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What is 1% Steps for Health Care Reform?
This project is an initiative of the Health Care Affordability Lab at Yale, led by Professor Zack Cooper. Launched in 2021, the project identifies evidence-based steps policymakers and health care purchasers could take to lower health care costs.
The Health Care Affordability Lab at Yale produces new evidence to guide policymakers and lower health care costs for individuals and the health care system.
The Challenge
Rising health care spending is killing the American dream. It has suppressed wages, driven inequality, and absorbed a growing share of household budgets. Health care costs routinely top the list of Americans’ affordability worries and place increasing strain on employers and public budgets.
In a country that spends about $5.5 trillion per year on health care, no single solution could meaningfully reduce spending to deliver immediate relief. But there are dozens of smaller-scale inefficiencies that, if addressed, would reduce spending by a percent or two each—so-called 1% problems.
Our Goal
The goal of the 1% Steps for Health Care Reform project is to identify targeted reforms based on the strongest economic evidence that policymakers and health care purchasers could use to lower health care spending without compromising health care quality.
Our Approach
The 1% Steps for Health Care Reform project translates rigorous academic research into clear, accessible recommendations for policymakers and health care purchasers. We believe that relying on strong evidence to drive policy change is the most effective way to reduce health care costs. The project is updated on an ongoing basis with new proposals based on the latest academic research.
Common Questions
What are the aggregate potential savings across all the published briefs?
The evidence-based recommendations offered by the 1% Steps for Health Care Reform project add up to roughly $450 billion in estimated savings. This total does not represent a CBO-style estimate or account for interactive effects between proposals. Original savings estimates were calculated by the authors and the Health Care Affordability Lab at Yale. To allow for an aggregate savings estimate, the Health Care Affordability Lab at Yale adjusted estimates to a common base year of 2025.
Why is U.S. health care reform so difficult to achieve?
The sheer scale is the primary challenge. If the $5.5 trillion U.S. health system were a country, it would be the world’s third-largest economy. Because costs are driven by many small factors rather than one single problem, accomplishing savings in the near-term requires addressing numerous "1% problems."
What are "1% problems" in healthcare spending?
These are specific issues that incrementally raise costs by 1% or 2% of overall health care spending. In solving these problems one by one, we can achieve significant cumulative savings. Our current proposals provide a menu of policy options that could reduce health care spending by about 8%.
What specific policy areas does the project cover?
The project currently includes 23 policy briefs, authored by 38 contributors, that target every corner of the health care sector—from providers to payers to prescription drugs. We regularly update our library with new briefs based on the latest academic research to address inefficiencies.
How can policymakers and health care purchasers use the project’s research?
We offer a "menu" of ways policymakers and health care purchasers can cut health care costs. Each brief has evidence-based steps to address specific inefficiencies. Scholars can be called upon for their expertise as policymakers develop legislative proposals and implement these recommendations.
Is this a static project or an ongoing initiative?
This is a dynamic, evolving project. We are regularly integrating new academic research to identify further opportunities for reform. By adding new briefs and refining existing ones, we ensure that policymakers always have access to the most current, evidence-based strategies for lowering health care costs.
