
The US is the most expensive nation in which to have a baby - koolba
https://www.theguardian.com/us-news/2018/jan/16/why-does-it-cost-32093-just-to-give-birth-in-america
======
Brendinooo
First kid was no cost to us. My wife was on insurance with her employer. Long
day, but no complications. I kept waiting for a bill that never came. Couldn't
believe we didn't pay anything!

By the time the second kid came around, we were self-insured on the
healthcare.gov marketplace. We ended up paying $5000 out of pocket - $2k for
the prenatal care and doctors' services, $3k for the delivery and stay at the
hospital.

We made a $1500 mistake. My wife had a really fast and normal delivery, but it
was so fast that they didn't have time to administer an antibiotic that they
otherwise would have. They wanted to monitor her for a day to look for an
infection. We said okay, but if I had more closely read my policy I'd have
learned that the policy had a $1500/day copay for labor and delivery. We'd
have taken our chances and gone home had we known.

Kid three is coming! And this year's marketplace plan says that we're on our
own up to the individual deductible of $6950. That's a bronze plan that
carries a $950/month premium for 4 people; financial assistance from the
government drops that down to $700/month. So we pay $8400/year for the
privilege of not paying more than $7000 for an individual ($14,000 for the
family) on our plan.

I don't think state-run healthcare is the only solution here (nor is it an
inherently bad solution; I'm no libertarian), but I have to think that I'm
living in the worst of all worlds here. I'm forced to buy an expensive product
that I'm afraid to use, a product that costs more than the roof over my head
per month but delivers a fraction of the value. It's expensive because it's
violating basic principles of insurance, because the people who made the law
are trying to implement universal healthcare in a system that's not built for
that idea (at least not in the way it currently exists).

If I lived in a more market-based system there'd be price transparency,
presumably a better way to monitor outcomes, and a lot more say in what kind
of policy I could get to better accommodate the needs of my family.

Anyways, there are alternatives and means for assistance out there, and we're
exploring them. But we like our doctors and our hospital; it's a shame that we
have to look elsewhere. Not looking for sympathy, just adding a data point! My
takeaway from that article was that maybe we should price out a trip to Spain
sometime late in the third trimester :)

~~~
jostmey
My wife is a resident physician. She also went through the same experience of
delivering a kid.

Here's what I've learned:

* Pricing is not transparent. When the hospital tells you how much the procedure will cost, they are not telling you about the anesthesiologists portion, or the room fee, ect. There will be surprise bills. Why isn't it law that Hospitals provide transparent pricing for non-emergency procedures?

* Doctors are in short supply. This is because becoming a doctor is impossibly hard. Why can't undergraduates enter straight into a medical school program? Doctor's are in the 30's when they complete training and are already halfway toward the retirement age

* If things go badly during the delivery, you will be glad you are at a well equipped Hospital. A $5000 bill is a small price to pay to ensure the baby does not arrive brain damaged.

~~~
gaius
_Doctors are in short supply. This is because becoming a doctor is impossibly
hard_

That's an entirely artificial problem created by the AMA (or BMA in the UK) to
keep wages high. What if everyone who had the academic ability could train,
rather than having to compete for a restricted number of slots? It's how every
other discipline does it (they defer competing for places until the job
market).

~~~
tcbawo
This is a huge problem. The limiting factor appears to be the number of
residency spots, not the number of accepted medical school students. We should
take some of the billions our Federal government spends and increase the
number of residency spots and increase funding for tuition reimbursement for
practicing in underserved areas.

~~~
jhokanson
I can't personally speak to the accuracy of the linked claim below, but it
suggests that the coverage of residency spots is controlled by a physician led
advisory board called RUC that intentionally limits the reimbursement so as to
control wages.

[http://www.motherjones.com/kevin-drum/2013/11/its-doctors-
wh...](http://www.motherjones.com/kevin-drum/2013/11/its-doctors-who-control-
number-doctors-america-not-government/)

------
a_d
In India, there are small boutique hospitals that solve this very problem
(e.g. [https://www.cloudninecare.com/;](https://www.cloudninecare.com/;)
[https://www.motherhoodindia.com/;](https://www.motherhoodindia.com/;)
[http://ovumhospitals.com/](http://ovumhospitals.com/) and hundreds more in
every city). I have always been so surprised by how "broken" maternity is in
the U.S. and just how overtly "scammy" some of the things are e.g. if one
needed breast-pumps, there is a 'company representative' that would deliver it
to your hospital room and you get charged separately - by the company - and
nurses get a kick-back; There is a nexus of private practitioners roaming the
hospital wards helping mom's with early care - most of them looking for
'repeat business', after one is discharged. This is from experience in San
Francisco. Not to mention the 'baby-product-industrial-complex' where one is
convinced that highly special, safe and pink or blue colored equipment is
needed for baby care. So there is a LOT of money made in the U.S. from every
birth by a vast nexus of companies. Just the product choices one is forced to
make drives millions of panicked google searches a year (with 'listicle-
focused-SEO-hog-blogs' feeding off of this) -- just to search for the "right"
equipment. Why can't just one company consolidate this -- and offer a one-
stop-solution? Naked Capitalism is on its full-show during the birth process
in America. It is indeed very strange.

