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- [00:00]
A
Save over $200 when you book weekly. Stays with VRBO this winter. If you haven't seen your college besties since, well, college. You need a week to catch up in a snowy cabin. Take a week long vacation and save over $200. Book now@vrbo.com ever see an idea so clearly in your head but struggle to make it real? We've all been there. With wix, you can build a website for your business just the way you pictured it. Get the best of both worlds with AI and drag and drop tools all in one place. Stay in your creative flow and use AI when you want, how you want. Create a website your way. Try it out@wix.com hey everyone, it's Jonathan.
- [00:42]
B
Cohn of the Bulwark here. You know we have been talking a lot about healthcare because of this debate over the ACA subsidies. But as important as that debate is, and you know how important I think that debate is, there is a whole other separate, deeper conversation we need to be having and that is about why America's healthcare system is such a frigging mess and what we can do about it. You know, we spend more than any other country in the world on healthcare. We do not get the results that are much better than the rest of the world. And in many ways we get results that are worse. Quality is all over the place. The system is full of waste and outright fraud and the financial strain affects all of us, government, employers, and each of us. We all pay. And it doesn't matter how you get your insurance, whether it's through an employer, through the government, you buy it yourself or you have no insurance. You are paying the price in premiums, out of pocket costs. You're paying it in wages and raises you don't get. And in the most serious cases in the form of health care that you don't get, that you might need to stay healthy or even to stay alive. This is a complicated and serious debate, not something that can be done quickly or easily. But a good starting point is to make sure you're listening to everybody and bringing in voices that aren't necessarily health policy professionals or in politics, but know a lot about health policy. We are very fortunate today to have someone who fits that description. You know him as the world famous entrepreneur and investor, star of Shark tank owner I guess, now minority owner of the Dallas Mavericks. I know him as a dude who's doing some really interesting things on prescription drugs. Please say hello. Welcome to Mark Cuban. Mark, thanks so much for coming to the Bulwark and talking about healthcare with us.
- [02:27]
C
Thanks a lot, Jonathan. Thanks for having me.
- [02:28]
B
So I want to start. I'm going to tell you my bias here, which is that normally I'm very skeptical of people like you. I have been covering health care for a long time. Yeah, I mean, I'm skeptical about everybody, to be fair. But, you know, I've been covering health care for this for a long time. And there's been this steady parade of people from business and finance who are very successful in whatever their line of work is. And they think, well, I'm really good at picking stocks or I'm really good at selling groceries. So I. American healthcare is a Mexican. I can. I can fix it. And they last about three months and they're like, wow, this is really complicated and hard and I'm going to go do something else. But you are different. You got into health care and you've stuck with it and you've done some really interesting things. But maybe the place to start is why. I mean, you had your gig on Shark Tank. You had those sweet seats for the Mavericks games. Why do you even want it? Why do you want a piece of any of this? What got you interested?
- [03:18]
C
Is there any more hated industry than the economic side of healthcare?
- [03:22]
B
Right?
- [03:23]
C
Is there any greater need in the United States other than, you know, we can argue about policies that of political things, but then healthcare, right? I mean, nobody dies healthy. We all go through it, through our. For ourselves, our families, whatever it may be. And so I actually got a cold email from a Dr. Alex Osmiansky, and he was like, I want to create a compounding pharmacy that makes medications that are on short supply. Things like pediatric cancer drugs. I'm like, wait, pediatric cancer drugs? Generic pediatric cancer drugs, short supply? And it was like, yeah, that's how the market is played. You know, the manufacturers of those drugs will let them, you know, go into short shortage and then jack up the price. So I want to take care of that. I'm like, that's great, but that's not big enough. And it was right around the time the pharma bro was going to jail. And I was like, how did this guy, how was he able to jack up this generic drug, Daraprin, by however, 750%, 7,500, whatever it was, and nobody really understood it. And it happened. And you know, then as I started digging in, it was obvious that the problem on the pharmaceut, and as I come to find out, the medical side as well, is the opacity, the complete lack of transparency. And when there's transparency. There's. When there's a lack of transparency, there's abuse. And where there's an opportunity for abuse, companies people are going to take advantage of it. And so we came around to creating costplusdrugs.com and so if I just stop.
