Too Big to Care

When Mark Cuban says health care giants are “too big to care,” it lands because it rings painfully true. His warning isn’t about bad intentions—it’s about scale. When organizations grow massive enough, caring for individual people stops being the operating system and starts becoming a rounding error.

The article highlights a staggering number: an estimated $3,200 per person per year swallowed by administrative overhead. Not care. Not outcomes. Paperwork, billing layers, compliance mazes, and middlemen talking to other middlemen. At that size, complexity becomes self-justifying. Entire departments exist to manage the consequences of other departments. No one is evil—but no one is really accountable either.

This is the paradox of modern health care consolidation. Bigger was supposed to mean more efficient. Instead, it often means greater distance between decision-makers and patients. When systems reach this scale, they don’t just lose empathy—they lose feedback. Patients can’t meaningfully vote with their feet, and clinicians can’t easily change how care is delivered. The system becomes optimized for throughput, not trust.

Cuban raises divestiture as a possible cure, but whether breakups happen or not, the diagnosis matters more than the prescription: scale without accountability erodes care. Health care depends on relationships, continuity, and judgment—things that don’t compress well into massive bureaucracies.

The quiet counterpoint is that smaller, simpler models already exist. When care is local, transparent, and directly accountable to the patient—not a distant payer—administrative gravity collapses. Fewer rules are needed because incentives are aligned. Fewer dollars leak because fewer hands touch them.

“Too big to care” isn’t just a critique. It’s a warning label—and maybe permission to build something smaller on purpose.