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Nobody has babies anymore (except Sarah)


Sarah and Matt talk about America’s rapidly falling birthrate, and a study on the long-term benefit of the 1980s Medicaid expansion. References and further reading: National Center for Health Statistics report on declining birth rates Vox's Julia Belluz's piece on the low birthrate trend NPR piece on the CDC report on declining fertility rates in the U.S. Sarah's piece on why teen births are declining Lyman Stone paper Sarah mentioned arguing that government interventions don't boost fertility NY Times piece Matt referenced on American women having fewer children then they'd like Dylan Matthew's piece explaining the child allowance plan The white paper on Medicaid coverage and economic mobility Converge with Casey Newton is a new conversational game show from The Verge. Listen to the first episode today, and subscribe wherever you're enjoying this podcast.

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This is an unofficial transcript meant for reference. Accuracy is not guaranteed.
Three Prager welcome to another so that the weeds on the box media access networks are mathematically CS outward joined today by Sarah close at an empty chair. Deborah has just announced earlier to Australia. She may be on an airplane, as we speak, lavishes listening to the way, I think it's very far away. Austria, quite fire, told to New Zealand and its real fire yeah. Do you there's a pack ass? Another? I wouldn't want to invite us to do. I'm alive shown Australia. I think we would definitely get some kangaroos about as Ruby grumpy about it may have rapidly. But ego guess: ok- that within an hour, is an invitation to what we really want to talk about israeli weeds, eager research paper about Medicaid, one of my favorite things
We're here really to talk about babies wearing to talk about babies, as I am prepare to leave the weeds her view month? Do a baby and me having a baby. It turns out that other people are not making the same decision. So we wanted How about this federal report so against trend? I'm doing what I can to keep up the fertility rate? How because we are seeing that it is declining back and twenty fifteen when it was when people started here, while you now, if you're, moreover, baby having hips hipsters sort of thing. So any would you want to talk about this report that came out last week from the National Centre for health statistics that show is that once again, the fertility rate and the United States is declining and talk a little bit about why that happening? Should we be concerned that is happening in kind of thing through what this means so first, I want to start off by kind of grounding since some of the numbers this that came out last week. It shows that the fertility
in the United States it fell to a record low for a second street year. Kind of extending out the trend we ve, seen since the great recession of declining worse than the United States SAM since two thousand, eight or so so activity rate and the United States. It fell to sixty point to births per one thousand women of childbearing age, which is down three percent from twenty sixteen and they also noticed the largest single year decline since twenty ten, when you know the economy was still quite weak and One other way to frame this to go out a little bit longer is that in twenty seventeen women had nearly five hundred thousand feet we're babies than in two thousand seven. Despite the fact there were seven percent more women in prime childbearing years, which are defined as twenty to thirty nine we are definitely seeing this decline. It is happening over about a debt. Aid or so that we ve seen the steady year after year decline and were now entering this
second of hitting a thirty year allow in fertility rates in the United States. One things I think it's important to know is that this does not look uniform across the population. You are seeing declines, infertility it's for women in their twenties and thirties you're actually an increase in fertility rates for women over forty suggesting more women having later using a massive decline in team. Birthrates team birthrates went downstairs ten percent just between twenty sixteen and twenty seventeen, which is a real. These significant decline for one year. If you go all the way back to two thousand. Seven teen births are down fifty five percent, so they essentially fallen and half for over a decade which is just a sea change to see in a public health trend. In one decade think that some important framing contacts that we are seeing fertility rates go down but
where they're going down and in a four who they're going down is not Constance by any means anything. Another important just piece of sir framing information for for this discussion. as it can. It can sometimes go a low off the rails, and people start thinking again we're talking bout like crazy, like handmaids tail type type ideas are or bad things is that have a pretty good. You know survey based research that general social survey. They ask women how many children they would like to have and their number has fallen. It fell a lot in the sixties and seventy is but since thanking eighty- or so it's around two point: five children per woman. It it's gonna little bit below that its in in some of the past years. It's kind of a bit above that in in recent years, and so that sort of important.