- [04:46]
B
You for one second because I think just for people who are kind of coming to this new. When you say transparency, you mean that basically nobody really knows what they're paying for drugs, what they really cost, right?
- [04:54]
C
Well, think about what happens. You go to the doctor and hopefully you don't need anything. But he says, okay, Jonathan, you need a prescription for xyz. The first question out of their mouth is not, can you afford it? Here's the price, here are the options. It's what pharmacy do you use? And then the whole chain of events just starts from there. And we, it wasn't, you know, it wasn't a big stretch. It wasn't brilliant. We figured out very quickly that people who can't afford their medications, people who have to ration their medications or make determinations on, you know, childcare versus medications, if they knew what the price was, then they would have better options. So that was part one. Part two is, you know, the generic injectables going on shortage taught us that, you know, most companies price to market and nobody does it from a cost plus basis. And we thought if we just, you know, marked up our medications that we sold at a fair price, which in our case is a markup of 15%, that our prices would be a lot less expensive. So by connecting transparency and a reasonable markup of 15% and underpricing everybody else out there, we thought that we could start a real business. And that's what we did with costplusdrugs.com.
- [06:05]
B
So how does it work? Cost plus drugs? So it's a website. I mean, if I want, if I want to use it, can anybody use it?
- [06:10]
C
Yeah, anybody can use it. Yeah, you just go to costplusdrugs.com, put in the name of the medication. If it's one of the thousands of SKUs that we cover, it comes up. So let's just say guys of my age used to Dilafil generic Cialis, right? So you put into Dilafil and it comes up, but we actually show you our cost and then we show you our markup. And then because it's. If you choose mail order, it's a $5 markup for shipping and the total cost is going to be less than a bag of M&M's, it's going to be like $8.95. Whereas prior to that you might pay 30, 40, $200 depending on where you were buying it, to get that same medication. And the same applies across the full range of drugs, particularly drugs that are considered, quote unquote specialty, you know, generic cancer drugs, Ms. drugs, things like IM is for cancer. But before we got in, people would pay $2,000. Like if you had a big deductible of $2,500, let's say, or more, you might pay 200,000 to $2,000 in your first month. Then we came out with it at 3450, you know, and then people realized they were getting ripped off. Word got around. Cancer patients talk and people started coming to Cost plus Drugs and checking us out not just for cancer drugs or ED medications, but for everything. And that was. We launched January 19th of 2022. And in almost four years we've just been skyrocketing and growing.
- [07:38]
B
Why did it have to be you guys coming in to do this? Why were the drugs so expensive before? I mean, if you could sell them at this lower price, why weren't they being sold at this lower price?
- [07:45]
C
Because I'm rich as fuck and I didn't care about the money. Honest guy, right? Any other business, right. My next dollar is not going to change my life. And I recognize that. And I feel like it's an obligation for me to try to do more that I have been this bless. If I were 25 years old or 35 years old and just getting started, I probably would have priced to market. If I had a public company, I would price to market. It was just the circumstances that allowed us to do it. And in doing the analysis, I thought not only could we be fair, not only could we be trusted, but we could at least break even if we grew big enough and added other features. And that's what's happening now. We're not quite break even, but we're getting there.
- [08:25]
B
So that all makes sense. And it's great that you, that you have that sort of public spiritedness and all that. But in theory at least before, before you came along, right. I mean there were insurance companies and it was their job to get prices down, right. Or you're an employer, I mean, because I mean I'm gm, right. I don't want to be, I want to, I want to get that cost as low as I can. So presumably I was trying to find a lower cost of my drug. So why, why wasn't GM able to.
- [08:48]
C
Do it before because there's an information asymmetry that the people at GM are just trying to get through the day, do their jobs. It's hard. They want to get the best price that they can. They have a fiduciary responsibility to their members and they do their best. You know, Warren Buffett, I think, said GM is a car. Com is an insurance company masquerading as a car company. And that's true. Right. They're trying to figure it out. Whereas with us, we just really lasered in on generics and medications to start and now brands as well, to really just serve one purpose. And when you look at the insurance companies, they're behemoths. You know, when you hear them talk now, if their stock goes down one day, they're having conference calls with the analysts about how they're going to get the stock price back up as quickly as possible. That does not align with getting the lowest possible price to. To patients.
