Just saw Elon Musk drop a pretty straightforward question on X — why can't Americans actually afford healthcare? Turns out Mark Cuban had a lot to say about that, and honestly, his breakdown is pretty eye-opening.

Cuban didn't hold back. He basically laid out seven reasons why the whole system is broken, and most of them point back to pharmacy benefit managers (PBMs) and the contracts companies sign with them. It's not about the government or some abstract problem — it's about the actual deals businesses are locked into.

Here's what stood out to me. Companies literally don't own their own claims data. They can't even see where their money's going, which means they have zero leverage to negotiate. Then there's the drug selection issue — PBMs decide which medications employees can access, and surprise, they usually pick the expensive ones over cheaper alternatives that work just as well.

Cuban called out "specialty drugs" as basically a pricing scam. These aren't actually special, but PBMs mark them up anyway. And get this — the sickest employees end up paying the most because of how rebates are structured. It's backwards incentives all the way down. Independent pharmacies are getting crushed too because PBMs reimburse them below cost, which kills competition and drives prices up for everyone.

Maybe the wildest part? CEOs can't even negotiate directly with drug makers because their PBM contracts ban it. And if they try to speak up about how bad these deals are, they're legally silenced by NDAs.

So what's Cuban doing about it? He's actually building an alternative. His online pharmacy model — Cost Plus Drugs — cuts out the PBMs entirely and sells directly to consumers. No hidden fees, no artificial markups, full transparency. It's the kind of disruption the healthcare industry probably needs.

When Elon Musk asks why Americans aren't getting value for their healthcare spending, Cuban's answer is basically saying the system itself is designed to benefit everyone except the people actually paying and using it. Whether an online pharmacy model can scale enough to force real change is another question, but at least someone's trying to break the cycle.