Context here that the fall in the number of of babies that people are having has not been accompanied by a drop in the number of babies. The people say that they would like to have wait. It seems to be the case that we ve gotten a lot better at avoiding like unplanned pregnancies in the ten years that we ve also had a trend. You know related to economics, education. Things like that two people delaying childbirth. Out of their twenties morceau, and then we ve had some technological and medically driven success in making it possible for more people to have babies in their forties when they want to, but there
You know some biological and other limits, tat sort of how far that's gone, and so this sort of fertility gap has opened a pride in which were getting we're getting better at people not having kids younger than they want to at a faster rate than we're getting better at helping older people who would like to have children do it, and then there is a question of economics and sort of feasibility life circumstances, but for for whatever reason why people are not it's not that way, point. Eight children per woman per SE is a social crisis, exactly I mean there will be some dispute about it, but people say they want to have on average, two to three kids that would be and above a replacement rate, fertility would be in line with historical transit would be high. Parenthood developed world norms banana high in historical sense at all, but does not actually coming together for people
I think I think, is reasonable to consider that a significant social problem on a par with all kinds of other things that we talk about on the weeds, family, life and childs, as it is very important to people and its is actually kind of sad- were not able to four people to have the kind of families that they would like to have as well as economic issues about you know, potential population decline as it is on these targets are how much does it think you felt through these issues more than I have how much to worry about like Setting aside and like excepting, you know what you're saying that this is something that is important for people to have the film is they want? How do you think about the economic effects of childbearing, which has got us more towards like handmaids and reproduction? I'm not saying we're going down the path by any means, but like how do you think about look from an economic point of view for the future of the United States? Like does this report? We're talking about worry you. I think that people should take this
seriously. I couldn't think there's like a left and right version of not taking this issue seriously and on the left version. I think that there is some willful blindness about like America's role in the world and related issues too, that if you look at you know Japan, they have had very rapidly aging population now shrinking population. For some time there are some difficult social challenges. That with that, you can find endless number of stories about lonely, old people and, and things like that, there are also some upsides. I mean Japan, for a variety of reasons, has a much better, attentive housing, affordability, trajectory than the United States. Obviously, if your population is shrinking rather than growing it's easier to like accommodated everyone. Space wise at the same time in Japan, postwar were too has been this kind of like modest country in the world you now can. I keep,
who itself claims do not have a military things like that. I think that Americans, you know this is a reason why make Amerika great again, like makes sense to people as headline. We are these sort of flagship carrier for a set of liberal and democratic ideals in the world we have traditionally for early. For a long time, we ve been like a really big country, that, like cats, who big presence on the international stage and like I dont, think we want to sort of quietly age. This issue the fact that
All of the western democracies are experiencing the same trends right and in some cases like much much lower red, Spain and ITALY are down to about one child per woman, Germany, as is also very low at about one point, five other they are in an upward trajectory. France is now a little bit of the United States. I dont think that we want like to say that the end stage of liberal democracy and market capitalism is that society is like this will just die off right and that, like the future- Humanity is gonna, belong to a small number of eccentric fanatical religious sects. Now, but you don't mean, because I can't do that to me- is actually the real handmaids tail scenario where it is not that, like democracies, become fertility conscious and think about family policy is that we pretend not to see what's going on
and then like only like we're colts right, which are like keep women barefoot pregnant and having nine children that becomes. The entire future of the human race seems like not that appealing to me and then that the right is like I do think we should take seriously the economics of this issue right that, like as time goes on, people need more education to have like a basic middle class life so that delays the point at which you can realistically like responsibly, have children. It also raises the cost of having a child, because you need bear that as a parent right, then we have technological improvements. We have rising wages which we want to have rising wages, but, like the internet, does not make it possible for child care providers to be more efficient in taking care of infants.