- [09:37]
B
Now, my recollection was, I'm a little bit of a leading question here, that there were these people who came around who were supposed to help the insurance companies or the big employers that they were going to be the middlemen who were going to get the lower prices. They were called Pharmacy Benefit Managers, PBMs, great acronym in the world of healthcare. And their whole job, right, was to get downhill. That was what they were going to do. They were going to go and say, hey, we have the expertise. We're going to get down the prices. So you the insurer or you the employer, you won't have to pay so much.
- [10:03]
C
It's.
- [10:04]
B
It didn't really work out that way, you discovered. Is that right?
- [10:06]
C
No, no. It's like what's the movie, Usual. Usual Suspects, where they said the greatest lie the devil ever told was telling you they don't exist. The greatest lie Kaiser.
- [10:15]
B
So say Kaiser. So say kaiser.
- [10:17]
C
So say PBMs do the same thing. The greatest lie ever told by PBMs is that they get the best price for you. And don't forget that the biggest PBMs are owned by the biggest insurance companies. And they play that game of where to hide the margin and how to. How to manipulate pricing all day, every day. And I'll give you the perfect example of how PBMs lie to everybody. So if you're buying a brand medication, let's just say it's eliquis. Just use it as an example. It's just, it's the same with every brand medication or specialty medication.
- [10:51]
B
Remind people what Eliquist is. So they know what it is.
- [10:53]
C
Yeah, it's an anticoagulant so that, like, if you have AFIB and it reduces your risk to stroke, you know, it's one of the most widely, not the most widely prescribed drug in the country. And so the list price, the retail price, the retail price of Eliquis is give or take $600. If you are in your deductible phase, let's just say you have an ACA Silver plan and your deductible, you have a family of four, your deductible now is going from 9200 to 9600 or something like that. Right. You pay the retail price during your deductible phase, and so you're paying $600 all 12 months. If you have a $9,400 deductible, the PBMs are the ones that are managing and negotiating the prices for you for the insurance company through who you buy your ACA Silver. Getting you retail price is not negotiating a great price for you, is it? And to make matters worse, the way pricing is done, and I won't get too wonky like we discussed, but the way pricing is done in pharmaceuticals is it all work. The retail price at the wholesale level, too. So the pharmacies are actually buying it at that same list price minus about 5 to 7%. So the pharmacies are paying, particularly independent pharmacies, are paying $570 for that $600 drug, and you're walking in paying $600. But they sent that money to the pharmacy benefit manager, who then keeps a portion of it of what would have been a rebate. And it's not precisely like this, but this is, you know, how it works generally. So they're taking that $600. They've already paid 570, so they're taking your $600 and sending it to the PBM, who then keeps a chunk of it as the rebate. And then rather than paying the pharmacy the full $570 that they already paid for that inventory they distributed to the patient, they'll pay them less. So not only are the PBMs not negotiating good prices for the patient, they're not giving them better than retail price under the deductible, but they're also underpaying the independent pharmacies less than they paid. So pharmacies are literally losing money on every single prescription they fill for branded medications.
- [13:19]
B
Obviously, if you look around the world, they have a very different way of doing drug pricing. Government in every Other developed nation, the national government, they had some combination a, of a national budget and then for drugs specifically, there's a whole process they have. Typically they evaluate them and then they set a price and they'll negotiate back and forth a little bit. And either the drug company will, at some point it comes to a sort of take it or leave it to the drug company. You know, they take it or leave it. We've taken a few baby steps towards that in this country, but we really were very baby steps. I'm curious, your model obviously is a private sector model. Do you see it does something like your enterprise. Is that something that could coexist in a world where the government was also, or do you feel like it's an alternative to government negotiation?
