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When Health Insurance Costs $10,000 Per Person, It’s Time for Reform

When Health Insurance Costs $10,000 Per Person, It’s Time for Reform

In a strong Op-Ed in the New York Times, Dr. Zack Cooper of Yale’s Health Care Affordability Lab points out simple, straightforward stesp that would help reduce out-of-control health care insurance costs.

NYT: When Health Insurance Costs $10,000 Per Person, It’s Time for Reform

Health Care Affordability Lab at Yale

 

AI Summary: “Health Care Premiums Are Going Up, Again. Here’s What We Can Do Now.”

Author: Zack Cooper, Director of the Health Care Affordability Lab at Yale University
Published: November 3, 2026, The New York Times, Opinion

Central Argument

America’s health care costs are spiraling upward, but meaningful relief does not necessarily require a sweeping overhaul of the entire health care system. Instead, Zack Cooper argues that a series of relatively small, targeted reforms could collectively save hundreds of billions of dollars annually without sacrificing the quality of care.

Cooper believes that politicians devote too much attention to comprehensive proposals, such as Medicare for All, while overlooking practical reforms that could deliver substantial savings much sooner.

The Growing Health Care Crisis

Health insurance is becoming increasingly unaffordable for American families. Cooper highlights several alarming figures:

  • 13%: The average increase in individual-market insurance premiums for 2027, following a 26% increase the previous year.

  • 10%: The expected increase in employer-sponsored health coverage costs.

  • $10,000: The projected annual employer-sponsored coverage cost per person, exceeding this amount.

  • $5.5 trillion: The approximate annual size of America’s health care system.

These rising costs discourage people from seeking necessary medical treatment, strain household budgets, and contribute to the federal government’s mounting fiscal problems.

A Different Approach: Fix the Leaks

Cooper argues that America’s health care system is not one unified structure but a collection of overlapping systems, including Medicare, Medicaid, private insurance, and veterans’ health care.

Each contains inefficiencies, excessive charges, unnecessary administrative expenses, and practices that benefit powerful financial interests.

Rather than replacing the entire system, Cooper proposes identifying and correcting these individual problems.

Researchers at Yale’s Health Care Affordability Lab have identified 23 evidence-based reforms that could save as much as $400 billion annually, approximately 8% of total American health care spending.

Examples of Practical Reforms

Cooper identifies several opportunities for reducing costs.

1. Combining insurance markets

Most states maintain separate insurance markets for individuals and small businesses. Combining these markets could reduce administrative expenses and create larger insurance pools. Researchers estimate this could save households approximately $500 annually and the federal government more than $8 billion.

2. Increasing childhood flu vaccinations

Making flu vaccinations more convenient, including through pharmacies, could reduce illness, doctor visits, and emergency room treatment. Increasing vaccination among children ages two through five could save approximately $500 million annually.

3. Regulating hospital prices

Hospitals frequently negotiate dramatically different prices with insurance companies for similar services. Better regulation of these negotiated prices could reduce excessive spending.

4. Encouraging competition in prescription drugs

Certain agreements between brand-name and generic pharmaceutical manufacturers delay the introduction of less expensive medicines. Eliminating these anticompetitive practices could lower prescription drug costs.

5. Reducing fraud

Strengthening oversight of fraudulent medical billing, particularly in home health care, could recover substantial amounts of wasted money.

Why These Reforms Face Resistance

Cooper identifies a fundamental political problem: The financial waste in American health care is often someone else’s income.

Hospitals, pharmaceutical manufacturers, insurers, and other businesses have powerful lobbying organizations protecting their financial interests.

By contrast, there is no equally powerful political constituency advocating for greater efficiency.

Furthermore, incremental reforms rarely capture public enthusiasm. Politicians prefer promoting ambitious transformations rather than discussing technical changes to insurance regulations or billing procedures.

Consequently, even reforms that could save billions of dollars face considerable opposition.

