Mark Cuban doesn’t usually mince words, and this weekend he didn’t bother trying. When a single MRI scan can cost more than a used Honda Civic, subtlety goes out the window.
On Saturday, the billionaire entrepreneur lobbed a blunt question onto X that immediately lit up healthcare Twitter: “Explain to me why the insurance company will pay $2,500 for an MRI when there is a center down the street that will do it for $350?” No policy paper. No jargon. Just a number so absurd it barely needs commentary.
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But Cuban wasn’t ranting into the void. The post came amid a longer thread where he’d already been unloading on pharmacy benefit managers, insurers, and what he sees as a system designed less to heal people and more to extract money from them.
Why Cuban’s MRI Question Hit a Nerve
At face value, the question sounds almost naïve. Surely there’s a reason, right? Different machines, different billing codes, different risk pools.
That’s exactly the point.
Cuban’s argument is that the system hides behind complexity to justify prices that make no economic sense. If an insurer is willing to reimburse $2,500 for a scan that can be profitably offered for $350 nearby, something is broken. Badly.
In the same thread, Cuban wrote, “I’m all for PBM reform. But realize that the biggest PBMs are owned by the biggest insurance companies… They are TOO BIG TO CARE.” He went on to list the casualties: employers, patients, states, hospitals, physicians. If there’s a way to charge them, he argues, the system will find it.
When another user pushed back—claiming insurers merely pay what providers bill and don’t set prices—Cuban’s response cut straight through the noise. Insurers may not write the sticker price, but they absolutely decide which prices they’re willing to tolerate.
The Incentive Problem No One Wants to Admit
Here’s the uncomfortable truth Cuban keeps hammering: insurance companies don’t have a strong incentive to lower healthcare prices.
In many cases, higher prices actually justify higher premiums. Bigger numbers flowing through the system don’t hurt insurers nearly as much as they hurt patients and employers. As long as costs can be passed along, the urgency to negotiate hard simply isn’t there.
“They aren’t required to be,” Cuban added in a follow-up. “And that is the point. They increase prices.”
That statement alone explains why his post resonated. Americans have long suspected they’re being taken for a ride. Cuban just spelled it out in plain English.
Real Patients, Real Numbers, Same Story
The replies to Cuban’s post filled in the human side of the math.
One user shared that their MRI was quoted at over $1,500 with insurance. Paying cash? $275. Another said their insured price ranged from $1,200 to $3,200, depending on the facility. A local imaging center offered the same scan for $212.
These aren’t edge cases. They’re everywhere.
The U.S. healthcare system routinely produces situations where paying out-of-pocket is cheaper than using insurance. That alone should tell you the pricing logic has gone off the rails.
According to data from the Centers for Medicare & Medicaid Services (https://www.cms.gov), imaging costs vary wildly across providers, even within the same zip code. Meanwhile, the Health Care Cost Institute (https://www.healthcostinstitute.org) has repeatedly documented massive price variation for identical services with no corresponding difference in quality.
How PBMs and Insurers Became Too Intertwined
Cuban’s frustration isn’t limited to MRIs. Much of his anger is directed at pharmacy benefit managers, or PBMs—the middlemen who negotiate drug prices between manufacturers, insurers, and pharmacies.
The catch? The biggest PBMs are owned by the biggest insurers.
That vertical integration creates conflicts of interest that would raise eyebrows in almost any other industry. When the same corporate parent controls insurance coverage, drug pricing negotiations, and reimbursement flows, transparency becomes optional and accountability disappears.
Cuban has been vocal about pushing Congress to force PBMs and insurers to divest overlapping interests, echoing concerns raised by the Federal Trade Commission (https://www.ftc.gov), which has already launched inquiries into PBM practices.
His view is simple: you can’t fix pricing when the referees own the teams.
Why This Fight Is Personal for Cuban
This isn’t billionaire theater. Cuban has real skin in the game.
Through Cost Plus Drugs, the low-cost pharmacy platform he co-founded, Cuban has spent the last few years doing something radical in healthcare: showing the math. The company publishes drug prices transparently, breaking them down into manufacturing cost, a flat markup, and shipping.
No secret rebates. No backroom negotiations.
That model has embarrassed the rest of the industry by proving how much padding exists in the current system. When a generic drug drops from hundreds of dollars to a few bucks overnight, it becomes harder to defend the status quo.
Cuban now appears to be applying that same logic to medical services like imaging. If price transparency works for drugs, why not MRIs?
The Broader Policy Implications
Cuban’s comments land at a moment when healthcare costs are once again creeping into the political spotlight. U.S. healthcare spending topped $4.8 trillion in recent estimates, according to CMS, and continues to outpace inflation.
Lawmakers on both sides of the aisle talk about reform, but structural changes move slowly. Insurers, PBMs, hospital systems, and private equity-backed provider groups all have powerful lobbying arms.
What Cuban does differently is strip the debate down to a question ordinary people can understand: why does the same scan cost 7x more just because an insurance company is involved?
It’s a question regulators at the Department of Health and Human Services (https://www.hhs.gov) have tried to address through price transparency rules. So far, compliance has been uneven, and enforcement has been soft.
What This Means for Patients Right Now
For everyday Americans, Cuban’s rant doubles as advice—whether he intends it or not.
More patients are learning to ask for cash prices, shop around for imaging, and question insurer-approved providers. It shouldn’t require detective work, but in today’s system, it often does.
The bigger takeaway is more sobering. Until insurers are forced—or incentivized—to care about prices the way consumers do, the gap between what healthcare costs and what it charges will remain enormous.
Cuban isn’t saying every insurer is evil. He’s saying the system rewards indifference.
FAQs:
Why are MRIs so expensive with insurance in the U.S.?
Prices are inflated by negotiated rates, facility fees, lack of transparency, and weak incentives for insurers to control costs.
Is it really cheaper to pay cash for medical scans?
In many cases, yes. Independent imaging centers often offer far lower cash prices than insured rates.
What are PBMs and why does Mark Cuban criticize them?
Pharmacy benefit managers negotiate drug prices but are often owned by insurers, creating conflicts of interest and opaque pricing.