Right and then you have the same thing for new parents widely. Just like an inherently labour intensive occupation like you have to spend time with the children, you have to pay other people to take care of them and it gets worse over time and you can get sort of grumpy and free market. He about it and be like well. You know like to have the kids, unless you can afford them right, but like the relative cost of like watching a movie how money or couch has plummeted over the past fifty years like this so much, and that means it's like that in more more expensive to have children and like if we want our society to persist in the long run like we need to take that seriously like for the exact same reason that, like you know, we have aircraft carriers and roads and police officers like we need to do something to make it viable for people to live
have families. Yet I think I'm you know that tone of a lot of the coverage I've seen around this report that came out last week is very worrying. About what does this mean and why aren people having children? Unlike what sort of policy these are holding them back and we'll get to that in a little bit Riddick wanna things a decent lose that map touched on a little better. I do want to into a little bit Some of this is is probably very, very good news, particularly a lot of them. sing- a priest. Steep decline and unintended pregnancies for women who are not ready to become parents, and that's really this story, of teen pregnancies. I think it's really important to keep in mind that were saying over all three percent decline in the fertility rate. But then, when you go down to team births, it goes up to a seven percent decline that using a much deeper trend end. You know, I think I e, when you look at these different segment of the puppy,
they send. You have different stories about. You knew women in their thirties. You are not having children and maybe, in the case, that maps out of having this gap between the desired number children they want to have an actual number of children they want to have. But then, when you look at the decline in teen birth, I mean that's just an undeniably really really good trend for the economic viability of those teens for the ability of them to go to school to give a complete a college degree to get jobs to be self support. Ed. So a lot of intergenerational facts that start happenings. I wanna things are things in this chamber. The client- then happenings in Saint in any one. There are fewer kids born, detain, moms at this point, and that's one of the big risk factors for becoming a team parent yourself is being born to attain parent, so you're saying this kind of in a snowball effect over the past, nearly thirty years or so at this point from when we had a high in the team, birth rate and the name in nineteen anyone
so some of this is good, and some of this is due to policies that seem to be working one of the big things that seems to be driving down the teen birth rate and probably driving down the birthrate. You know among all segment say: you're allege segments of the population is access to better contraceptives. You see like a huge uptake among teens, using implants control which are long, acting and irreversible put it in your arm for like three and they last for three five years, do don't think about it like a unlike a birth control. Tell that you have to remember to take every day, which you know an adult and especially for a teenager, can be quite challenging. So as you know, some good news and some public health success in this particular our study- and I think it omitted, certainly does get tricky to think through like Guinea, who were things you want to celebrate here. Unlike what are the things we want to be about. There's no point like when you turn twenty were thick
That is when the government defines the beginning of your prime age childbearing years. I dont think when I was twenty, I was ready to have a child there's like no line or we say. Oh those are the birth. We don't want and those are the births better. going to people who are going to be ready to parents and going to be responsible it's a little tricky figuring out kind of like, whereas this good, whereas this bad, but I think tat. they're, like one area, you can look at and say that
like I'm very Kate. What, if I'm ok with the fertility of teenagers, I would say actually the trend regiment if you wanna get like specific about what happened. When I saw a lot of reaction to this on social media, that was like. Oh my god, you know. Journalists like, I can't believe you're, not writing about how America needs paid family, we event and subsidies preschool. But if you should see what accounts for the fact that fewer children were born in twenty. Seventy in that in twenty fourteen right, it's not that America used to have generous paid leave policies. It's pretty clearly that the use of effective contraceptives has gone up
right and so like. That is in its an unadorned good thing right it just like, but we haven't seen we ve seen a little bit of an off said, encounter trend which is like better medical interventions, have allowed more women in their forty to have children, which has been just like a challenging thing to to achieve historically, but one would like to see like another offsetting trend right wing which, like it, is easier for people who want to have children and who biologically are well position to have children to also be
Social policy and economics. Wise well positioned have children, and we have not seen the red fertility declined during the recession, which is almost always happens because people gettin straightened financial situations, but as the economy has improved, there hasn't been some like big bounced back and it's hard to say that, like because our child and family policy has an improved because it was just as bad fifteen years but like it is striking, and I think it is undeniable that, like without the fertility cushion of unplanned team pregnancy is, we are now falling below replacement rates, which is like a reason to think seriously about like. Can we create an environment in which it is we listing for people to have sex?