The Role of Comprehensive Reform

Cooper does not reject large-scale health care reform. In fact, he favors eventually allowing Americans to buy into Medicare.

However, he believes such changes are politically unlikely before 2028 and would take additional years to implement.

He also observes that comprehensive reform would not eliminate difficult decisions about prices, payments, and financial incentives. Those decisions would still have to be made under any new system.

Implementing smaller reforms now would provide immediate financial benefits while building the political experience necessary for more ambitious changes later.

Conclusion

Cooper’s essential message is that Americans should not have to wait for a political revolution to obtain more affordable health care.

By addressing inefficiencies, excessive profits, anticompetitive behavior, and administrative waste individually, policymakers could generate enormous savings.

His argument is both economic and political: Real health care reform may be achieved not through one dramatic transformation, but through dozens of practical improvements that collectively produce transformative results.

An Important Implication

One particularly significant aspect of Cooper’s argument is his recognition that excessive health care spending is not simply the consequence of an inefficient system. It is also the product of financial incentives that reward inefficiency.

This raises an important ethical question: When practices that increase medical costs also generate income for powerful institutions, how can public policy put patients’ welfare ahead of financial interests?

That question could provide an especially productive starting point for a broader discussion of health care as a moral responsibility rather than simply an economic commodity.

Source: Zack Cooper, The New York Times, November 3, 2026. The article was also republished in the Salt Lake Tribune on November 4.

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One-Third of Insured People Have Medical Debt

One-Third of Insured People Have Medical Debt

Even among those with private coverage, medical debt stemming from both hospital visits and routine care looms large over about a third of U.S. adults, according to a nationally representative Commonwealth Fund survey.

The thinktank reviewed over 4,100 survey responses from adults with continuous employer, Affordable Care Act marketplace, or individual market coverage, as well as focus groups with 45 participants.

That survey, conducted from July to October of last year over the phone or online, found 32% were paying off medical bills or debt, with higher rates among women (37%), those with low or moderate incomes (38%), those living in the South (39%) and people who reported Black ethnicity (41%). More than a third of the full sample said they could not pay an unexpected medical bill of $1,000.

Read more here:

One-third of privately insured have medical debt, Commonwealth Fund survey finds

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Private Equity Firms Destroying Hospitals

Private Equity Firms Destroying Hospitals

The New Republic recently ran a story about how private equity firms buy hospitals, extract the capital, and then walk away from the remains:

The Private Equity Firms That Gobble Up Hospitals and Spit Them Out

Looking to turn a quick profit, the firms buy medical facilities and then unload them just a few years later, often leaving devastation in their wake.

The article, written by Sara Degregorio, profiles the death throes of Crozier-Chester Medical Center in Pennsylvania, once a vital and respected general hospital.  Purchased in 2010 by Prospect Medical Holdings (in turn owned by Leonard Green Associates), the new owners cut staff, didn’t maintain equipment or purchase new equipment, sold the property off to a real estate company and leased the building back to the CCMC, which had previously owned the property and buildings outright.

“When Leonard Green exited Prospect Medical in 2021, the Rhode Island attorney general investigated and found that the ownership group “realized hundreds of millions of dollars and would leave behind a system that is highly leveraged, that is, where liabilities greatly exceed assets.” Prospect Medical continued to own Crozer-Chester until the company closed that hospital and others amid the company’s bankruptcy in 2025, leaving residents with nowhere to go for care.”

Read more about other hospitals closed by Prospect Medical Holdings.

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2025 Christmas Campaign Succeeds!

2025 Christmas Campaign Succeeds!

Our 2025 Christmas Campaign ran from December 14, 2025 to January 15, 2026.  We sought to raise $15,000 to purchase and forgive $1.7 million in medical debts owed by our neighbors in Forsyth county. At the end of the campaign, we had collected over $17,648.  With this, Undue Medical Debt was able to purchase $2,215,705.73 in medical debts owed by 1,631 households in Forsyth County.  Letters went out to each household certifying that their debt had been eliminating.