- [14:03]
C
No, we can coexist with anything. Right. Our mission is just to get the prices as low as possible. And but let me take a step back to when you're comparing and contrasting to other countries, know the other big difference. They don't have PBMs right there. They are not in the middle. So remember, think of my eloquist example, $600 retail price, give or take hypothetically $300 as a rebate. So the net price is $300. That net price is not all that different from the actual price that they pay for the drug in Canada, the UK and other, you know, universal healthcare countries. And so we're not that far off. And so it's not that we can't get there or they can't coexist. It's just that we have these middlemen that are owned by the biggest insurance companies that game the entire system.
- [14:54]
B
Okay, that's a nice segue to talk to us to kind of take a step back. And, and because prescription drugs in day are about what, 10% of our total drugs, the GLP1s.
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C
But they're growing.
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B
Yeah, yeah, yeah. And, and they are growing. And that's actually a whole other conversation. We'll have to have to the back talk about GLPs and also the, the, the, the, the, the tailor made, you know, the, the genetically, the, the very. That's gonna be a whole other era of drug price.
- [15:16]
C
Another conversation.
- [15:17]
B
Yeah, another conversation. I want to talk to you about bigger system reforms in the American healthcare system in general. And before I ask you sort of what you imagine if, if you had your druthers and could wave a magic wand. And before we get to that, I always think it's important to get a kind of baseline of what's important to you. So I mean, if you had to define what should a healthcare system accomplish. I don't mean how it accomplishes it, but like what are the goals here? You know, is it cost? Is it, how do you, what do you want?
- [15:47]
C
I think everybody gets the healthcare that they need at a price they can afford.
- [15:52]
A
Ever see an idea so clearly in your head but struggle to make it real? We've all been there. With wix you can build a website for your business just the way you pictured it. Get the best of both worlds with AI and drag and drop tools all in one place. Stay in your creative flow and use AI when you want, how you want. Create a website your way. Try it out@wix.com ever see an idea so clearly in your head but struggle to find the time to get it all done? Wix helps you go from eh, I'll get to it to done. Build a full site just by describing your idea. Let an AI agent handle daily tasks, plan your next marketing campaign or help out customers so you can grow your business the way you want without it taking over your life. Try it out@wix.com.
- [16:48]
B
That'S a good one liner. That's good. So let me actually just. If you could sort of snap your fingers, let's pretend for a second you have the power to wave a magic wand and you could give us any kind of healthcare system. You could design a healthcare system from scratch. Don't have to worry about what's there now, don't have to worry about politics, transitions. We'll get to that in a second. And it would be the, and as if it had been there all time. So you don't have to worry about taking apart the old system. And you, you're familiar with some of the systems abroad. I mean and you know, they come in all different varieties. I mean Germany is different from Switzerland, it's different from the uk, whatever. What would our system look like? What would your ideal system look like?
- [17:21]
C
It would be completely transparent. And the government, you'd pay what you could afford and the government would pay the rest. Every employer would pay some set amount that would end up being less than what they're paying today. So it might be, you know, 10% of everybody's income. We wouldn't change Medicare, we wouldn't change Medicaid. Right. We ditch the aca, we ditch employer based healthcare, but that employer would still pay their percentage. That would go into a pool. That and along with some premiums from the employee. But then premiums would be a lot lower. Right. 200, $300 a month again means tested and then anything you couldn't afford because the prices are published, the government would know what to pay and we would allow providers to opt in or opt out. If you're Mayo Clinic and you only want to deal with rich people and you want to charge a fortune and tell everybody you have the best doctors, more power to you. If you are a rural hospital, if you're, you know, a smaller hospital or an urban hospital, whether it's Medicare rates or a reference price of Medicare rate, that's what you'll get paid by the government directly. But the hard part in all of this isn't that the economics actually are the hard part are the easy part. The hard part is, is there a gatekeeper? Because when every other system talks about universal healthcare and then the UK with NHS and Canada, they all have gatekeepers. You have to go to prime a primary care doctor first who then refers you out to somewhere else. If we do that, then this becomes easy. Now, whether or not that's politically tenable is a different question.
- [19:07]
B
So when I hear you sort of describe your ideal healthcare system, it sounds like just at a very broad level of abstraction here you are in favor of the government making sure everybody can pay their health care somehow. You're in favor of some kind of government role in setting prices or at least setting standards for prices.