Finland has 'baby boxes' delivered by the govt:
[http://www.bbc.com/news/magazine-22751415](http://www.bbc.com/news/magazine-22751415)

Sweden has a govt sponsored program for end-to-end support for new parents:
[https://sweden.se/society/10-things-that-make-sweden-
family-...](https://sweden.se/society/10-things-that-make-sweden-family-
friendly/)

The reason for this comment is that HN has a 'startup' bent to it, so I hope
some entrepreneur just Warby-Parkers (is it a verb?) the baby birth process.
There is definitely room for massive simplification. Make each decision simple
-- that alone is a giant opportunity.

~~~
grkvlt
> Finland has 'baby boxes'

Interestingly, Scotland now has 'baby boxes' too [0] - but not the rest of the
UK, it is an initiative by the devolved Scottish government only it seems.

0\. [https://www.mygov.scot/baby-box/](https://www.mygov.scot/baby-box/)

~~~
stevekemp
I moved from Scotland to Finland, with my Finnish wife, and I admit I cried
when I unpacked our baby-box:

[https://imgur.com/a/I0NYI](https://imgur.com/a/I0NYI)

The box itself is great, but the reason that Finnish mortality rate for babies
fell so sharply after the box was introduced was because to qualify for one
you had to visit a doctor early in your pregnancy.

Having early contact with healthcare, when pregnant, means you're more likely
to do well. The doctors/nurses/midwifes/assistants can frown at you, tell you
to eat your vitamins, stop smoking/drinking, etc.

For what it is worth healthcare is not free in Finland, but we paid about €300
for mother, father, and baby to stay in a private room for 3-5 days. (Just
over a year ago, I can no longer remember that period. I just remember in the
3-5 days I drank a full bottle of whisky, and smoked a cigar in the car-park,
in subzero temperatures. Finland, remember?)

------
burfog
A free-standing birth center, without a financial incentive to divert you into
an associated hospital, could run you $700 out of $3000. (you pay $700,
insurance pays $2300) Some of these places are very nice, feeling far less
like a prison or mental institution than a hospital. I know one where the
laboring mother can open the door to her room, then step out on to a patio
that is separated from the street only by some large bushes. There is no
feeling that the place is ready to lock you in and call social workers over a
bit of dark humor.

A midwife at home would be perhaps $1000 out of $5000. (you pay $1000,
insurance pays $4000) Residents of California may have trouble finding this;
the obstetricians got their competition mostly outlawed.

Doing things by yourself is of course free. I did that with twins and with a
10-pound (4.5 kg) kid.

With all of the above, you are far less likely to be subjected to time
pressures that will lead to drugs and ultimately to major surgery. Surgery is
not just an expense; it is a hazard to both mother and babies because it
impairs the ability to maintain and deliver future pregnancies. Surgery rates
in the USA are improperly high because of how an uneducated jury is thought to
respond; death and injury from surgery ("at least they tried everything")
looks better than death and injury from non-action.

Except for the do-it-yourself option, there is emergency equipment. People
greatly overestimate the chance of having a fast-developing problem, and they
overestimate the ability of a standard hospital to respond effectively. If you
truly need surgery, the time to travel for it can overlap nicely with the time
it takes a hospital to prepare.

~~~
marcell
> Doing things by yourself is of course free. I did that with twins and with a
> 10-pound (4.5 kg) kid.

Do not attempt this at home...

Sure, 95% of the time you'll be fine and have no complications (for mom or
baby), but do you really want to risk it for that 5%?

I suspect this will be one of those trends that seems very appealing until we
get a few headlines of home births gone wrong. Especially dangerous if it is
your first baby, or if you have other risk factors.

~~~
manmal
The idea that at home birth is so much more dangerous is controversial. Look
at this very lengthy review:
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4399594/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4399594/)
(search for death and mortality to find the interesting sections).

~~~
zxcmx
My son had cord wrapped around neck and SO glad I was around people who knew
what they were doing with medical support.

It might be only a few % different but if its your few % you might come to
feel differently in the end.

I suspect homebirth statistics in the west suffer heavily from selection bias
since sensible antenatal care will direct complicated births to hospitals.
They do mention this in the intro to the study you linked - homebirths in
western countries tend to be experienced mothers from advantaged backgrounds
having second or further children.

~~~
manmal
Cord wrapped around the neck is quite common actually, the occurence is about
1 in 3 babies. It’s normally nothing to be concerned about, as blood flow is
not hindered, even if it’s wrapped around twice. This would be no reason to
not give birth at home.

Misconceptions or fears like this make people totally dependent on hospitals,
which is IMO a shame - it hinders making a well informed decision (weigh
actual risks vs benefits).

------
notadoc
Well for starters...

[https://i1.wp.com/investingdoc.com/wp-
content/uploads/2017/0...](https://i1.wp.com/investingdoc.com/wp-
content/uploads/2017/08/admin-jobs.jpg)

~~~
RGamma
What do these administrators do (i.e. what's their value)? Are they like
physicians with a leading/management role?