On February 8, 2-16, at our annual Scouting Sunday, Pastor John and the Scouts symbolically burned the list of debts.  Our special guest was Michelle Santoro from Undue Medical Debt in NYC.

This was our 8th campaign, and the first where we were not able to buy all the available debt in Forsyth county.  We encourage other Forsyth churches to chime in with our campaign — or start their own!  We need to help our neighbors, and this is now a proven way to directly help those who have been victimized by a broken health care financing system.

 

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Jubilee Project Surges Past Goal – AGAIN!

Jubilee Project Surges Past Goal – AGAIN!

Our Summer 2025 Debt Jubilee Campaign aimed to raise $15,000 to purchase past-due medical debts in FORSYTH, GUILFORD, DAVIE, DAVIDSON, and STOKES counties – totaling $2,980,086! Overflow would be used to purchase debts in nearby Surry, Yadkin, and Wilkes counties.

We closed the campaign on September 15 with a total of  $21,118.40 – 140% of our goal!  We will be announcing the final total of debts abolished at our service on Sunday, November 2, when we will also hold our ceremonial Debt Burning.

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Little-Known Appeal Could Force Your Insurer to Pay for Care.

Little-Known Appeal Could Force Your Insurer to Pay for Care.

When a health insurer refuses to pay for your treatment, you may have the right to have the denial reviewed — and potentially overturned — by an independent provider. Duaa Eldeib of ProPublica has compiled six steps experts suggest to help you through the external appeal process.

This Little-Known Appeal Could Force Your Insurer to Pay for Lifesaving Care. Here’s How to File It.

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Bankrupt Steward Health Sues Former CEO

Bankrupt Steward Health Sues Former CEO

PHOTO: Dr. Ralph de la Torre, former CEO of Steward Health Care, and the Amaral (formerly “Lady Sheridan), his 190-foot superyacht, valued at $40 million, featuring six bedrooms, accommodations for up to 15 crew members, a gym, and various living and dining areas. This yacht’s operational costs are estimated at $4 million annually.

Steward Health Care has sued its former CEO and other leaders for misappropriation of assets, blaming the hospital chain’s bankruptcy on financial mismanagement and intentional looting of the assets.  CBS News reports:

Steward Health Care claims former executives’ “greed and bad faith misconduct” led to hospitals chain’s bankruptcy

Background:
Steward Health Care, once the largest privately-owned hospital network, famously filed for Chapter 11 bankruptcy in May 2024 with about $9 billion of debt – leaving many areas without a hospital or with insufficient health care.  A court approved its plan to liquidate by selling assets and pursuing lawsuits against former executives and other insiders to raise funds.

We reported on the closure and controversy:
Steward Health Care Declares Bankruptcy Amid Controversy

Lawsuits Against Former Executives:
The company alleges ex-CEO Ralph de la Torre and three other insiders misappropriated $245–262 million through excessive dividends, overpaid acquisitions (e.g., $205 million overpay for Miami hospitals), and diverting assets to personal entities—moves the company says left it “perpetually undercapitalized”

Feasibility of repayment through litigation:
Steward’s legal plan—backed by creditors—anticipates recovering at least 13% of claims. Even that modest recovery would cover all administrative and professional fees (lawyers etc.) of over $100–270 million, with actual expected recoveries between $800 million–$3 billion.  This financial recovery will do little to help the cities and rurla areas that have been left without sufficient health care.

The privatization of struggling hospitals began in the 1990s, and in many cases has resulted in controversial moves by private equity to strip assets, sell off the properties and lease them back to the hospital at usurious rates which result in major profits for the equity company but often result in decreased service and even the failure of the institution.  About 1/4 of the emergency rooms in the US are now owned by private equity firms.

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AI Helps Appeal Denied Medical Insurance Claims

AI Helps Appeal Denied Medical Insurance Claims

Insurance denials seem to be a persistent reality – even when the medical need seems clear.  Many initial denials are in fact generated by a computer algorithm — so now there is a company that has trained an AI large language model to help write appeals – with significant success.

