What Mark Cuban REALLY thinks of Medicare for All

0:01NPR.

0:06Medicare for all is one of the hottest topics this election season. Do you want a national health insurance program that replaces the private system? And a lot of Americans are saying, yeah, give me some of that. A poll from The Economist and YouGov found about two thirds of Americans now support Medicare for all. And if you've been to a doctor's office, paid for a brand name drug, or just a health insurance premium, you probably understand why. This is The Indicator for Planet Money. I'm Ricky Mulvey. I'm Adrian Ma. Today on the show, Part B. We're continuing our conversation about the economics of Medicare for All.

0:42We'll address two questions. One, are we being honest about the cost of Medicare for All? And two, do we know what we spend on health care right now? I mean, it's so bad, you can go through a long list of really quality hospitals, and they don't know their costs. That's Mark Cuban. You may know him as an owner of the Dallas Mavericks from Shark Tank. Mark is also co-founder of Cost Plus Drugs, an online pharmacy that offers transparent pricing on medicines. And Mark has basically stared into the belly of the beast that is the American healthcare system. And what he saw, well, he tells us that after the break.

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1:59Not knowing what to expect. Instead of listening to an ad, hear from the people who've actually been there. Visit betterhelp.com slash reviews to explore real client reviews that are updated every day. With an average live therapy session rating of 4.9 out of 5, based on more than 1.7 million client session reviews, the feedback speaks for itself. Visit BetterHelp.com slash reviews. For Mark Cuban, the questions about Medicare for All come down to cost. I'm all for universal health care, regardless of what form, single payer, Medicare for all. And the analogy I always use is if it costs one dollar per person per month for universal care, nobody would even question it.

2:45Right. Everybody would be an automatic yes, because there'd be no reason not to. Mark said it's difficult to know how much money it would cost or save when there are so many interests in this debate. For example, there is a highly touted paper out from Yale researchers who estimated that a Medicare for all system would save about 114 ,000 lives annually and more than a trillion dollars in annual health care spending. But Mark is doubtful about a major assumption in that paper, something he posted about on X. Did you see my tweet on that? I did. The Yale study writers assume that overall fraud in the health care system would go down by$286 billion under a Medicare for all system and that one health care payer provides fewer opportunities to scam.

3:35$286 billion would be a lot of fraud savings. I mean, that is close to the total sales Costco makes in a year. Mark wondered how they came up with that number for anticipated fraud savings. And when you go down and look, it was from an article written in 2003 about the chaotic transition of Taiwan in 1995. Mark says that a Taiwanese number from 30-something years ago may not be an appropriate comparison to the current American health care system. For example, the Taiwanese health care system was paper-based, not computer-based like ours is. There's just, it's apples and oranges. You can't apply one to the other.

4:22Still, he believes there could be benefits from a new healthcare system. I am not saying that there are not a hundred different ways that universal healthcare, single payer, Medicare for all cannot create savings. There are. But why lie, right? Why be unserious in your references in doing this? We talked to Alison Galvani, a co-author of the paper that Mark criticized. Alison is an epidemiology professor at Yale. She's one of the authors who Mark Cuban says is lying and being unserious. And Alison told us that she had just spent hours on the phone with Mark Cuban before the interview, and she defended using Taiwan as a reference point.

5:06Taiwan shows us what the alternative looks like as the most recent advanced economy to move from a fragmented system like ours to single payer. Allison says that fraud is rampant in the U.S. system because it is so fragmented. She says her numbers also came from the FBI and the National Healthcare Anti-Fraud Association. We asked her about another assumption. The current Medicare for All legislation has really broad language about who would be included in Medicare for All. And current Medicare only covers U.S. citizens and some lawful residents. The Medicare for All proposal covers every resident in the country's borders.

5:46In fact, the current bill on Medicare for All prohibits discrimination based on citizenship status. We asked Allison how that would impact the costs of a Medicare for All program, one where the government pays for all necessary health care costs. I didn't get into the issue of citizenship. She thinks the efficiencies of a Medicare for All program will make up for the costs of providing government-sponsored health care to every resident. I mean, it's not going to be a huge proportion, right, of the population. I guess they would still be accounted for in our overall national health care expenditure because we're just taking the data that's provided by the government on national health care expenditure.

6:31One estimate from the Migration Policy Institute, a think tank, estimated over 15 million undocumented immigrants living in the United States in 2024. for. Allison says that savings comes from negotiating power, the removal of for-profit health insurance companies and paying providers Medicare rates. Plus, Allison says that health care for all would mean fewer undocumented people using emergency rooms and hospitals for care. Still, Mark Cuban is concerned that the economics of a Medicare for all system may not work for hospitals. See, private insurers generally pay hospitals more for care than Medicare and Medicaid do.

7:09You have hospitals that are designed to provide the best care in the world, and those hospitals weren't built with the expectation that they would be paid using Medicare rates. Mark says that Medicare for All proponents should ask hospitals if they could run under Medicare rates and the proposed cost savings of Medicare for All. Other countries that have universal health care accept a trade-off. Those who work in health care are generally paid less than similar workers in the United States. Is there a path where you can get doctors to continue to work if they're paid Medicare rates, or would they opt out and not participate at all?

7:52Mark believes this is worth a conversation. Doctors, nurses, support staff might be paid less. And look, there's even an argument to be made that it could cost more and still be good because the benefit to society and the economy secondarily, but society primarily, will be we'll have far more healthier people. But he says we need to have an honest conversation about the trade-offs. Mark says the U.S. government needs to take other steps before launching into Medicare for all. For example, he says we have a transparency issue. We don't know, for instance, how much the military spends on many prescription drugs, what the reimbursement rates are.

8:31We only know the total amount it spends. And if she can't get those prices, how can we expect that we'll be able to negotiate brand and specialty drug pricing and cell and gene therapy, among other things, pricing? We can't. Mark says that opacity is the problem and that even hospitals aren't fully aware of their costs for a basic procedure. Yeah, there's no way you're getting a deal on Shark Tank if you can't tell the sharks how much it is going to cost to make your widget. Basically, Mark wants more transparency across the whole system. And to do that, he believes we need to break up the healthcare conglomerates.

9:09Pharmacies, drug negotiators, and health insurers. Because the current structure, it incentivizes self-dealing and lack of transparency. Incremental steps before throwing out the whole thing. Yeah, that should be easy. Just break up the healthcare conglomerates. Ultimately, he says that the healthcare system really needs daylight. Unless we have really true information, it's impossible to make this stuff work.

9:58So, I appreciate you listening, and thanks for the follow.

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