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Notes -
The 7 Habits of Highly Fertile People
I Background
Look into the comment section of any mainstream video or article on below-replacement fertility, and you will find a familiar refrain: it is simply too expensive to have children.
However, despite this common meme, the data do not bear it out. Plotting Total Fertility Rate (TFR) vs Household Income actually produces a U shape with peaks at household incomes <$20k and >$1m, and trough around $200k per year. 2012-2016, 2018-2022.
What is happening here?
My wife and I are members of the PMC, as are most of our friends. We are in our mid-thirties. We have noticed that our friends are branching into one of two forks:
Recently, I have had the opportunity to get to know well two families quite outside our social circle. The first is the family of a carpenter who makes $30/hour, lives in a rural area 45 minutes outside of a tier-2 city, stay-at-home mom, five kids. The other is an urban family, headed by single-mom who works as a receptionist at a low-end hotel (making, I would guess $20-30k/year), also with five kids.
While these families are superficially quite different, when it comes to childrearing, they actually have a lot of beliefs and habits in common. And, these beliefs and habits stand in stark contrast to those of my peer group - folks who are making quite a bit more money and yet cannot imagine affording five children!
I document them below, mostly for myself:
TL;DR: High-fertility families structure their lives in such a way as to make children extremely cheap and dramatically less time-intensive.
II Habits of Highly Fertile People
1) High-fertility families do not believe that every child needs their own room.
2) High-fertility families pay roughly $0 for education.
3) High-fertility families pay roughly $0 for kids' stuff.
4) High-fertility families pay roughly $0 for enriching activities.
5) High-fertility families start early. They have known no other adult life, besides being parents. Their tastes are quite modest.
6) High-fertility families pay roughly $0 for childcare:
7) High-fertility families pay very little for (and think very little about) healthcare
I am not trying to say that having five children is the only worthy goal in life. And, it is entirely possible that the progeny of the PMC will somehow be “better” than the progeny of the Carpenter or Receptionist - healthier, higher-IQ, more worldly.
III Policy Ideas for Increasing Fertility
It also occurs to me that, even if you cannot change the beliefs and habits of the PMC, you could still make policy decisions that increase their fertility:
1) Decrease the cost of housing.
2) Improve the public schools
3) Decrease the cost stuff
4) Enriching activities:
5) Starting early:
6) Childcare:
7) Healthcare:
Reminder that physician salaries are a low percentage of healthcare expenses, that the AMA has nothing to with supply restriction, spots can be expanded by local governments and hospitals (and have been!), and that the AMA has been lobbying for a supply expansion for decades.
At the end of the day, all the dollars spent on healthcare end in someone's pocket. If not doctors (and I'll believe some aren't hugely compensated compared to their efforts), then who is keeping the dollars my insurance company (and I) pay the local "nonprofit" hospital for care? Obviously insurance gets it's share (capped by Obamacare). Their executives (doctors!) are compensated pretty well as far as I can tell.
I believe the actual answer to this is "Private Equity firms". Where the money eventually goes after that is incredibly complicated to track (by design), but last I checked they played a fairly important role in cost inflation.
Why does Private equity play such a big role in modern investing? Is it a new thing, or did some regulatory change happen, or is there some reason I hear them brought up in almost any economic discussion nowadays, or am I just misremembering a time before private equity was a talking point?
I don't think that private equity is a particularly new thing - it was how Mitt Romney made his money, after all.
My personal belief, which I freely admit has no actual verifiable statistical backing, is that the main reason you're hearing more about them is that the proboscises of parasitic capital are being turned inward. A lot of financial instruments and practices, whatever their legality or the finer points of how they work, essentially functioned as wealth pumps that funneled treasure from various parts of the world to the imperial core. But those wealth pumps develop constituencies and dependents, so they can't just turn off when the flow of lucre begins to slow, and as a result they're forced to target the interior of the empire. These engines of exploitation, which have for years been going into poorer countries and exploiting them for profit, are being forced to turn to the US heartland because that's where the easiest money is. Now, instead of buying hospitals and dramatically raising prices while lowering quality in the global south, they do things like buy Red Lobster and suck out so much capital it dies, or set up cartels in the firefighting equipment manufacturing sector, driving up costs of equipment massively while also simultaneously creating shortages in both repair parts and finished vehicles (https://www.thebignewsletter.com/p/did-a-private-equity-fire-truck-roll).
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A big piece of it is admin bloat, just as in academia the number of middle managers and other folks like that (assistant infection control nurse - whose job is to make sure we don't order any labs that may show signs of infection!). Also more general middlemen/industries of various kinds.
Examples: PBMs, billing staff, EMRs.
If you look at a surgery a small fraction of the cost is the surgeons professional fee - yes lots of labor costs but thats because their are literally scores of people involved. Supplies, instruments, equipment....all places where someone could be greedy (see: ortho vendors).
Executives in healthcare are increasingly MBAs or nursing and often have authority over the doctors that can lead to both increased cost and decreased quality (see: travel nursing).
Doctor supply issues may be a problem but they are pretty orthogonal to the overall cost disease problems.
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A bunch of it is surely administrative bullshit.
Administrative bullshit maybe, administrators probably not.
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