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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.
Interesting. I need to look into this. Perhaps my model of the world is wrong or out of date. I was under the impression that the AMA severely restricts the number of medical schools and the number of spots within those schools - such that the typical new doctor graduates with hundreds of thousands of student loan debt. Any links as to what drives healthcare costs?
Everyone points fingers at a variety of things but physician salaries are under ten percent of spending. A massive drop in doctor salary only gets you 3-4 percent less expensive healthcare.
The AMA historically was engaged in what you are talking about but then spent multiple decades lobbying for increased role for midlevel providers which is a de facto supply increase. It's finally moving away from that in the last few years but has yet to find a new passion lol.
Historically the limiting factor on doctor production has been residency spots which are mostly funded by the government, however plenty of states and private corporations will fund those spots because the labor is dirt cheap and they actually make a ton of money.
Additionally ability to increase spots in the higher paying/lower number specialties is limited because you need enough work to adequately train and all kinds of things have caused problems with that (ex: a reduction in surgical frequency secondary to an increase in medical technology meaning not enough cases). Lower paying specialties like FM and Peds have more room to grow but nobody wants to do them because of the poor (relatively speaking) pay.
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