NBC News did a story recently  on Claimable, a company founded by a team of healthcare and insurance insiders, data scientists and technologists who are committed to challenging the 850 million denied U.S. health claims each year uisng the same technology insurance companies do to minimize expenses.  They follow the case of Stephanie Nixdorf in Davidson, NC and her successful appeal of denials.

Watch the story here:

AI is helping patients fight insurance company denials

Claimable website:

Getclaimable.com

 

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Jury Rules Against Blue Cross Louisiana

Jury Rules Against Blue Cross Louisiana

Blue Cross authorized mastectomies and breast reconstructions for women with cancer but refused to pay the full doctors’ bills. A jury called it fraud and awarded the practice $421 million.

Read the full article on ProPublica:

“Slow Pay, Low Pay or No Pay”

Quick Summary:

  • Blue Cross Green-lighted, then underpaid: Blue Cross Blue Shield of Louisiana (“BCBSLA”) approved over 7,800 mastectomies and breast reconstruction surgeries—but paid just 9% of the billed charges for them, averaging roughly $43 million on $500 million billed.

  • Jury verdict: In September 2024, a Louisiana jury found BCBSLA committed fraud by authorizing procedures without ever intending full payment. They awarded the Center for Restorative Breast Surgery and St. Charles Surgical Hospital $421.5 million .

  • Insurance tactics:

    • BCBSLA maintained that prior authorization didn’t guarantee payment and often bundled payments without provider agreement .

    • They flagged the center on “Targeted” and “Blocked” provider lists, which triggered deeper scrutiny and payment cuts.

    •  Thousands of pre-authorized claims were never paid at all.
    • BCBSLA received a “kickback” reward from other BCBS when it paid less for out-of-state patients..
    • Notably, BCBSLA signed one-off deals to fully cover treatment specifically for the wives of their own executives — highlighting inconsistent practices .

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Atrium and Medical Debt – The Guardian

Atrium and Medical Debt – The Guardian

UK-based newspaper The Guardian has published an extensive article about Advocate Health (owner of Atrium Health and other hospital systems).  Advocate is now one of the largest health care systems in the country, the result of multiple mergers and acquisitions.  Atrium has had a number of embarrasing stories published about their aggressive collection tactics; in 2023 they ceased selling off debt to third party collectors – or debt abolishment organizations such as Undue Medical Debt.  When Governor Cooper announced his plan last summer to encourage hospitals to forgive unpayable medical debts — mostly owed by people who would have had Medicare had it been expanded – Atrium and its parent fought the plan vigorously, only agreeing at the last moment.  However, after agreeing, Advocate/Atrium set about a media campaign to gain good PR about how they were generously forgiving debts and removing liens placed on homes during their aggressive collection efforts.  An exposé by NBC profiled an example of an older lien, which embarassed the hospital chain into removing some liens that fell outside the Governor’s program.  NBC later followed up on the expanded forgiveness program.  In many cases, debtors had made regular payments but ballooning interest debt meant that after many years of payments, they still owed almost the same – or more – than was originally financed.

However, extensive concerns remain about Advocate/Atrium’s billing and collection practices.  The focus of the organization, mostly led by financiers and insurance executives, seems to be maximizing cash flow and constant expansion.  Critics say that the bureaucracy is top-heavy and overpaid, resulting in high costs for medical treatment.  Former NC State Treasurer Dale Folwell published a report in 2021 that Atrium’s spending on charity care equaled less than 60% of the value of the tax breaks it received as a non-profit.  Advocate/Atrium and the Charlotte-Mecklenburg Hospital Authority are governed by state statutes from 1943, which never envisioned the corporatization that is occurring today.

Read the full article:

A giant US hospital chain says it’s leading the fight against medical debt. Not all patients agree. — The Guardian

Photo of Atrium Health hospital in Charlotte, North Carolina by Jesse Barber/The Guardian

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