~~~
jbooth
They apply "MBA 101" to the system, best summarized as "extracting more money
with better care as a distant second".

Was chatting with the doc during our second birth, the admins had just pulled
a bait and switch on the practitioners. Instead of better equipment and
surgery rooms, they were getting a few hundred more beds. Beds are easy to
bill for. Surgery and actual care are way less profitable.

------
jvagner
When my son was born, I paid $5K to a birthing center in Boise, a couple of
blocks from the hospital.

We visited frequently over the 9 months, and each time stayed for about 4-5
days in a birthing room with a hot tub. Also true after my son was born. And
then for a few return visits for checkups. And then for a return visit just to
visit Boise and hang-out and chill with other parents, expecting parents, etc.

$5K, all inclusive. Just like Club Med (been to the one in Cancun... lovely
vacation spot).

I had insurance... if anything would've happened, an ambulance would've picked
us up and taken us to the hospital and then insurance coverage would've kicked
in.

~~~
bashcoder
Yes - I’ve had five kids. The sum total cost was less than the claim in the
title of this article.

~~~
exhilaration
Everyone's experience varies. Our first kid cost [our insurance] $100k - he
spent 18 days in the NICU.

------
hiyer
Is there _any_ medical procedure/medicine for which the US is _not_ the most
expensive nation (or among the most expensive)?

~~~
BaronVonSteuben
Doesn't seem like a very good comparison considering it's "free" in most other
countries.

~~~
randyrand
It'd still be worthwhile to know how much the government pays in costs in
those countries.

~~~
isostatic
The US as a whole pays about 3 times as much per person than most Western
European countries, and over twice as much as the most expenesive ones.

~~~
kthejoker2
What? We don't even pay twice as much as most countries, although our cost
curve is rising.

[https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...](https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita?wprov=sfla1)

~~~
randyrand
Great source. I enjoyed looking at that. Socialized health care is not the
silver bullet in terms of cost reduction. No shock there though...

------
m3kw9
So a hospital can theoretically have everything out of network and the patient
will risk financial ruin just by using hospitals in America.

~~~
koolba
It's well beyond theoretical. The system is total nonsense.

I think a sane first step would be a N-month statute of limitations on bills.
Anything you're going to be billed for should be sent within N-months. I'm not
saying that it _should_ take that long. I'm saying right now there's no limit
whatsoever. You could receive a bill for some itemized sub portion (lab work,
specialist, a different doctor, etc) a year after a hospital visit and you
have no clue what it's for.

~~~
TallGuyShort
And this happened to me. Got a call from a collection agency claiming I owed
them money a year after the birth. I called the hospital and got a written
confirmation that they had no record of an unpaid or even late bill. I called
my insurance and confirmed they had never received a bill for the amount
claimed. Upon getting details from the debt collector (later than required by
law), I saw a doctor's name. So I went to the hospital, and they had no record
of a doctor by that name ever working for them.

The bill turned out to be legitimate, in that the doctor was a "traveling
anesthesiologist" and was never an employee of the hospital. And they billed
separately, and were never given my insurance information. The whole case
ended up relying on my wife's signature on a long legal form that she signed
while she was dilated to an 8. All the contact information (address, phone,
company name) on the documentation led to people who could not confirm any
details on the bill. The hospital told me that they have had a lot of reports
of doctors who do their own billing not sending bills for months because
they're not very organized.

Eventually the anesthesiologist billed it to my insurance correctly and I paid
10% of it. I later found out I could sue the debt collector for not providing
details fast enough, but the statute of limitations on their violation had
expired.

~~~
solidsnack9000
_I later found out I could sue the debt collector for not providing details
fast enough, but the statute of limitations on their violation had expired._

What was the statute of limitations in this case?

~~~
TallGuyShort
1 year. It was also a 1 year limit on when they could collect the bill if it
wasn't billed to my insurance. Not sure if that would've counted, since the
hospital had my insurance and technically I didn't give it directly to the
independent doctor, but the only reason they billed my insurance days before
it hit a year is because I was crazy persistent and proactive about getting to
the bottom of this. Next time I'll let more of the burden of proof remain on
them longer.

This is all under Colorado law, btw.

------
jkingsbery
I'm not arguing it's cheaper to give birth in America, but it doesn't seem
like this article makes fair comparisons. What an insurance company or
hospital charges includes some amount of mark-up, so is more than just the
"cost." Likewise, in countries with socialized medicine, the hospital might
charge the patient nothing, but it _cost_ someone something (people's time,
depreciation on equipment, electricity, and lots of other things). Adjusting
for these probably doesn't make everything come out the same, but it would
make the claims less sensational.

------
bfrog
Healthcare here is a joke. No clear pricing, no clarity on what is or isn't
actually covered, mega bills that get delivered a year late then you then have
to argue over.

The only way to not go bankrupt is to not get sick, ever.

~~~
TheCoelacanth
It's often not even clear who you will be paying much less how much it will
cost.

~~~
freedomben
Isn't this the truth. I had a test done and got bills from _3 different
people_ , at _3 different times_ , separated by a couple of months. Some
submitted to insurance, others didn't.

------
remotedreamer
I agree that our healthcare system is messed up but the insurance company paid
for 95% of her bill. Seems like she got her money's worth from the insurance
company.

