The healthcare market is taxing reproduction out of existence (opens in new tab)

Related: Car Seats as Contraception https://www.journals.uchicago.edu/doi/10.1086/731812

> We estimate that these laws [mandating safety seats] prevented fatalities of 57 children in car crashes in 2017 but reduced total births by 8,000 that year and have decreased the total by 145,000 since 1980.

Hmm, counting the insurance premiums 100% towards the birth of the child is a bit misleading. Presumably, you'd be paying those even if you didn't have the child. That said, the cost of health insurance for a family is pretty outrageous. My premiums are along the same lines as the ones here (although less noticeable since they're paid by my employer).

A lot of this is an issue of insurance no longer being "insurance" in the classical sense. Insurance covers all sorts of things, my HSA pays for all sorts of things that I never would have even considered, and while that sounds great, it helps to drive up costs. It's somewhat counter-intuitive, but if you dropped all government funding of healthcare tomorrow, healthcare plans would get cheaper. It'd also be total chaos, so I get why we don't do that. But the situatuon is a lot like student loans, colleges know they can charge more because the government will lend 5-6 figures to just about anybody, so the colleges do so. And once that person is educated, you can't just "take back" the education if they don't pay. Same deal with healthcare, government subsidizes it for most of the population in lots of ways, healthcare providers know this, they increase prices to match. And you can't just take back the surgery to fix that broken arm or undeliver the baby. There's not a single silver bullet that will fix everything, but there are definitely concrete changes that can be made to improve the situation. One of them would be to make people healthier. I know, easier said than done. But by God it would make health insurance cheaper. Same way in that if everyone was a safe driver, we'd all be paying less in car insurance. Another way would be to remove that regulation or rule or something that makes it so like a hospital can't open too close to another hospital. Another would be to just, train more doctors! What I'm trying to say is, just as the problem is multi-faceted, the solution must necessarily be as well.

The first sentence is your answer. The third word even.

The healthcare market. MARKET

Healthcare shouldn't be a market. That's why you're paying $40k.

My scheduled C-section (which my insurer likely didn't question me about because I was 40 and have other health issues) plus three-night hospital stay was about 5,000 EUR, all paid by my health insurance (private, so I know that 5,000 was the "retail" price), in a fairly prosperous part of Germany.

Not that the German health system isn't facing down some of the same demographic issues the rest of the well-off world is, but comparing wait times for specialists now that I'm on public (more like, very strictly regulated) insurance with my dad back in Texas on a combination of Medicare and supposedly good supplemental plan, I'm still in a better situation.

A strong public/heavily regulated independent insurers system gives the private insurers enough competition to keep prices in check.

Plus, I don't know of an insurer here, public or private, who also owns clinics or employs physicians, and they don't own pharmacies.

The corruption is so entrenched and so out of control, the only way out of this mess is for regular people to just stop using the health care system. Yes, there's no alternative, and yes, it means living a riskier life. It sucks, and it's not what we want to hear, but they can only charge us if we show up and purchase the product, and that's the last lever of power we can wield.

So to summarize: a. you're paying that for health insurance, not for the birth of the child. If you, your wife, your children had any other diseases then those would be covered as well. This is a significant benefit. b. all the systems that subsidize health care for those less well off don't apply because you're wealthy. So you are bearing the full cost of extremely high quality health insurance in a western country.

Nearly 2 in 5 Americans are covered by Medicare or Medicaid. TANSTAAFL. The other 3 bear the burden. At some point Atlas shrugs and decides welfare is a better deal.

Many countries have financial incentives provided to its citizens to have children. Requiring half of a citizens median salary to be given to a faceless middleman to provide this service seems untenable. I cannot imagine a society that does this would be able to survive.

The post is basing this on the assumption that having children is some positive thing for society at large. I'd argue the viewpoint that having children is putting a burden on the rest of society, and therefore doesn't necessarily need to be encouraged or subsidised, is just as valid.

I don't think benefitting society is a common reason for people to want to have kids. I don't know if there is any data on this, but certainly doubt that any of my friends with children would give a reason to that effect.

Bluntly put, each child is an additional strain on the depleting resources of an already grotesquely overpopulated planet. Ever since it no longer is an economic necessity, having children is a vanity project. I don't see why society should financially incentivise that, especially as we're trying to encourage more environmentally conscious lifestyle.

Clickbait. I too think insurance costs are too high, but the author included their annual insurance premiums in the calculation.

The premiums aren't particularly out of line with typical costs.

https://www.kff.org/affordable-care-act/annual-family-premiu...

