Surgeon's Record November 17, 2025
Creating a functional marketplace for specialty care
A short exchange with Mark Cuban on Twitter this weekend highlighted a question that’s plagued healthcare for years: if price transparency and direct-pay models are so obviously better for patients and employers, why haven’t they scaled?
Cuban argues that removing intermediaries and exposing real prices should let markets function. He’s directionally correct. But the reality on the ground is more complicated.
My current work on Commons’ direct contracting platform has driven home this point.
Direct-pay options exist, and many deliver excellent value. However, they remain fragmented, niche, and (as yet) insufficient to shift broader economics, particularly in specialty care.
The will is there. The infrastructure is still catching up.
In my view, three...
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