~~~
YetAnotherNick
Why don't insurance companies lead the change towards transparent pricing?

~~~
ebragg09
Because their profits are limited as a percentage of revenue (aka "they must
spend x% of their revenue on patient care"), and thus there's a huge incentive
for prices to go up across the board to increase their dollar amounts that
don't have to be spent on patient care.

------
Neil44
When we had our daughter I was annoyed that I ended up paying about £50 for
parking for the week that recovery from the cesarian took. Looking back I
guess that was a bit short sighted!

~~~
GordonS
Hospital parking has been free in Scotland since 2008, so just the cost of
fuel for getting to/from the hospital!

~~~
alkonaut
I thought the NHS reimbursed travel too?

~~~
GordonS
I haven't heard of that. If true, I guess it's only in very particular
situations.

~~~
alkonaut
Checked, and yes, it’s for people on benefits effectively.

------
aidenn0
At the company I work for, our previous insurer doubled our premiums, so we
switched. It went from so-so to terrible.

My daughter cut her hand and needed stitches; I took her to the ER; their
surgeon was booked, so they sent me to a different one. I got a $160k bill for
an "elective surgery."

It took a couple of phone calls to get the point across that stitches for a
hand bleeding through 3 dressings is not elective. 6 months later, the surgeon
still has not gotten paid (I know this because sometimes get copied on the
"request for extra information" that is sent out by the company).

Also I get about 3 letters from the insurance company for every visit that
involves insurance (PT after the hand injury was weekly, so this was a lot). I
asked if I could get those electronically, and apparently my plan doesn't
qualify for paperless...

~~~
GordonS
$160k?! Was this seriously just for stitches? How come an actual surgeon was
doing something as simple as stiching?

~~~
aidenn0
A tendon needed reattaching too; that's why they needed an actual surgeon (and
the ones at the ER were booked).

------
EvanAnderson
My wife ended up w/ an unplanned C section to deliver our daughter in 2013 in
Dayton, Ohio. Both mom and daughter had reasons for two extra days in the
hospital. The bill to my wife's insurance company was just under $60,000 for
her portion. My daughter's portion was out-of-pocket (because she was on my
insurance) and was around $12,000 after the hospital's "cash discount".

A lot of factors contributed to our decision not to have any more children,
but the cost of maternity care, birth, and follow-up medical care figured-in
prominently. My wife was leaving her job after the birth and everyone was
going on my insurance (self-employed, have bought my own insurance since
2004). Had the costs been less I'm not sure we would have opted to have any
more, but it would have changed the calculus.

~~~
briffle
Our insurance had excellent coverage, but I remember being excited when I
payed a bill for my wife, and thought that we were good, since we hit the
$3,000 max out of pocket per person. And then bills started arriving in my
Son's name.. So another $3k..

------
tathougies
It cost us $2000+ for the hospital to help my wife deliver our dead baby. The
shitty part is that it would have been free under our insurance if the baby
were alive. Yay insurance...

~~~
hueving
Wow, that's a terrible emergent cruelty from a complex labyrinth of years of
backroom negotiations. I'm sorry for your loss and that you had to pay for it
like that monetarily as well.

------
fredrikcarno
Regarding sweden

We had premature twins and it cost us zero. The taxes are sky high but I feel
ok that others get ot free also since I got it

~~~
craftyguy
I think there are two sides to this. You paid nothing because you were
subsidized by others. I can definitely see the other point of view from folks
who do not have children and/or do not want children.

Here in the US, I don't particularly want to pay for the masses of folks who
refuse to use contraceptives and are up to 4+ children already. There are
already way too many people here (and on Earth in general). On the other hand,
people should be entitled to free healthcare to a MUCH larger extend than we
currently have here. There's a big difference between having a child and you
catching the flu, breaking a bone, or getting cancer. The environmental and
social impact of having a kid is much larger, and I can see how some folks
don't want to subsidize this.

~~~
factsaresacred
> You paid nothing because you were subsidized by others.

This is the story of civilization. You've been around for a blip and yet the
Internet, flight, mobile phones, vaccines, civil rights, central heating etc.
are all available to you.

You didn't contribute to any of that and yet you're the benefactor. For
society to flourish it's necessary - within reason - to think beyond your own
individual interests, and consider what type of society you want to live in
and leave behind.

One in which people are financially ruined if they fall or give birth is
surely not the best we can do.

~~~
point78
Excellent post. Sums up everything why I agree with this governmental model.
Will save this comment.