- [19:26]
C
Standards, yeah, yeah.
- [19:27]
B
I don't know whether you think there should be a national budget overall like they have in a lot of countries or not.
- [19:33]
C
So let's talk about that. The only so Canada, local Canada, I think it was the province of Alberta in 1947. They were the first to do universal for their province. Right. But they were able to look at their claims, historical claims, and look at prices and say, okay, we can extrapolate if we grow a little bit, here's what our cost out of pocket is going to be. You can only do that if prices are transparent. If prices aren't transparent, you can have all the budget in the world and they're just going to raise prices to meet your budget if you have transparent prices. That's why we push so hard for transparency, because starting with our medications, we can go to a state and say, here's the price. Right. You know your claims, hopefully, because not all PBMs provide claims even to states, believe it or not. But you should know your claims. And so if you want to it have universal care for medications that cost plus drugs cover based on your claims, you can do it today. Now, if we're able to extend that to medical and we know and we bundle, do bundles and we do better groupings and using AI because it's impossible for a human to go through all this. We come up with actual prices for all these claims and hospitals opt in or opt out to get government money for these claims. Then based off the claims, the state, city, county, whoever company has, you can offer your own version of universal healthcare. And if it takes off, great. And if not, not, we have the opportunity to do all those things every other country does. But those countries get transparency because there's no PBMs in the middle. And like in Singapore they owned 80% of the beds and hospitals there. I don't think that's possible here. You know, not that we couldn't run hospitals as well as some of the hospitals are run today in terms of cost and performance, but it's going to be difficult. But all that said, once you get transparency, you can start making those choices and that's why transparency is so important. Without transparency, whoever's providing the service is just going to game it like they do now.
- [21:37]
B
One thing I hear a lot from people, I'm sure you hear also, is whenever you get into this conversation about reorganizing healthcare, people say those healthcare systems abroad, they're terrible. Everyone waits in line, no one gets the care they need. And a lot of that is this story from Canada, that story from the uk, where there is often long waits for, especially for specialty care. You've seen countries all around. Would you say in general that those systems abroad are failures or do you.
- [22:04]
C
Think they're just different? First of all, there's huge cultural differences, but the primary difference is they require some form of primary care to not just act as a gatekeeper but to provide care. Like, like I, I posted it on X. I'm like, if you want to give money out to the HSAs with this premium subsidy money, please require a hundred or $150 a month of it to go to a direct primary care outlet where you pay on a monthly basis. So people get that first level of care. That's what makes it different. We don't, we don't require that first level of care. They do, I think, you know, I mean, we don't need to go through different countries in different ways, but that's the difference, right? And in doing so, they don't have the R that have all the high end branded medical hospitals like we do, you know, and so I don't have a problem with the Mayos and you know, the fans, the Stanfords and all. The fancy hospitals, they can do what they're going to do, but we need to come up with a way where we're transparent and we have direct primary care. And then as long as we cover what people can't pay because they know they're going to have to repay it, they may not go if they want to go to Mayo Clinic, right. You know, we might only cover it up to a certain amount of money as a reference based price of Medicare and then they have to figure out the rest and you know, Mayo's not going to take them at that point. But the disconnect is overseas. They have enough public beds, if you will, and public services to fit into their prices on a transparent basis. So everybody knows the cost here. We have no idea what the costs are. And we, we don't have the will to say to people, you can't go to that fancy doctor if they're the best heart surgeon in the world. That's just the way it goes in Canada. They say that specifically, you know, and that's why people go here.
- [24:03]
B
A couple quick things. I don't want to have that much more time looking in Washington. What you see now, you talk to a lot of senators, representatives, Democrats, Republicans, first of all, all Democratics in Congress that you talk to. People might be, you know, thinking about futures and national politics. Do you give me your assessment of how they are approaching healthcare? Do you feel like they're serious about it? Do you hear interesting ideas?
