the power centers of the system, including physicians, will oppose with all their might.
Designing the financial mechanisms for the system reform -- payroll taxes paid by employers and employees and something similar for non-wage income + modest premiums -- is not the hard part.
Ditto for the gate keeper mechanisms that Cuban advocates, which is necessary to control overuse and direct patients to the most effective care.
On paper at least, those elements make sense.
It's getting those who are the price setters in the profit centers of the system to become price takes -- that's the hard part that Cuban minimizes in his analysis.
- it costs less to see my endocrinologist vs my PCP (not-for-profit vs profit)
- Providers have almost no choice but to be bought by systems. They have to have entire billing departments and prior authorization systems.
- providers in my area have started charging for 2 visits if you take more than 15 minutes.
- I’m on Mounjaro. Previously approved, it’s now denied. The weight loss use of these drugs has hurt those of us that need it (to Mark’s point, my friend in Germany said it was $2-300; it’s $1000/month here.
- speaking of PBMs, Cigna started a separate company for GLP1s. They’ll even get you a doctor. Of course, I have my own doc and my plan doesn’t cover Zepbound, which is where my FDA-approved use falls. IMHO, these are miracle drugs.
- if Big Pharma is to take on more research with all the cuts that have been done, that’s not going to help prices.
- when I started 1 med, the retail price was over $300. It was supposed to be $68-69 due to a Cigna partnership with GoodRx. I found a new Good Rx coupon and paid $38!
I could go on, but you get the point. I just had a test Monday that I wanted to do next year. But, my deductible has doubled and now we have coinsurance. I make good money and my premium is close to last year, but I’m worried. I just had 2 surgeries. It just seems a little crazy… I didn’t do it but Cigna is now offering the supplemental and catastrophe plans (it was offered through my employer). So I can have Cigna health insurance and then insurance for Cigna to pay what it didn’t pay to start with…
Anywho - thank you so much for covering this stuff! It’s very important!!! ❤️
I would add: Big Pharma will be even harder pressed with all of the (mindless) cuts to NIH grants. And I don't shed a tear for them generally. Aside from PBMs, I can't believe we're not naming and shaming *drug wholesalers and distributors.* Like AmeriSource Bergen, Cardinal Health, McKesson, etc. I'd bet the average American has no idea how much these middlemen make.
Yep - I was trying to figure out if I needed Pre-Auth, there’s a separate company that does pre-Auth for some procedures. I used to do pricing. To Mark’s point, each level you add has to cover their costs and add profit.
I’m of the opinion we shouldn’t need subsidies.
I just checked out my claims - I’m always amazed at how low some of the “negotiated” prices are… we can’t even get decent customer service from these companies anymore. I know more about the system than they do.
I have no problem with a CEO making a lot of money, but they’re not delivering. If docs don’t leave practice due to lawsuits, they’ll leave from this system. (I lost a PCP once due to the time limits and quotas that were put on her - and she went to a nursing home system!). <sigh>
And this is just me ranting from what I’ve seen. I’ve had very few issues over the years. I just think the whole system is criminal.
If Cuban can create a health care system where coverage is mandatory and universal; where cost of all services is set and accepted; and where malpractice is replaced by standard payments for loss he should be President.
Health Policy is the single most complicated policy sphere in the US (and why we're so lucky to have Jonathon to cover it). f Mark cracked the code on delivering low cost generic drugs to cash paying patients. Sweet. That's one thing we don't have to worry about.
Time to turn him loose on another sliver. See what he comes up with.
also, mr. cohn, thank you for talking with these people regularly. I may not like what they say, but it's better to know. and really appreciate the general health care news.
Great talk with Mark Cuban...lots of ideas and hard to follow but overall I like the ideas he is voicing, especially ridding the healthcare world of PBMs. His admiration for ScoItt and Johnson is perplexing however. Im a retired physician and will say that I believe all healthcare should be non-profit organizations. I worked for a non-profit run by physicians who were required to see patients as well as their admin duties and I have never seen a better run organization. And there was complete transparency. A key, as Mark Cuban eluded to. Personally I see it as a model to a better healthcare system for America. Not a political winner...not a free market winner...but if we are serious about improving the dismal healthcare provided in America for a reasonable price it's a start. BTW what is everybody's beef with Medicare Advantage?
if you say "Ron Johnson and Rick 'My Company Stole Billions From Medicare While I Was In Charge!' Scott" are the two people you are talking with on how to fix health care, than you are not seriously engaging in this conversation. Is he visiting the ketamine lounge with Elon?