------
lamarpye
Interesting, lets look at a link from the article:

<i> Results—In 2010, the U.S. infant mortality rate was 6.1 infant deaths per
1,000 live births, and the United States ranked 26th in infant mortality among
Organisation for Economic Co-operation and Devel­ opment countries. After
excluding births at less than 24 weeks of gestation to ensure international
comparability, the U.S. infant mortality rate was 4.2, still higher than for
most European countries and about twice the rates for Finland, Sweden, and
Denmark. U.S. infant mortality rates for very preterm infants (24–31 weeks of
gestation) compared favorably with most European rates. However, the U.S.
mortality rate for infants at 32–36 weeks was second-highest, and the rate for
infants at 37 weeks of gestation or more was highest, among the countries
studied. About 39% of the United States’ higher infant mortality rate when
compared with that of Sweden was due to a higher percentage of preterm births,
while 47% was due to a higher infant mortality rate at 37 weeks of gestation
or more. If the United States could reduce these two factors to Sweden’s
levels, the U.S. infant mortality rate would fall by 43%, with nearly 7,300
infant deaths averted annually. <i>

How much does treating babies with low-birth weight add to the average cost?

------
lamarpye
For some reason the article didn't mention the cost of malpractice insurance.
I wonder why? My cousin, a doctor in Pennsylvania, said at one point, the
insurance was getting so expensive, it was driving obstetricians from the
state.

------
vadym909
Yup- Wanted to burn off some blackheads and a US skin specialist charged $175
to take off 1 using a Ultrasonic machine, went to Mexico and took off 20 for
$5 using the same machine.

~~~
dopeboy
How did you find & vet the provider in Mexico?

------
Overtonwindow
I've long suspected that a driver of the cost of medical care in America is
the middle-people. Everyone who wants to take a cut, and tack on a fee, and
increase profits. From the drug maker to the bandaid company. There was a
really fascinating article here recently on doctors who only take cash, and I
think it really hits to the idea that we're being taken for a ride from a lot
of these companies, hospitals, insurers, etc.

------
peapicker
I don't recall what the itemized bill was before insurance took care of it,
but with health insurance, each of my kids actual cost to me was $100 out of
pocket. In the US.

I'm sure the quoted price before insurance was probably ridiculous, though.

~~~
jonathankoren
No one knows how much healthcare costs in the United States. Not the insurance
companies. Not the hospitals. Not the doctors. No one. The prices vary widely
across providers, and insurance companies. I was reading a few years ago
(alas, I can't find the link, but I think it was in the LA Times. KQED was
also working on this recently.[1]) where the author tried shopping around and
found where same provider would come up with different itemized breakdowns
depending on the insurer. It came down to the provider and the insurer
negotiated prices. Say the insurer provider agrees that a procedure costs
$1000, but says an x-rays can only cost $500, so the doctor fee is $500.
Another insurer says treatments can cost $800, and x-rays can only cost $!00,
so suddenly the doctor fee is $700. What's the true price of anything?

Under America's about the only thing you can tell is that total costs are much
higher than the rest of the world, and outcomes are actually slightly worse
than the rest of the OECD countries.[0]

[0] [http://beta.latimes.com/nation/la-na-healthcare-
comparison-2...](http://beta.latimes.com/nation/la-na-healthcare-
comparison-20170715-htmlstory.html)

[1] [https://www.npr.org/sections/health-
shots/2014/11/17/3647197...](https://www.npr.org/sections/health-
shots/2014/11/17/364719763/in-california-that-mri-will-cost-you-255-or-6-221)

~~~
freedomben
It shocks me that this isn't criminal. I can't think of any other good/service
where we accept this sort of thing. It also really exposes the extreme
arbitrary nature of healthcare pricing.

~~~
jonathankoren
The thing is, you could figure out how much an x-ray costs. You just have
amortize the cost of the machine, consumables, technicians, and radiologists
over the number of images taken. The data is sitting there at every hospital,
just spread out across departments. The thing is, gathering that data and
calculating these numbers requires a nontrivial amount of effort, and if all
you care about is if your bottom is going up or down, then what’s the point?

------
nvahalik
It doesn't. We paid <$4K when my daughter was born for a midwife.

The hospital wanted $5K before even seeing my wife _just to schedule an
appointment_. All because she is "advanced maternal age" (whatever that
means).

~~~
1123581321
It means she would be at least 35 when delivering, but I agree; 5k upfront
isn’t justified by that.

~~~
nvahalik
Well I get the age bit but haven’t been told why exactly things are different.
Especially if this is not your first child.

~~~
giarc
Increasing age increases complications.

Old papers, but just the first that came up during a google scholar search.

[http://www.nejm.org/doi/full/10.1056/NEJM199510123331501#t=a...](http://www.nejm.org/doi/full/10.1056/NEJM199510123331501#t=article)

[https://academic.oup.com/humrep/article/17/6/1649/2919231](https://academic.oup.com/humrep/article/17/6/1649/2919231)

------
sercand
I had seen
[https://www.reddit.com/r/dataisbeautiful/comments/7ra3w4/the...](https://www.reddit.com/r/dataisbeautiful/comments/7ra3w4/the_cost_of_our_babys_birth_csection_in_the_us_oc/)
this on reddit a couple of days ago. Guy calculated the all the cost.

------
gaius
Having a baby _should_ be expensive. There are nearly 8Bn people in the world;
"making more people" is not a problem that the human race has. The problems we
do have with pollution, climate change, resource depletion, extinction of
other species, food and water supplies are entirely caused by there being too
many of us competing for too little of _everything else_. This is especially
the case in the US where individuals are extremely high-impact on the
environment in terms of natural resources consumed and pollution generated.
Those externalities have a real cost attached, that isn't reflected in the
current price, which would be much much higher if parents had to pay their
child's say CO2 impact up front.