- [24:24]
C
Dumb as, right? They don't come up with solutions, they just game it to, to get the political benefit. Look, the ACA had all the best intentions, it really, really did. But he got nitpicked down to not being the ACA anymore. And along the way, these insurance companies and hospital systems grew into behemoths. And the behemoth set the economics of the entire system, particularly the insurance companies. The insurance companies make it hard on the providers. And because the insurance companies underpay and play all these games with Prius and turn the providers into subprime lenders to help people, you know, pay off their deductible or pay off their care, everything gets convoluted, right? They're not offering any solutions and they're certainly not saying break up the big insurance companies, break up the big hospital networks. At least if they said that, it would show that they understood what the hell was going on.
- [25:21]
B
I think Bernie Sanders would say he's saying that, right?
- [25:23]
C
I mean, he said that forever. And then when you read the Medicare for All bill, like go back to one of my tweets. I went through it like there's mistakes in it. And the very first lines of it, the first paragraph said all this shall be done at the discretion of the Secretary of Health and Human Services. Is how the. Would that be working out right now?
- [25:42]
B
Yeah, well, you know, fair point, fair point. What about the Republicans? What do you see from the Republicans on healthcare?
- [25:49]
C
I mean, I think they want to do something. I give them credit there. Ron Johnson, Rick Scott want to do something. Elizabeth Warren wants to do something. You know, there are people on both sides that want to do something that have talked about specifics, but they're not, it's not hard to come up with these plans. They just do it half ass. You can come up with alternatives, but it's not Medicare for All the way it's been offered. It's just not like a Medicare for All. It says we're going to renegotiate drug prices every year. No, you're not. Right. You know that you can't. That hospitals can opt out and that you can't offer. I forget exactly. It's in my tweet. But there's just all this stuff that, that doesn't make any sense at all. And they just always talk about medicare for all. 32 or 33 countries offer universal healthcare, but they don't come up with anything specific. That's why I try to dig down on details on this all the time, because the details matter. And there's a path to go from here to there so that everybody gets health care that they need.
- [26:53]
B
So you really don't see anybody in Washington? I mean, I feel like there's some, definitely some serious people, both parties who are sort of working on this stuff. They may not get that much attention.
- [27:00]
C
Who?
- [27:01]
B
Well, I mean, there's been bills to sort of take PBMs out of the picture. Right. I mean, that's. Actually those are half.
- [27:06]
C
Okay, so those aren't bad, but those are just carving at the edges. Right.
- [27:09]
B
Okay. Even the Medicare for All bill, and I'm someone who's been very critical of Medicare for All on certain. On the transitional parts. But I mean, it's an idea. It's, you know, it's a, it's a model. Right. I mean, it's, it's not even a model.
- [27:22]
C
If it's a concept, it's a, it's what, what did Trump say? If you got a concept of a.
- [27:26]
B
Concept of a plan.
- [27:28]
C
Concept of a plan. Medicare for all as written by Jai, Paul and Bernie are concepts of a plan. You can't say that we are going to renegotiate drug prices every year. There's all these little things that just won't work in the. In the current environment. And, you know, you've got to be realistic. There are things you can do. Like I said before, we will guarantee a student loan. We will guarantee a mortgage. We will guarantee a business loan. We won't guarantee a loan that you have to take out for your health care. And we won't look. And I was sometimes I just stupid on the shit. And I just realized I was talking to a bunch of doctors. And one of the things that happens with independent physicians is they don't get paid on time for anything. And when they issue a claim for somebody comes in with an insurance card, you come in on your wife's insurance and insurance, and they provide a claim to the insurance company. Right? It's a claim. It's not an invoice. There's a very big difference between the two. A claim has to get approved, it has to get reviewed. They don't pay it all at once. Those are the little things that we can change to say that, look, once care is rendered, it is considered to be, you know, done and the service completed, unless there's some level of fraud or, you know, malpractice. So, you know, whether it's a hospital that has to pay them or the insurance company, that is an invoice, that is a bill, that is not a claim. And that allows those independent physicians to get paid. And when they're getting paid, particularly if it's at a reasonable rate, not one that, you know, is the outpatient rate as composed to the hospital inpatient rate, so that those practices can get bought and arbitraged where it moves from outpatient to inpatient, because inpatient pays more, even though nothing's changed. If those independent physicians can get paid in 30 days for the services that they've rendered, they don't have to get bought. They can make a reason. They can make a living wage, to quote Bernie Sanders. Right. They should be able. I want my doctors taking off on Wednesday. I want them to be able to really focus on giving their patients time time, not on spending all their money on trying to collect bills they don't even know if they can collect. So it's all these nuanced details that happen within the system because there's so much leverage with the biggest hospital systems and biggest insurance companies and all the things that they own that that's what these politicians are ignoring or maybe they're not ignoring it, but, you know, they're getting too much money on the back end from those stakeholders.