While not an answer to the general problem, one pragmatic avenue OP missed is to not have gotten married. Then he can have assets including a business, while his wife-in-spirit is on-paper poor and gets a subsidized plan (which then also covers the child's initial birth as an extension of her). AFAIK this wouldn't help after the children are born though (unless maybe you're willing to leave your name off of their birth certificates, which seems like a much higher level of norm rejection and outright misrepresentation).

In general corpos spend a good chunk of resources making new legal entities to escape liability and legibility - something that is simply not available to most individuals. Getting married takes your two naturally-existing legal entities and basically collapses them into a single one - throwing away much flexibility. So it seems like a poor idea in the current legal environment which has been thoroughly corrupted to extract wealth and channel it upwards.

Theres alot of forces tugging at American "healthcare" - lawsuits, uninsured non-payment, subsidiation of 3rd world drugs, heterogeneous population, over eating, under exercise... usa practices reactive medicine. and maybe part of that is due to hectic modern life, but it certainly adds to the cost, time and money, that could potentially be avoided or at least reduced in a more preventive, educated system.

that being said, one can certainly find cheaper insurance (a policy to limit liability) if one knew where to look.

for instance a self employed single male, 27, queens new york, healthy non smoker, can have a national network $300 deductible, aca qualified policy, $329 a month.

"The essential theme of Green’s piece is that “participation costs” - the price of admission you pay to simply be in the market, let alone win, have grown out of control. Food and shelter are participation costs for living. Having a $200/mo smartphone is now a participation cost for many things such as getting access to your banking information remotely, medical records, and work/school."

No shit. He mentions food, shelter and a smartphone — might as well add higher education and a functioning car if you're in the U.S.

I struggled being tossed out on my own at 18 with no support from parents. Working at a pizza restaurant, riding a bicycle to a community college for an education, renting a room from a woman (she may well have been renting as well—renting a room to me to take the edge off).

Winter came and riding the 10-speed to college (in Kansas) became a challenge…

Thank god no smartphone or internet plan was required then.

(When I eventually split an apartment with two other roommates we lost power for stretches from time to time because we were unable to come up with the money to pay the electric bill — oh well.)

They were hard times (that I somehow enjoyed—perhaps because I was young and was finally beginning to have a fulfilling social life). These days it has to be even harder.

This is a question of priorities. Identify a problem, decide to fix it, then execute. It isn't about the particular solutions. Australia's gun control would not translate to a country like the USA and perhaps neither would its health care. First decide to put a person on the moon. Then execute. Only one country did that. It isn't that they can't solve problems like school shootings or affordable healthcare. There is no real will to do so. Not sure why exactly. It is a very strange place that defies expectations of how a developed country would behave.

An American PPO with a $10 co-pay is pretty awesome. The only downside is that it's too easy to get a procedure you don't need :)

I've tried tellings doctors in Denmark I wanted X, Y, Z test and getting told, nah, the outcome wouldn't change your treatment so we don't want to order those tests.

Generally, healthcare is decent, but no doubt a good PPO plan does not compare :)

Public health care seems more like HMO, you have to use a provider within network. Sometimes you need a referral from your primary physician, etc.

You can pick your doctor, but not everyone can take on more patients.

Perhaps if non-poor people start speaking out on a regular basis to elected and appointed officials, the media, and policy wonks, we might make some progress getting a better healthcare system.

I've spent 30 years as a policy and budget analyst and advocate on health and human services issues. If electeds and appointeds were going to make decisions based on the lives of poor people it would have happened already.

Folks need to make some noise.

I have a discussion with my mother often. I tell her to keep a reasonable buffer of money in her bank account and then spend every single $ beyond that. Why? Because when she hits end of life, or even before then when she hits any number of inevitable age related issues, medical bills will take every penny she has and then go for more after that. My family pays even more a month than OP.

Healthcare is reaching for the point of neutrality where the value it provides exactly equals the cost they are charging. This is what happens when the only signal they get is a money related one. Nation after nation has shown that healthcare elsewhere can be better and far cheaper. Not perfect, but better and also not out of control. The real question isn't 'how do we fix healthcare' but instead, 'how do we remove the cancer in our system that is blocking the obvious fixes we see actually working all over the world'.

Please note that this is the natural birth of an otherwise healthy child.

