Episode #114: Reducing the Costs of American Healthcare – One Percent at a Time, with Zack Cooper, PhD


The focus of this interview is on a solution created by Yale Economists to address the rising & unsustainable costs of healthcare in our country. Most of us are aware that healthcare costs are a problem, but our guest today argues the cost of healthcare is actually devastating to American workers & families. The approach he and his colleagues are taking to solve this massive problem is unique & I’m excited to explore it with you today.

Zack Cooper, PhD is an Associate Professor of Health Policy and Economics at Yale University. Cooper has published his research in leading economics & medical journals and has presented his research at the White House, the Department of Justice, the Federal Trade Commission, & the Department of Health and Human Services. Cooper received his undergraduate degree from the University of Chicago and his PhD from the London School of Economics.

In this episode, we’ll discover:

  • The meeting at 10 Downing Street that led this extraordinary Yale Healthcare Economist to come up with the idea for 1% solutions.
  • The specific healthcare issues being addressed by these 1% solutions, such as Surprise Medical Billing & Kidney Transplantation.
  • Why Zack believes employer-based health insurance is contributing to bloated costs that are profoundly harming the health & welfare of working Americans.
  • How the unprecedented drop in American life expectancy and the American epidemic of “deaths of despair” might be linked to healthcare economics.
  • Why the 1% solutions are intentionally focused on incentivizing providers & healthcare organizations rather than attempting to change patient behaviors through cost-sharing and other demand-side interventions.
  • The opportunity cost to the American public and the American future resulting from bloated healthcare costs.

This is an extraordinary story of a ‘scholar-activist’ who is battling the insidious mistruths that are guiding policies for an industry that makes up nearly one-fifth of the US GDP.  With this latest 1% project, he’s not only debunking harmful myths, but also using evidence-based, scientific methodology to build solutions to lower the staggering costs of healthcare. Make no mistake about it, the stakes are high. For example, Zack refers to a recent study which demonstrated that a $10 increase in Medicare Part D copays (prescription medications) led to a 33% increase in monthly death rates among seniors. People couldn’t afford their medications and so they simply stopped buying them.

Zack is reframing the field of healthcare economics by attempting to accomplish a number of things. First, he is actively recruiting leading scholars to adapt their research to current policy-relevant domains. Second, he is inviting leading scholars to more directly engage with and influence politicians and policy makers. Third, he is catalyzing a movement toward more scientific, peer-reviewed, evidence-based healthcare policy decision-making. Fourth, he is calling for a shift from research that purely critiques to briefs that develop and support tangible solutions to lowering the costs of healthcare. And fifth, he’s influencing the next generation of healthcare scholars to view themselves as ‘scholar activists’.

What Zack & his colleagues are attempting is courageous. They are battling on behalf of the plight of the majority of Americans who simply can not afford healthcare. They are battling the status quo of a huge, well-funded, complicated & opaque industrial complex. As Zack points out, there are few other industries as heavily lobbied as healthcare – underscoring the need for independent, peer-reviewed, evidence-based, policy decision-making.

At one point in the interview, Zack says that he’s been “coarsened” by what he has discovered. He is, in my opinion, experiencing what many clinicians & others in healthcare have recently been terming ‘moral harm’. One domain of moral harm that is of “gripping” concern for Zack is the economic and healthcare inequities in this country. His current research is focused on how healthcare inefficiencies and costs might actually be contributing to the economic & health inequities, and the growing disparity chasm in our country.

What I greatly admire and respect is Zack’s ethical conviction, commitment and persistence to challenging and changing the fundamental policies causing this moral harm. So, while the 1% approach may appear incremental, what Zack and his colleagues are doing is nothing less than transformational.

Until next time, be safe and be well.
Zeev Neuwirth, MD