Joan Esposito is joined by Zack Cooper, director of the Health Care Affordability Lab at Yale University and associate professor of public health and of economics at Yale. 

The discussion examined health care affordability and policy changes proposed through Yale Healthcare Affordability Lab’s 1% Steps for Health Care Reform project. Here are a few key points from the conversation:
- U.S. health care spending is nearly 20 percent of GDP, with family premiums around $28,000 annually and significant out-of-pocket costs.
- Hospital prices have risen faster than prices in other economic sectors, contributing to lost jobs and broader economic effects.
- Cooper argued that limited competition, hospital mergers, and acquisitions of physician practices drive higher prices and fewer patient choices.
- The discussion considered whether ownership type matters less than competition, transparency, and enforceable quality standards.
- The project identifies evidence-based interventions that could reduce costs without waiting for comprehensive reform.
- Aligning Medicare payments for hospital-owned and independent physician practices could reduce incentives for consolidation.
- A proposed “one baby, one bundle” payment would use one rate for vaginal and cesarean deliveries to reduce incentives for unnecessary cesarean sections. "Doctors respond to incentives," Cooper told WCPT, "and there are lots of reasons why we think there are too many cesarean sections happening nationwide, and often it's among moms who have a little less of an ability to negotiate for themselves. And it might be that at the end of a long shift, doc doesn't want to wait around and they sort of nudge mom to to get a cesarean section. And so we think less cesarean sections is a good thing. It also lowers spending. And so what they did in Arkansas was they basically said, look, instead of having a separate rate for cesarean sections and vaginal deliveries, we're going to have one payment rate that's sort of between the two, so that we're not creating a financial incentive for doctors to choose cesarean sections over vaginal deliveries. That's the kind of thing that we talk about in this project."

Catch "Driving It Home with Patti Vasquez" weekdays from 5:00 to 7:00 p.m. Central on WCPT (heartlandsignal.com/programs/driving-it-home).

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