A $20 aspirin doesn't happen by accident. It happens by design.

Mark Cuban, billionaire entrepreneur and co-founder of Cost Plus Drugs, is not new to healthcare disruption. His pharmaceutical company was built on a simple premise: show the cost, add a transparent markup, and publish it. So when he returned to his blog "Blog Maverick" last year with a post titled "A Few Words On Healthcare," he wasn't just offering commentary. He was expanding that same pricing philosophy to the entire $5 trillion U.S. healthcare system.

He opened plainly. "I haven't published anything on here in a long, long time.. Thought it would be fun to start up again," he wrote. What followed was a direct critique of how money moves through medicine.

"Healthcare is a very simple industry made complicated," Cuban wrote.

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He clarified that he was not attacking innovation. "I'm not talking about the relentless search for better ways to care for patients," he wrote. "Whether its surgery robotics or better bandaids, the quest to improve care is vitally important." The issue, he stated, is financial engineering. "What I'm referring to is the complication of the industry in search of margin dollars."

Cuban framed the conversation with a straightforward question. "What Should it Look Like?"

His answer stripped the system down to its bones.

"Hypothetically, It should look like 1955," he wrote. "Patients go to providers for care. Providers provide that care. Patients get a bill and if they can afford it, they pay that bill. That's it."

That simplicity leads directly to what he calls the defining issue. "The ONLY question in healthcare should be ‘How should care for people who can't afford to pay for their care be paid?'"

In Cuban's view, every reform, regulation and reimbursement formula should orbit that single question.

Cuban cited total U.S. healthcare spending at roughly $5 trillion and proposed working backward. "Before we start that discussion, let's do a very, very simple back of the envelope discussion of the cost of healthcare in this country," he wrote. "So call me a dreamer."

His first lever is transparency, but not the standard version of posting procedure prices. That, he argued, fails because "everyone bundles and upcodes and plays games in order to extract as much revenue from whoever is paying as possible."

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Instead, he called for publishing a true "Bill of Materials" at cost. That means listing everything directly attributable to patient care, including "the fully burdened with benefits doctor, nurse, PT, and anything else that is used specifically for the care of that patient," while separating capital expenditures and overhead.

He also proposed that providers show their gross margins openly rather than embedding them in individual charges that create distortions such as "$20 aspirins." By isolating margins, pricing becomes easier to compare across systems.

Then he extended the idea further. "Remove Insurance Companies From the Equation." Under that framework, "All Payments are Cash Pay." Cuban cited estimates that administering and managing payments accounts for 20% to 30% of healthcare costs. He added another 10% for fraud, overbilling and upcoding. Applied to $5 trillion, those percentages represent significant sums.

Using simplified math, cutting roughly half from $5 trillion would reduce total spending to about $2.5 trillion before factoring in additional savings in pharmaceuticals, which currently account for about 11% of spending, or roughly $550 billion.

After outlining cost reductions, Cuban returned to the central issue. "Who pays for the care patients can't afford to pay themselves?" he asked.

He assumed Medicare and Medicaid remain in place at approximately $847 billion and $570 billion. Subtracting those from $2.5 trillion leaves about $1.1 trillion in spending outside federal programs.

With roughly 160 million employees receiving insurance through their jobs, dividing $1.1 trillion by 160 million equals about $6,875 per employee per year.

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From there, Cuban presented structural possibilities. Employers could redirect what they spend on premiums to the federal government, which could process provider payments through Medicare. Employers could raise wages and allow individuals to fund care through higher taxes. The government could operate as a reinsurer while employers contribute to health savings accounts.

"These options only work if the top changes are made," he wrote.

He closed by acknowledging the proposal's rough edges. "I did all of this in about 90 minutes," he wrote. "So its far from perfect." Then he invited criticism. "Feel free to rip it apart. That's how change happens."

Cuban's argument follows the same logic that built Cost Plus Drugs. Show the cost. Strip out the hidden layers. Decide who pays for those who cannot. Everything else, he suggests, is design.

Healthcare isn't just a $5 trillion policy debate. It's one of the biggest variables in personal retirement planning. Fidelity estimates that a 65-year-old couple may need about $330,000 set aside for healthcare expenses in retirement alone — and that figure continues to climb.

Even if structural reforms like the ones Cuban proposes ever materialize, individuals still have to plan for Medicare premiums, supplemental coverage, out-of-pocket costs and tax-efficient withdrawals today.

That's where platforms like Finance Advisors can play a role. The service helps Americans approaching retirement connect with financial professionals who specialize in tax-aware retirement income planning — including strategies around healthcare costs, Medicare timing and after-tax withdrawal sequencing. For many households, mapping out how medical expenses intersect with taxes and portfolio withdrawals can meaningfully affect long-term outcomes.

Because while Cuban is debating how the system should work, families still have to plan for how it works today.

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This article Billionaire Mark Cuban Says 'Remove Insurance Companies From the Equation' —Make 'All' Payments Cash And It'll Be Cheaper originally appeared on Benzinga.com

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