~~~
dictum
> Having a baby should be expensive (...) This is especially the case in the
> US where individuals are extremely high-impact on the environment in terms
> of natural resources consumed and pollution generated.

So those who benefit the most from resource depletion (i.e. those who can
afford the hypothetical Baby Tax) would be free to have as many babies as they
want, while the poor, already impeded in most activities and burdened by the
cost of livinng, would make a sacrifice.

Sorry if my reading is too harsh.

~~~
2ion
> So those who benefit the most from resource depletion (i.e. those who can
> afford the hypothetical Baby Tax) would be free to have as many babies as
> they want, while the poor, already impeded in most activities and burdened
> by the cost of livinng, would make a sacrifice.

Yes. Because those population strata, not only in the US but across the world,
produce the bulk of population with no education, high ecological impact, and
scarred by social depravation. It doesn't advance humanity toward an 22nd
century-appropriate standard of living to raise a vast population of people
who are to become even more utterly worthless in the face of automation and
extreme competition even among the elite of the 1st world.

It is beyond me how humanists can support unlimited population growth/"self
expression of the individual/right to give birth" when that populuation growth
is going to drive countries and continents toward a demographic and social
catastrophe. Then again, my personal opinion is we are already on track and
about to arrive there on schedule, so what gives.

~~~
thriftwy
You're barking at a wrong tree here. Absolute absolute majority of children in
poverty and without access to education are born outside the USA. You solve
nothing other than being explicitly mean to (I assume) your compatriots. See
if it gets you anywhere in the long run.

Let me repeat it for you: you've got two arguments and they're in major
conflict. You can't use both and neither one holds water sole.

~~~
2ion
> Absolute absolute majority of children in poverty and without access to
> education are born outside the USA.

That's a fact. Just that doesn't mean that the USA would do better now or in
the future with more poor people giving birth to more disadvantaged children
inside its own borders. Also, I wasn't explicitly limiting my argument to the
United States on purpose.

> You solve nothing other than being explicitly mean to (I assume) your
> compatriots.

[I'm not American.] All I'm advocating is a realistic and pragmatic approach
to demographic management. The goal should be to ameliorate life for any given
compatriot in the long run. Though of course in the long run, the population
of the present will be dead.

~~~
thriftwy
> with more poor people giving birth to more disadvantaged children

Maybe they wouldn't be poor if not for excessive charges in some areas? How is
that for an idea?

Many people who are considered "poor" in the USA, would be considered "totally
ok, just in slightly disadvantaged line of work" in less polarizing locales.
That after a safety net that won't put $10k worth of charges on you after
hospital visit.

There are poor and marginal, who should probably be incentivized to avoid
children - and then there's working poor, who should have their condition
fixed. That's all.

------
pwaai
It boggles my mind, that a country with the most billionaires still has not
addressed gun laws and universal healthcare.

~~~
refurb
Sure the US has addressed gun laws. It has maintained that firearm ownership
is an individual right and the laws reflect that.

~~~
pwaai
I see you ran with a different notion of what I meant by "addressed".

I'm certain victims of mass shootings will beg to differ. Individuals also
have a right to not be deceased or live in fear of mass shooters whom you are
right, has been addressed with individual right to carry.

Having laws that favor one side heavily is not a standard for 'addressed'.
Take a look at Australia, that is proper 'addressing' the issue.

~~~
refurb
My reply is your position on what "addressed" means is no more correct than
mine.

------
boubiyeah
Living in France, these comments are all so sad :(

------
HenryBemis
In a negative connotation: because insurance companies and hospital owners are
taking you for a ride and politicians sit back, sipping their whiskeys and
enjoy their lobbying. And if anyone DARES to make such comparisons to Sweden
or Finland, some republican will start yelling "down with socialism!!!". One
day USA's citizens will "have enough of this" and perhaps do something about
this, but this day is anything but close.

~~~
plehoux
Quebec, Canada == free + 1 year maternity leave at 75% of your salary + a lot
$$ by both Quebec province and federal governments.

~~~
koolba
Who pays the 75% salary when you're not working? Does it come from the company
you were employed at, the government, or some combo?

~~~
LeifCarrotson
You do, through taxes, but would you rather pay lower taxes for fewer benefits
and more aircraft carriers in the US, or more taxes for huge benefits like
maternity leave and education?

~~~
koolba
Speaking selfishly, I can’t get pregnant and primary education is primarily
funded by local property taxes so I’m for the lower overall taxes.

~~~
toomuchtodo
That’s the crux of the problem. If you speak selfishly without looking at the
big picture, you can’t make a rational decision at scale.

~~~
koolba
The decisions are still rational, we're just optimizing a different variable.
In my view the majority of the money I give the government gets squandered and
I have no realistic expectation of getting back anything close to what I've
contributed to social security.

By that standard if someone suggests raising taxes further to increase the
amount of money in the equation I'd be firmly against it. The problem with our
government is that it doesn't collect enough taxes, it's that it doesn't spend
the money it collects wisely.

We're getting off topic from the original article though. If this was a
conversation about something like a single payer system it'd be apt (and I'd
be for it as well!) but (chronically underfunded) pensions are an entirely
separate topic.