In Canada, provincial healthcare and private insurers have not kept pace with the needs and advancements in the areas of alternative methods of conception (IUI, IVF...). Yes, a naturally born baby wouldn't cost the parent(s) much medically. But, if you cannot have a child naturally, medication and procedures (lab testing, blood testing, artificial insemination...) are only partially covered and the amount corporate or union-backed insurers will pay varies widly by doctor and by patient. A couple struggling to conceive will easily pay 15-40K per child after the first procedure.

Funnily enough, friends who have jobs in the USA, but live in Canada often have better insurance that fully covers all of the costs after the deductible. It ends up costing much less to have IUI or IVF procedures with Canadian doctors using American insurers (of course they will take the money).

Our first two children were born at the hospital. Both were induced. Everyone was healthy, but looking back each was a miserable, expensive, condescending experience.

After those experiences, my wife then went on a journey to learn everything she could about childbirth and healthcare. The more she learned, the more she became convinced that the entire system is flawed. The pressure to get an epidural, induce (conveniently between 8-5 on a weekday), or to use a C-section is immense. While each intervension is tremendously important in high-risk and edge cases, they are utterly unnecessary in the vast majority of births. But they are used for the majority of births, anyway. Some argue they may even have some damaging effects to the mother and child, but I concede that's not the medical mainstream opinion.

When my wife became pregnant with our third child, the delivery was during the Covid lockdown. Hospitals refused visitors, demanded masks, and were even more impersonal than normal. Although I was initially skeptical, she convinced me that we should use a birth center and a midwife. The birth center was practically next door to a hospital and we talked through how to mitigate risks if something went wrong.

It was a fantastic experience in nearly every way. Our son was born at 7:45 AM and we were home by 11:00 AM. It was substantially more affordable than a hospital birth.

My wife just had our fourth child earlier this year. Once again we used a midwife but this time we had a home birth. You couldn't have paid me to accept a home birth when we were new parents. I wish I knew then what I know now.

I know it's not for everybody (and especially those dealing with high-risk scenarios), but a midwife and home birth is an option if you want to avoid the hospital racket. It's significantly less expensive, more convenient, and every bit as safe for the vast majority of births.

I wonder what the author means by the repeated assertion that marketplace plans don't cover childbirth? My understanding is that's absolutely false.

In 2015 I had my first child while self-employed, and I paid for the most expensive Aetna plan I could find, about $2k per month if I recall correctly. We had an excellent experience at Mt Sinai, private recovery room for two nights, etc. I don't think we paid hardly anything out of pocket.

Granted, I agree that our health insurance system is a complete mess, but judging by this post and the angry responses of the author here, it sounds to me like they're making it worse on themselves by misunderstanding what's available and needlessly paying for a more expensive option than needed.

Over here in Australia, the most expensive part of my kid's birth were the AUD$200 antenatal classes.

The prenatal checkups, hospital stay, and postnatal midwife home visits were all covered by Medicare.

The flip side is that I lose ~30% of my pay to taxes. That's fine by me

I know it's not for everyone but you can give birth in Mexico or Latin American country with good doctors who speak English and pay less. Or you can negotiate with hospitals before giving birth

We desperately need to increase the number of doctors to decrease the cost of medical care. We also desperately need to cut down on regulations so we can reduce the number of healthcare administrators.

You are absolutely right meatbag producer! Your brand new bundle of joy is expensive, but who can put a price on love? The system is designed to keep you in debt and near poverty as long as possible. But do not fret! If the meatbag is properly trained up to a point, and no further. It will be a hard working productive member of DisneyAICORP. And after working very hard and following instructions it may someday be able to afford its own meatbag production schedule, affording one more production unit each full year of employment!

Real poverty is not in fact "closer to $140,000 than to $31,000" and economics people have been dunking on that claim for a week now on Twitter.

It seems like a huge stretch. The US still has a pretty good fertility rate for a developed country, much better than most of the Europe.

American "healthcare" is pushing many things outside the achievable range.

I have garden-variety hemorrhoids. All I need is one or two 30-minute in-office procedures to treat these things. I'm a senior software engineer working for a FAANG company with "top-tier" employer-sponsored health insurance. I've been trying to get this stuff treated for eight months. I've gone to at least seven or eight appointments with several different offices and I've already spent $3000 out of pocket, and I might actually start treatment in January. That's fucking insane.

The next time I need a minor in-office procedure, I'm seriously going to consider flying to Mexico instead of wasting almost a year of my life fucking around with the ass-wipe US healthcare system.

