> 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.

The healthcare market. MARKET

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

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.

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

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.

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.

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.

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.

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.

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'.

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).

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.

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

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).

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.

At least, that is what they did to me.

It's all a scam.

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)

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.

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).

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.

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.

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.

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

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.

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.

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.

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