- [30:10]
B
You mentioned Donald Trump and his idea of concepts of a plan. Do you think he takes health care serious? What are you seeing from him?
- [30:16]
C
I mean, I like Trump Rx. I'm not going to, you know, he's going to save. You know, we're going to offer, we're going to work with Trump Rx cost plus drugs. So we just want to get low discount pricing to as many people as possible. Right. So we'll give them 1500% savings.
- [30:30]
B
I mean, but I mean, more broadly in terms of dealing with. I mean, we're talking about these big problems. Who has ideas? Do you feel like he's engaging in a kind of serious.
- [30:37]
C
He's got some serious people that work for him that are really, really, really smart.
- [30:41]
B
Smart.
- [30:42]
C
So he might not know the details, and I wouldn't expect he knows the details, but the Chris Clamps of the world and other people that work from EG Sutton, they are smart as and they know what they're doing and they know how to get there now that then the politics are introduced and that kind of sanitizes the things that they know they should do into the things that are done. But they're smart and know what should be done. Not necessarily to the detail that, that you and I are discussing here, because they have to balance what happens to all the stakeholders, including Medicare and Medicaid patients. So it's a lot more difficult. But generally, in terms of redesigning the system, I don't think they're looking there in terms of optimizing the system. I think they're doing a good job of trying.
- [31:26]
B
Yeah. Yeah. Well, I mean, that's true. The Democrats. Right. I mean, that's how the ACA got the way it was. I mean, it was the same thing. You're always trying to balance what you want to do with what you can do. Since we're on Trump, just to kind of finish up, I did want to ask you a little more broadly about Trump. You were very critical over of him over the years. I remember. Yeah. Yeah. I mean, I think in 2016 you said something like, he scared the shit out of you and had fascist tendencies.
- [31:49]
C
I didn't think I said fascist tendencies, but yeah, I did say what was it was.
- [31:52]
B
It was a fascist. Something I have to go look at. I think you said you did say fascist tendencies. Maybe you didn't. Maybe that was something else.
- [31:58]
C
Yeah.
- [32:00]
B
Do you. Are you. In general, I mean, there's a lot going on right now between the immigration raids and these. Yeah. I mean, are you things going that.
- [32:08]
C
There's things that I think he did that are right, you know, and that I would have done them differently. But immigration, I'm. I'm sorry. The border, not immigration. Big difference. The border. Yeah. Closing the border is a good thing right now. And the way he did it, I'm fine with it. Deportation. Ridiculous. Right. We can't have people a mass on the street. And that's ridiculous. In terms of dei, I'm a huge proponent of dei, but I'm glad he did what he did because it takes the stigma off of every person of color who has a good job. Job, you know, and there's still companies who believe in DEI can still do the good things that DEI requires without having obvious programs. If you want to recruit new employees and look where other people are not looking and finding great employees who happen to be people of color, great. If you want to have equity programs in your organization, great. Put people in a position to see if, you know, if you want to make sure that. That you're inclusive in all your employees and let people be who they are, regardless of how they identify yourself, great. You don't have to have name programs, you know, so basically by Trump, you know, taking out the formality of dei, he opened the door for dei.
- [33:19]
B
Let's stop it. I mean, look at the immigration piece, for example. I mean, a lot of people are very worried about that. I mean, is that something. Is that something horrible for this country?