~~~
rektide
I'd think most people would realize that having a society raised by loving,
caring, well-adapted parents would pay off in the long run. I certainly think
it would be in my best interest to have my future fellow peers raised well.

Now, maybe you REALLY want to stare into the void and declare that the
decisions made now won't affect your life, won't change your peers. I guess
that's your right, but that's not how my societal calculus functions. To me,
this is a bargain for maintaining an upright, well functioning, positive
society.

~~~
koolba
So why stop at 75% for maternity leave? Why not 100%? Or even 200% of your
original salary? It’s for families and kids right? Why not double subsidize
it?

You claim it’s a bargain. At what tax rate is it a bargain? 5% increased tax
rate? 10%? 25%? 50%?

Specifics matter. Make your case with an actual proposal. Claiming I’m
heartless because I don’t want others to spend my money is hardly an argument.

------
ajsharp
Capitalism.

~~~
jstanley
This isn't capitalism. If it was capitalism, somebody would come along and
offer to let you give birth in their buildings for less than $32k.

I'm not sure what _is_ going on here, but it isn't capitalism.

~~~
FussyZeus
It's Capitalism applied to something that doesn't have a market, shouldn't
have a market, and who's participants are unable to properly participate in it
in any way that resembles a market.

~~~
gohbgl
The health sector is one of the most regulated sectors in the US. It has
nothing to do with free market capitalism.

~~~
FussyZeus
And yet for profit entities proliferate it at every level, and the constant
drumbeat of people against nationalization is for people to be "smart"
consumers of healthcare, as if you can make an informed market-based decision
about which provider to use while in the back of a damn ambulance.

------
dsl
I wonder if Medicaid dropping coverage for births would increase the overall
acceptance of contraceptive use among the poor.

~~~
dang
Flamebait is not welcome here; please don't post it.

------
vasilipupkin
this trope about how much things cost in the US vs other countries never dies.
Things are not free in Spain, they are paid for by heavy taxation, which then
results in a massive unemployment rate of 17% AND a lower birth rate than US.

~~~
alkonaut
So cherrypick any other country with a working universal healthcare system and
lower unemployment rate. You can almost pick any tax rate too, and there’s a
country with that.

~~~
vasilipupkin
So, why don't you do if then? Which country has lower unemployment rate and
higher birth rate than US where taxation is low ? Can you name one ? I love
the downvotes. I make a factual statement that Spain, which is referenced in
the article, has higher tax burden, a 17% unemployment rate and a lower birth
rate than US and they freak out.

~~~
alkonaut
Almost all other modern democracies (e.g OECD) have universal healthcare.
Almost all have lower unemployment rates than Spain (if not all).

Taxation _varies_. Was my point. Those that have the healthcare as a public
insurance on the side of taxes can have low taxes. Those with tax funded
single payer obviously have higher taxes.

My example of choice of low-ish taxes, high birth rate and universal
healthcare would be Ireland. There are others.

~~~
vasilipupkin
You are missing the point. Yes, countries have lots of benefits, what I am
having issue with is the claim those benefits are cheaper. No, they are paid
for in different ways.

There aren't any others. US has a lower tax burden than almost all OECD
countries except for Ireland.

[http://www.taxpolicycenter.org/briefing-book/how-do-us-
taxes...](http://www.taxpolicycenter.org/briefing-book/how-do-us-taxes-
compare-internationally)

Technically, Ireland fails my test because it has a higher unemployment rate
than US. Safe to say, Ireland is an exception due to being probably most
catholic country in the western world, which keeps birth rate high

My specific test is, find me a developed country with lower unemployment rate,
lower taxes and higher birth rate than US. There isn't one. And that's how
those benefits are paid for

~~~
alkonaut
Whether single payer or other universal systems are “cheaper” is one question.
The US system isn’t the only way of having a private system, and there are
reasons for it being expensive other than it being market based (monopolies,
legal reasons etc). While it’s hard to say _why_ US healthcare is more
expensive, it’s at least pretty easy to say that other systems aren’t like the
US, and are cheaper. They are paid for in different ways (e.g taxes,
fees,...), correct. And those costs are lower. Naturally countries with tax
funded healthcare have higher taxes. An apples-to-apples comparison is of
course between tax+healthcare in both countries.

Third: unemployment rate. This is also locally dependent on what full
employment is, which depends on, for example, unemployment benefits etc. 6%
unemployment in Sweden is pretty good, but would be terrible in the US. So
percentages are _not_ directly comparable. (For example 6% in Ireland is
comparably lower unemployment than the current 4% in the US in a fair
comparison as Ireland’s full employment rate is 5% - They are at full+1%)

As such, finding countries which have lower taxes despite including healthcare
and lower unemployment despite perhaps having 80% unemployment benefits isn’t
just impossible it’s a pretty useless comparison to begin with.

To make a fair comparison you have to correct for local factors: taxes
excluding healthcare, and unemployment as difference from full employment (to
begin with).