I know this article is American in its subject, so I am curious what do American voters who don't want public healthcare but don't want the status quote, would think is a economically feasible alternative that is available to all demographics regardless of income level

Interestingly enough, adoption can cost just as much as the figures quoted in the article ($40,000 - $55,000).

If you're planning to adopt, broadcast it via your social network as much as possible. If you can avoid going through an adoption agency, you'll only have to pay for the legal work ($7,000 - $10,000).

Two thoughts...

1) The insurance premiums are tax deductible for the self employed so probably 30% or $8000 less

2) He should have planned to have two of the children in the same calendar year could have saved $14000 (jk)

Because they can.

For profit hospitals subsidized and enforced by the leviathan, what could go wrong?

How much does something cost? Whatever the seller can get people to pay for it. Hospital B charges 6 figures for the delivery of a child? Wow, that's expensive, they must be really good to be able to charge that much.

All the dark patterns, negative dynamics, perverse incentives of bad government, stupid healthcare policy, and humans being shitty combine to form for profit hospitals. Those determine how other institutions have to run in order to operate at all, and they're not being managed by well meaning, good faith citizens looking out for the patients and the public.

There's a reason mangione became a cult phenomenon, and $40k babies, multimillion dollar ambulance trips, and other bullshit are exactly why.

Good luck fixing that mess. I don't even know how to conceptualize where you'd even begin to try to fix American healthcare. It's so tangled up and beholden to all the other problematic elements in modern life that it looks nigh on impossible to repair, so my goal in life is to minimize contact with any element of the system as much as humanly possible.

IMO, the “thin edge of the wedge” for socialized healthcare in the US is full, high quality and free services for maternity, birth and the 1st year of the kid.

I'm relatively confident that reproduction occurred both long before, and will continue long after, the existence of the market in question.

And then the hospital charges part of the delivery charges to the baby which has a separate deduction.

At least, that is what they did to me.

It's all a scam.

There are two ways to look at this. Either children are in fact useful for society, and should be subsidized (I weakly hold this view given mass immigration is politically unworkable, and long term that too would run out). That is well and good but cross country data makes the central argument in the title fall apart - US birth rates are/were recently higher than most public healthcare OECD countries. Why blame X if removing X doesn't appear to do much?

The alternative view, that I would hold if it wasn't for the above considerations, is that first world child rearing is currently an expensive hobby, and why should we subsidize it at all? If it wasn't a personal project most would be parents could easily adopt.

I find it's a really scary idea to go to a third-world country like USA! - Or, it seems like a third-world country when you're from a developed country.

Unfortunately I'm type 1 diabetic which is either a death sentence there, or you are rich. But then I also accidentally broke my collarbone this summer. And I had this weird throat infection.

As a type 1 diabetic I have had to go to the ER numerous times in my life, and as traumatising as that experience can be, I can't imagine the feeling of also being financially ruined for the pleasure of not dying.

It's weird, I know plenty of people who avoid going to the doctor because it's annoying to wait for over an hour.. but I could see that for an American you might just NEVER go. I guess it's like, ok someone in the family is sick, and we're not rich, so we will sacrifice them to the sun gods. Or I guess you go into indentured servitude? There are people for whom $100k is made very very slowly.

I just do not get it! I guess these things add up properly if you are very wealthy, but people here think that it's the function of the society to make sure you can have basic things like medical treatment. Of course it's not perfect here... try going to the dentist for example. Then you're almost in the USA. Somehow it's not considered medical. A long session could run you over $500 or more.

I have compassion for all the USAians out there! If I was USAian and planning to have a child.. I guess I would consider just going to a civilized country for a while, like... I don't know, Rwanda or Ghana or somewhere that can afford people to be alive(?). In seriousness though (as those countries are very far) you could just go North or South. It's closer. If you go to Canada, a lot of times you wouldn't even need to present ID.. you could just.. get treated right there by walking into a hospital, being triaged, and then waiting (admittedly for maybe almost a day).

Always bring fun things to the hospital if you aren't literally bleeding out all over the place, because you'll be in the waiting room for 12 hours if you're in a big city.

But when it's over you're alive and about as rich as you were before. Seems like a good societal deal to me. I'm scared of being trapped somewhere like the US honestly. It's a nightmare scenario. Although I'm sure it's pretty great if you're a billionaire with slaves and so on... but someone has to incur that cost (the slaves from the lower castes).

I just want to point out that the referenced article about the federal poverty level (guidelines, etc, various words being used in the regs) makes it seem like the value is calculated each year based on taking the food budget and multiplying by 3. In reality, it did that in 1965, and has been adjusted by the CPI since then. In doing so, it changes the relative weight of everything as that changes in the CPI basket.