Excellent interview, Jonathan Cohn! Mark Cuban has some fascinating ideas, and the money and time to test them out. Plus it's nice to hear from a billionaire that actually wants to help his fellow citizens.
I'm getting tired of coarse locker-room expressions (f. . .) in supposedly serious political comments. I assume that people who do use them (even Bulwark editors?) assume that it enhances their message. What it does do is convey the directions in which American has moved - and I don't think they're positive.
Enjoyed this interview, and would love to see a followup with Mark Cuban on weight loss meds (and whatever else comes into his head - that was a wild ride).
Also: Jonathan Cohen, thank you for your consistent, thoughtful reporting. Your newsletter is right at my level.
We can’t just unwind for profit companies with a snap of the finger….unless we snap the finger and figure it out for the benefit of the people and the companies.
He thinks Rick Scott is serious about healthcare? The same Rick Scott whose company was cited for one of the biggest Medicare/medicaid frauds in our history? Do tell.
Jonathan- I want another episode on his opinion on GLP-1 medications-
Can we get a part 2
Kudos to Cuban for his Cost Plus Drugs. But not so much for his
But I'm confused by his invocation of transparency, which he seems to equate to price-setting rather than price-taking. Yes, price setting is central for affordable health. But Cuban's pitch for transparency won't get us there if, as he says, government or his version of cost plus organizations should set standards, but not prices. Medicare (at the federal level) and Medicaid (on a state-by-state basis) set prices, which is the advantage they have over private pools (insured or self-insured). Medicaid payments are are as much as 30% less than private payments for the same procedures, Medicare is in between the two. But the price-controlled advantages they have lead to shifts in cost to private-pay patients, especially individuals and small groups. And both Medicare and Medicaid regularly do battle with the drug companies in Congress and in statehouses, so the drug companies are not exactly passive recipients of the prices that even governments set.
So Kudos to Cuban for leveraging his group's buying power to counter the cost shifting and middle man markups for this one segment of health care for people who are otherwise on the lowest rung of pricing power in the system.
Still, price setting -- not just transparency, not just jawboning -- is the key to cost controls in the system overall, as every state Medicaid administrator knows. But price setters need price takers to agree to their pricing, which leads to where the power resides in the system, from PBMs to insurance companies to hospitals and health care systems.
Anyone can design a better system (easy) and try to get there incrementally (smart, though still not easy), but it will require paying less to lots of power centers in the health care economy which refuse to be price takers (and that's the hardest part of all, financially and politically).
Bernie Sanders' pitch for Medicare for All has been focused on political will, but he has done a disservice by not admitting that, first, it's not free (Medicare has an income-based system of premiums for all of its recipients, despite the fact that we all pay to support it via our paychecks) as well as price controls that many in the power centers of the system, including physicians, will oppose with all their might.
Designing the financial mechanisms for the system reform -- payroll taxes paid by employers and employees and something similar for non-wage income + modest premiums -- is not the hard part.
Ditto for the gate keeper mechanisms that Cuban advocates, which is necessary to control overuse and direct patients to the most effective care.
On paper at least, those elements make sense.
It's getting those who are the price setters in the profit centers of the system to become price takes -- that's the hard part that Cuban minimizes in his analysis.
Who decides what you can afford? What if you can’t afford 10% of your income?
Healthcare is my soapbox…
- it costs less to see my endocrinologist vs my PCP (not-for-profit vs profit)
- Providers have almost no choice but to be bought by systems. They have to have entire billing departments and prior authorization systems.
- providers in my area have started charging for 2 visits if you take more than 15 minutes.
- I’m on Mounjaro. Previously approved, it’s now denied. The weight loss use of these drugs has hurt those of us that need it (to Mark’s point, my friend in Germany said it was $2-300; it’s $1000/month here.
- speaking of PBMs, Cigna started a separate company for GLP1s. They’ll even get you a doctor. Of course, I have my own doc and my plan doesn’t cover Zepbound, which is where my FDA-approved use falls. IMHO, these are miracle drugs.
- if Big Pharma is to take on more research with all the cuts that have been done, that’s not going to help prices.
- when I started 1 med, the retail price was over $300. It was supposed to be $68-69 due to a Cigna partnership with GoodRx. I found a new Good Rx coupon and paid $38!
