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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?
The bottleneck in producing new doctors in America isn't the schools, it's the residencies. After graduation, all doctors go to some teaching hospital somewhere and serve a 4 year residency to learn how to actually practice medicine. This training program costs the teaching hospitals money, which is reimbursed by CMS. So in practice, the number of available residencies is determined by CMS; hospitals won't spend money out of their own pocket to train new doctors above and beyond what CMS reimburses.
The impact this has on healthcare costs, I don't know. I'm sure it's something, but is it a major component, or a drop in the bucket compared to other factors? I don't know.
"We won't train doctors to the regulatory standard unless taxpayers give us bundles of money to do so," is an obvious confluence of terrible interests in the private sector and government, especially when the industry has achieved significant amounts of regulatory capture. Surely, there is a better way.
Imagine this in other industries. Grocery stores get the government to set up a licencing requirement to stock shelves, with some boilerplate reasoning about food safety or something. The thing is, the only way to get licensed is to get a grocery store to give you the mandatory years of experience. And, of course, they refuse to have such positions unless the government pays them for it. I would predict that there would be fewer grocery store employees, their pay would be higher, industry profits would be higher, government outlays would be higher, prices to the consumer would be higher, and service quality would decrease.
I don't think you're wrong on the broad impact on industry here, but your analogy falls a little flat for me. The difference in impact for poorly trained doctors versus poorly trained stock boys makes the idea of licensing requirements for one desirable and ridiculous for the other. It's possible the regulations on doctor training are overly burdensome and could be loosened without a corresponding increase in medical error induced mortality rates, but I'm not certain that's true.
It's less about the exact content of training and more about the atrocious incentives involved and who has control over every step of the process. Think about higher education. Sure, one might want to know the meme question, "Is our children learning?" Perhaps it would be desirable to have some system in place. Lo and behold, we have a system called 'accreditation'. Who controls this system? Why, it's the existing universities, of course! Or for another example, I've known unis that wanted to add a PhD in a certain discipline. The big dog universities in the area played defensive power politics and managed to make it so they were supposed to have to "prove" that there was a "need" for it. How is it possible to do that? There's obviously no actual standard. It's gonna be based on atrocious hidden incentives. See also Certificate of Need laws for healthcare.
They play the same games over and over again. I get that you want well-trained doctors, but there's gotta be a better way than giving control over every step in that process to existing cartel entities and letting them make all the choices.
Let's put it this way - perhaps there is a "right" level of training for doctors, and perhaps there is a "right" level of training for grocery stores. Maybe the latter is much smaller than the former. Now, imagine we set up the system I described in my last comment for grocery store training. Do you think their incentives would lead to them selecting the "right" level of training?
There's a lot of lemmings-off-of-a-cliff reasoning. It feels like you're assuming that some medical cabal is making decisions for the good of the group. But that's just not true in practice.
Incentives for residencies are individual and local. Most sufficiently large medical group/hospitals could open a residency and self-fund. However they don't. Because docs make money from seeing patients. Teaching a trainee takes away from seeing patients.
And the medicare funding issue is squarely out of our hands. For literally decades, medical associations and prospective/current residency programs have been asking for more funding for more slots.
The foreign medical grads is a whole other thing. I'll keep it brief, but mention a lot of cultural barriers. Perhaps best encapsulated by asking: Would unlimited free visas for indian/chinese phds be beneficial? The current limited system seems reasonable. But I think it's obvious how it could warp industries and training for the worse.
All of this comes after the standards have been chosen in a way designed to allow you to play this exact game. What game are you playing here? The "we won't train people to the standard that we've selected unless you pay us more money" game. Everyone who isn't a doctor (as you clearly are) can tell that this game is just extortion.
I don't know. What do you think? Why?
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