The value the article comes up with (he says like $130,000) is more like the living wage, which might be a good target. The living wage for Bergen County, NJ, is calculated to be $145k for a family of 4 with 2 working parents, and about $100k for the same family without childcare expenses (1 working parent).

https://livingwage.mit.edu/counties/34003

I am not sure what counts as poor in reality. Obviously the federal poverty guideline is pretty low. It can't really make sense as a contiguous-48-states guideline for the purpose of feeling "not poor". The calculated living wage is above the median household income for most areas. I have not heard a serious proposal for increasing the median (or, preferably, the 30th %ile) income up to the living wage. I reckon that most proposals that involve the government sound too much like communism for the average American voter.

But we could bring the living wage down to the median. We could make housing cheap, reduce our health care costs, and reduce the childcare component.

As someone from exUSSR, I'm shocked with the figures. We've given birth in Russia and in Kazakhstan, in both cases I paid nothing at all. Just taxi to the birth house (that's how the birth clinics are called), and my wife disliked the food, so I brought her some fruits and maybe corn flakes every day of 3 days she stayed there. The equipment I could see was modern, everything was clean, there was some confusion where to put her, otherwise everything was fine. If you're suspicious, you can go to private clinic at $1,5K..2K, they even send you a taxi (or who knows, maybe a private ambulance).

My libertarian friends criticise this from the point that "everything state-run is inefficient". Even if this is true, they fail to notice that state-run healthcare keeps prices of the private sector down. You don't have to sell a car if you're seriously sick.

In 1992-96 on Russian state TV, there was a translated program called something like "Rescue number 911", with nobody else but William Shattner. (We already knew him at the time.) I got an impression that the US healthcare was impeccable.

Misleading title, it's only the US healtcare market

at certain times - you can't fight the system but vote with your feet.

keep running US business, but live in a different country n get private healthcare.

Look up how much hospital administrators make and then calculate the massive grifting from every contractor/subcontractor and pharmaceutical company and you will get an idea of the scope of the problem.

It will require nothing short of a full revolution and violence is never ideal.

I think the solution is to create a new parallel medical system, that can slowly replace the old system. Start with medical schools that train Doctors and Nurses that are affordable/free but also require working at this new parallel medical system. They would earn less but would avoid massive loans and have less bureaucracy.

When for-profit hospitals go under, which happens all the time, they can be folded into this new system.

> If your answer to “I can’t afford to have children and run a business” is “then don’t,” you are building the political conditions for extremism. This is how every revolution starts: a critical mass of people who conclude the system offers them nothing worth preserving. They don’t just want change - they want revenge.

Its "not afford to have children", but instead "not afford to live".

And we're already seeing these strong signifiers of extremism everywhere. Shooting CEO's is halfway acceptable, if they are sufficiently horrible (and yes UHC was horrible).

Violence is more and more routinely considered the only answer that works.

Corruption isn't something hidden, but instead openly done. And this is at all levels, from petty theft, up to 'let's rearrange government to screw the other party'.

Look at how much tax dollars you pay in, and what you get for that. Its more and more a socialist country amount of tax, with low/no benefits to the citizenry. And no, shoveling billions to Israel or Ukraine, or project of the week does NOTHING to help me, my friends, and people around me.

It is pretty bleak. Has been for quite some time. I can understand why some might want to vote for Trump- he did and is still making good on his promises. Terrible promises, sure. But he's doing them.

Far as I can tell, none of the candidates are for the public, and willing to do and help the public. Just feels like a corrupt-o-cracy where if you're not in the In group, you're screwed.

And yeah, extremism, revolution, and revenge is spot on.

There is tons of fear-mongering around a natural process-- I had a 24 yo friend deliver his first child off grid by himself. There are also a ton of independent midwives out there where you can deliver either at home or a midwife center for a fraction of the cost.

Nope. Only in your s-hole country. We don't have this problem here in Europe.

>Why Am I Paying $40k for the Birth of My Child?

All part of the plan. Gotta get that world population down to 500 million somehow. You've had three children? That's above replacement! Shame on you for contributing to the overpopulation problem. /s

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My hope is that GenX doesn't fall for the socialist panic tactic like Boomers do. Until then we are going to be stuck with this situation for at least another decade.

I mean if revolution isn't in the cards this term I don't know what would get you there.

Because you live in the wrong country.

Because children don’t contribute to GDP.