I could go on, but you get the point. I just had a test Monday that I wanted to do next year. But, my deductible has doubled and now we have coinsurance. I make good money and my premium is close to last year, but I’m worried. I just had 2 surgeries. It just seems a little crazy… I didn’t do it but Cigna is now offering the supplemental and catastrophe plans (it was offered through my employer). So I can have Cigna health insurance and then insurance for Cigna to pay what it didn’t pay to start with…
Anywho - thank you so much for covering this stuff! It’s very important!!! ❤️
You're doing very, very well on your soapbox!
I would add: Big Pharma will be even harder pressed with all of the (mindless) cuts to NIH grants. And I don't shed a tear for them generally. Aside from PBMs, I can't believe we're not naming and shaming *drug wholesalers and distributors.* Like AmeriSource Bergen, Cardinal Health, McKesson, etc. I'd bet the average American has no idea how much these middlemen make.
Yep - I was trying to figure out if I needed Pre-Auth, there’s a separate company that does pre-Auth for some procedures. I used to do pricing. To Mark’s point, each level you add has to cover their costs and add profit.
I’m of the opinion we shouldn’t need subsidies.
I just checked out my claims - I’m always amazed at how low some of the “negotiated” prices are… we can’t even get decent customer service from these companies anymore. I know more about the system than they do.
I have no problem with a CEO making a lot of money, but they’re not delivering. If docs don’t leave practice due to lawsuits, they’ll leave from this system. (I lost a PCP once due to the time limits and quotas that were put on her - and she went to a nursing home system!). <sigh>
And this is just me ranting from what I’ve seen. I’ve had very few issues over the years. I just think the whole system is criminal.
If Cuban can create a health care system where coverage is mandatory and universal; where cost of all services is set and accepted; and where malpractice is replaced by standard payments for loss he should be President.
Only one way to eat an elephant folks:
One bite at a time.
Health Policy is the single most complicated policy sphere in the US (and why we're so lucky to have Jonathon to cover it). f Mark cracked the code on delivering low cost generic drugs to cash paying patients. Sweet. That's one thing we don't have to worry about.
Time to turn him loose on another sliver. See what he comes up with.
Uh...a hard NO to taking advice from a rich white guy who thinks Ron Johnson and Rick Scott are serious about health care. Rick F'ing Scott?
also, mr. cohn, thank you for talking with these people regularly. I may not like what they say, but it's better to know. and really appreciate the general health care news.
Great talk with Mark Cuban...lots of ideas and hard to follow but overall I like the ideas he is voicing, especially ridding the healthcare world of PBMs. His admiration for ScoItt and Johnson is perplexing however. Im a retired physician and will say that I believe all healthcare should be non-profit organizations. I worked for a non-profit run by physicians who were required to see patients as well as their admin duties and I have never seen a better run organization. And there was complete transparency. A key, as Mark Cuban eluded to. Personally I see it as a model to a better healthcare system for America. Not a political winner...not a free market winner...but if we are serious about improving the dismal healthcare provided in America for a reasonable price it's a start. BTW what is everybody's beef with Medicare Advantage?
Medicare Advantage doesn't work for people with chronic diseases requiring currently expensive treatments.
if you say "Ron Johnson and Rick 'My Company Stole Billions From Medicare While I Was In Charge!' Scott" are the two people you are talking with on how to fix health care, than you are not seriously engaging in this conversation. Is he visiting the ketamine lounge with Elon?
Anyone else see "TrumpRx" and think: I'll buy from TrumpRx when Hell freezes over?
Excellent interview, Jonathan Cohn! Mark Cuban has some fascinating ideas, and the money and time to test them out. Plus it's nice to hear from a billionaire that actually wants to help his fellow citizens.
I'm getting tired of coarse locker-room expressions (f. . .) in supposedly serious political comments. I assume that people who do use them (even Bulwark editors?) assume that it enhances their message. What it does do is convey the directions in which American has moved - and I don't think they're positive.
Enjoyed this interview, and would love to see a followup with Mark Cuban on weight loss meds (and whatever else comes into his head - that was a wild ride).
Also: Jonathan Cohen, thank you for your consistent, thoughtful reporting. Your newsletter is right at my level.
We can’t just unwind for profit companies with a snap of the finger….unless we snap the finger and figure it out for the benefit of the people and the companies.