- [33:27]
C
The way he's doing it is horrible. Right. We're losing. There's more exodus than there is immigration of brain power, and that's a negative for the country. I think he defers to, you know, his is the Tom Holmans of the world and the Stephen Millers of the world. Too much there. I don't think we're approaching that the right way at all. But that's who he is. You know, it just is what it is.
- [33:50]
B
Let me ask you. So, I mean, you're somebody with a lot of influence and a platform. What do you feel like your role should be in something like that? I mean, should you be speaking out about that or I got to win.
- [33:59]
C
You can't win all battles. Right. And the more I talk about the political side of it, the less impact I'm able to have on healthcare. And the thing about healthcare, it impacts everybody. Nobody dies healthy and nobody likes the economic side of healthcare like we have it today. And I truly believe that I can have an impact there. I truly believe, I know we've saved millions of people. We've made the lives better of millions of people in just four years. And we're up and to the right. We keep on growing and we're doing so many other things that we haven't even talked about. We're manufacturing medications in Dallas, Texas using AI and robotics where we'll be able to manufacture at prices that are less than they can in China. China, you know, and I don't want to that up, you know, because we do live in a political world and the more I deal with that side of it, the, the more noise there is that might prevent me from doing the other side of it. And I'd rather at the end of the day be called the guy who didn't speak up on A, B and C but changed healthcare in the United States so that X number of people didn't die because they could afford their medication or when you know the next pandemic or whatever bad happens. We have the manufacturing facilities in the United States of Americ to manufacture those drugs. So we're not depending on somebody overseas. I can't win every battle. I can't do everything. And I don't want to sound arrogant, you know, so to make it. People think that I think I can, I don't. But I do think I can impact healthcare and I do think we have and I do think there's a long way for me to go to impact it more on both the pharmacy and on the medical side. We're coming out with something called Cost Plus Wellness that we're beta testing right now where we're contracting, doing direct contracts with providers and I'm using it for my companies first. And we'll make. But what we'll do is different. We'll take the contracts that we negotiated and put the actual contracts on our website so that any employer can use them. And by going with a direct contract and a third party administrator, you don't have to use an insurance company. You don't have to send your money to the insurance company and then hold hope your, your members, your employees and their families get that back in care and that that care is the care that they need or want. If I can keep on doing those things, you know, reduce the stress on the most stressful side of people's lives these days. To me that's a win and it's worth it.
- [36:23]
B
Obviously we just the Republicans passed this bill over the summer, takes a trillion dollars out of Medicaid projections suggest millions of people are going to lose insurance because of that, you know, who knows how many? Exactly. These projections are always pretty rough. But you know, I think it's fair to assume a lot of people are going to lose insurance. How do you feel about that?
- [36:41]
C
I mean, it's awful, but at the same time, we need to recalculate and refigure everything. They're not, they're not independent of each other. They all fit hand in glove. And PBMs are managing a lot of Medicaid. Insurance companies are managing a lot of Medicaid so that the money that the states are using now, they're looking at doing their own PBMs instead of using third party PBMs to offset a lot of the money that they lost or some portion of the money that they lost dealing with GLP1, you know, putting together a state GPO group purchasing organization where all the states get together and can use their buying power instead of leaving that to the PBMs so that they can buy drugs and healthcare at far lower prices. Now, when I say health care, meaning there's these special, there's these drugs that are administered called J code, da da da da da. Not the Medicaid. Prices for actual care are already set.
- [37:37]
B
Well, Mark Cuban, thank you for all your time and getting wonky with us on health.
- [37:42]
C
Yeah, anytime, Jonathan. This is fun. I love this stuff.
- [37:45]
B
And you know, we'll be watching, watching your projects and then listen for you in the debate and everyone else, we'll see you again soon.
- [37:52]
C
A new phone for Billy, a necklace for Sam. All the while on the lookout for scams. A swipe here and tap there. Better make it go far. Turns out mom didn't know she needs a new car this year.
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Guys, thanks for helping me carry my Christmas tree.
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C
Zoe. This thing weighs a ton. Drew Ski, lift with your legs, man.
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B
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C
He's talking to you, Bridges. I'm not that.
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A
Of course he did.
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B
Right, Santa, you know my elf Drew Ski here. He handles the nice list.
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C
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