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Most founders know their biggest expenses.
They track payroll closely. They scrutinize software spend. They negotiate rent, vendors, and cloud costs. But there’s one line item that quietly grows faster than almost all of them and rarely gets the same level of scrutiny.
Healthcare.
In a conversation on Unordinary Pod, Mark Cuban made a blunt point: healthcare and benefits are one of the largest expenses in a growing company, yet founders treat them like an HR checkbox instead of a leadership responsibility.
After payroll, healthcare is often the next largest cost on the P&L.
As teams scale, benefits costs compound automatically. Premiums rise every year. Pharmacy costs creep up. Plans get more complex. Yet many founders only look at these numbers once a year, usually when they’re told an increase is unavoidable.
What makes this dangerous isn’t just the size of the expense, but how little ownership it gets as the cost compounds year after year.
Founders often rely on a broker or benefits advisor they trust.
The conversation usually sounds the same. Rates are up across the market. Other companies are seeing increases. Your increase is actually better than average.
This framing is almost meaningless. When incentives are misaligned, being told remember you’re doing “better than everyone else” doesn’t mean you’re doing well. It just means the system benefits from you not asking deeper questions.
This kind of dynamic shows up most clearly in healthcare, where complexity and delegation make it easy for costs to grow without real scrutiny.
Founders assume healthcare is too complicated to understand.
That assumption is convenient for everyone who profits from complexity. Layers of intermediaries, opaque pricing, and bundled services make it hard to see what anything actually costs.
Cuban’s point is that complexity has become the business model. When accountability gets diffused, no one feels responsible for outcomes.
Managing these premiums is usually left to HR, but HR teams are built to administer benefits, not renegotiate the system behind them.
Given that founders don’t outsource responsibility for payroll, office leases, or core vendors, healthcare should be treated the same way.
“It’s not the core competency of a CEO to know how their healthcare works, but it is their responsibility to understand why it costs what it costs. You don’t have to be an expert, but you do have to ask why the numbers are what they are and who benefits from them.”
That level of understanding changes how founders make decisions across the company. Even if they’re not the ones implementing benefits changes day to day, knowing where the money goes sharpens judgment, clarifies tradeoffs, and prevents blind spots from creeping into other areas of the business.
Companies that manage healthcare costs well don’t do anything exotic. They assign clear ownership, compare prices instead of accepting defaults, and ask basic questions about what they’re paying for and why.
Most importantly, they treat healthcare like any other major supplier relationship, not a black box that only specialists can touch.
Reducing healthcare costs doesn’t just save money. It creates margin flexibility, improves hiring leverage, and frees up cash for growth, retention, and resilience.
Because healthcare expenses compound quietly, improvements do too. Over time, that difference becomes meaningful.
Ignoring healthcare costs isn’t neutral.
It’s a decision to accept a system you don’t fully understand and numbers you don’t actively manage.
You don’t need to become an expert in every single area in order to run a company well. But you do need to understand why one of your biggest costs keeps growing, who controls it, and what tradeoffs you’re implicitly accepting by not paying attention.
Want more operator-level thinking like this?
This piece comes from a longer conversation on Unordinary Pod, where we talk with founders and operators about overlooked costs, hidden leverage, and how to run companies with more discipline.
Subscribe to the newsletter or listen to the full episode for deeper context and practical insights.
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