Mark Cuban says hospitals ‘don't know their costs’ — why they need to be run ‘as a startup’

“The fundamental issue is transparency and trust,” Cuban said, adding that “there are a lot of hospitals … that don’t know their costs.”

Some hospitals, he argued, can track their overall finances but struggle to identify the actual cost of providing a particular service. In his words, “they just know their cash balance.”

Cuban compared that lack of cost discipline to what he would expect from entrepreneurs appearing on Shark Tank, the business reality show where he spent years grilling founders about their companies and funding pitches.

“If we brought them on Shark Tank … and we asked them, ‘What are your costs for this, this, and this?’” Cuban said, hospital executives might not have an answer grounded in their actual costs. For Cuban, that gets to the heart of why simply changing who runs healthcare may not solve its underlying economic problems.

“It doesn’t matter who runs it,” he said. “Whether it’s the government or private enterprise running it, if it’s the same people either way, you’re gonna have the same problems.”

“You’ve got to think of your hospital as a startup,” Cuban said, where knowing exactly what things cost is essential to running a successful operation.

The murky economics of hospital care

Cuban’s criticism goes beyond whether individual hospitals are being run efficiently. Hospitals account for nearly a third of all U.S. healthcare spending, making questions about their costs and prices consequential for patients and insurers.

Total U.S. hospital spending reached $1.63 trillion in 2024, up 8.9% from the previous year, according to data from the Centers for Medicare & Medicaid Services (CMS). That spending is expected to keep climbing, with CMS forecasting average annual growth of 5.4% through 2034.

While much of the recent spending surge has been driven by greater use of hospital services, prices are rising too. Per CMS, hospital prices increased by 3.4% in 2024, the fastest pace since 2007. That also exceeded the 2.9% average inflation rate that year, according to Bureau of Labor Statistics data.