~~~
vasilipupkin
it's not a useless comparison. In aggregate, US has one of the lowest tax
burdens in OECD. So, in countries where you have lots of benefits, those
benefits are paid for with higher taxes !!! so, to say, that in aggregate
those benefits cost less is simply inaccurate. You have to correctly account
for the costs.

~~~
alkonaut
Yes. And healthcare costs are lower in nearly every way you measure:
individual procedures, cost per individual per year etc. That Americans (and
their employers) pay more than others pay for healthcare through taxes isn’t
just widely known it’s also by a pretty wide margin. So yes benefits are paid
for by taxes. And the question is: does that make it cheaper?

~~~
vasilipupkin
cost per individual per year is lower in other OECD countries because its
subsidized through heavy taxation. So, it's not really lower, it's just
shifted into a different bucket for accounting purposes. But it didn't go
anywhere - that's the point. You can see it easily by the fact that taxation
as % of GDP is much higher than in the US. Where does that extra money go?
Subsidizing healthcare and other benefits

~~~
alkonaut
No. That’s _not_ what I’m talking about. If you think _thats_ what people mean
when they say “healthcare is cheaper in countries with single payer” then no
wonder you don’t seem to find it attractive.

The cost of providing healthcare (total) is lower in all those countries. That
is, a country might use $10k per individual per year for healthcare, financed
by taxes. Meanwhile the average for a US individual (paid with insurance) is
twice that (those numbers were made up but you get the point).

As you are saying, there is nothing magic about this. Having a _single_
insurance pool and putting the premium on the tax bill doesn’t change much -
it’s just accounting. And obviously it will make taxes look higher. But if you
pay $1000 per month in taxes and $1000 to healthcare, or $2000 in taxes, it’s
just the same thing with a different name.

The difference is this: you could pay $1500 in taxes (with healthcare costing
500 when single payer instead of 1000 via private insurance) And _then_ it’s a
very real difference. Again, numbers made up for illustrative purposes. A new
US system would likely look like Canadas, so should have similar costs.

Oh - a fun fact: the US spends more _public_ money on healthcare than some
OECD countries with universal healthcare (e.g Sweden)!
[http://www.visualcapitalist.com/u-s-spends-public-money-
heal...](http://www.visualcapitalist.com/u-s-spends-public-money-healthcare-
sweden-canada/)

~~~
vasilipupkin
No, you don't understand. The actual, economic cost of providing healthcare in
those countries isn't lower. It looks lower from accounting point of view
because of various hidden subsidies. How do we know this? It's very simple -
they have to have a significantly higher overall burden of taxation. Where
does that money go ?

~~~
alkonaut
I don’t know why I’m arguing in circles here.

In many of those countries the healthcare is _completely_ tax funded. You
don’t have to ask people what they pay for healthcare, it’s known from the tax
budget.

So these aren’t somehow made up numbers. We know exactly how much money the
Swedish government uses to provide healthcare for each Swede. It’s ALL tax
money.

So we can compare that number to what an average American pays for healthcare.
And when doing that we have a fair comparison of the cost of healthcare.

Tax burden etc does NOT change this comparison. It’s exactly what this
comparison IS. One persons TAXES vs another persons insurance policy + out of
pocket expenses for healthcare.

Please don’t reply now with “but taxes are higher so it just looks cheaper!” -
if it didn’t sink in now there is nothing more I can do to explain it.

[https://data.oecd.org/healthres/health-
spending.htm](https://data.oecd.org/healthres/health-spending.htm)

~~~
vasilipupkin
You still don't understand. The total level of benefits and taxation is
relevant. Healthcare doesn't exist in isolation. For example, you can pay
doctors a lot less because they go to medical school for free and don't have
malpractice insurance at the same level and also because their retirement is
taken care of by the state. You can pay hospital administrators less and on
and on. This lowers the accounting cost of healthcare - but not economic cost.
Somebody paid taxes to send that doctor to medical school for free

This high overall taxation enables subsidies which are then used to make it
look like healthcare costs, when looked at in isolation, appear lower.

Empirically, we can see this: very few developed ountries are able to provide
lower healthcare costs than US while also having a lower overall taxation
burden.

~~~
alkonaut
Oh. You are thinking of _secondary_ effects of high-tax societies, such as
flatter wage structures influencing (production) costs of healthcare. Yes - I
absolutely agree that is a factor, and I genuinely believe that if the US
wants to see the _full_ economic benefits of single payer they must _also_
make higher education cheaper, reform the malpractice legal frameworks, and so
on. The fact that I tax-pay my doctors MD likely makes less of my tax money go
to healthcare. Agree.

The UK does have a good single payer system and not (entirely) free higher
education, so they naturally have more wage inequality (for other reasons as
well including much weaker labor unions and labor laws) and should be a better
comparison than e.g Scandinavian countries which has flat wages and tax-funded
everything. Canada seems similar (tuition there seems to be around 50%
subsidized?)