third children. You know who like they want to have and who surveys indicate that, like many american women but like to have three or four children of the very few actually do, and I think it is clear that the cost is an important factor in Yes, it's doctors- and this is the weeds, like some of the like policy situation like you. If you decide, this is a problem and like I think we ve got to the point where, if you like, this is a serious issue, like what are the sorts of policy. Is one implements to deal with this and I do you know- I've been thinking through, especially as I come personally face to face with the cost of child care. in America, which is turns out quite high? That people are people are right when they have said that you know what can I do see it? I think I saw a lot of this about uniting as guardian article title like it's. No wonder the! U S, fertility rate is going down like where we have a garbage. Family policy is here Don't you think you know it's an important point? The EU?
mad. That childcare is one of those industries similar to health care, where you don't see, it getting cheaper overtime that because it is so human intensive that the comparative costs of spending on child care. You know until we have light robot nannies or something like that, just getting higher higher compared to the other things those same dollars could by you in terms of technology or cars or whatever others things at the same time. You know look at data of the falling birth rates in other Rita western european countries that have much stronger social safety nets like places like Norway, you know it's all there you're saying the places where they have a full year of paid leave. in subsidized childcare, are showing indifferent trend to us and it gives a. It seems to me, and I read it- there is a really nice piece open and shone out by Am Lyman Stone where he really made a pretty effective argument. I thought about policies.
to encourage childbearing. They just don't actually seem to be that effective, You can create a lot of economic incentives, but a lot of that kind of like comes down to do you want to you're, not which has to do some one of economics because way way beyond those? So I think this is an interesting framing question right about what's feasible and why is it twice because I, whether peace is super interesting? He said like he. He looked at a bunch of policy ideas and people out there, and he compared them, because various european countries have different things in pretty good research on how response if people are to these things
and he said nothing that american liberals have proposed- would get american fertility rates back up to replacement rates. The thing that comes closest was a child allowance plan that Timothy's meeting and some other people in where she was constant, came up with and that plane would would get you very close. According to most researcher, possibly above replacement wait fertility. That happens. We complain that I've looked at before because another that that plan would do is cut America's child poverty rate in half. So here you might think. Ok, here's a policy idea. It will accomplish two things: one is: it will make America's demographic sustainable over the long term and the other is that a cartel poverty in house, and you might think that, since I got really good policy Matt like we should really do that, but
a lie, mental, a lotta peoples or dismiss it- is like well, that's like pie in the sky right in no democratic party. Politicians have taken it up and you might ask yourself it's like how much does is unrealistic policy cost right. That will cut child poverty in half and make America's demographic, sustainable means is excessive. Save it so expensive that it is almost though not entirely as expensive as the trumpet tax cuts not as expensive as the Trump tax cuts and also the term tax cuts, have a lot of budget gimmicks in them. So, like the real cost of the term, tax cuts is higher than that from tax cuts and cost of a stabilizing american demographics and be cutting child poverty in half is little bit less than that. So It seems to me that, like this, like dump This is what we should improve family policy. Smart take is like actually liberals, like your ideas, aren't big enough to address this problem, but like Galaxy brain
is like never really like. We should approve family policy right that like if we took the long term existence of Americans society as seriously as we take the problem of corporations with like attacks got, so they can increase their dividends tell me more about this plagues I've not familiar with this plan. Is this plan actually so general meeting it's basically thirty six hundred dollars a year of child benefit per child to every family in America said like the government by two big tack. for having kid, this is designed by the De Madison people as a eighty poverty programme, and so it it has a lot of anti poverty. Efficacy would mean based play that you're, normal single parent with one or two kids, and some earnings won't get themselves out of the poverty threshold along with the other, such sports and
and its design, though, to be universal in this case in order to make it not stigmatized and well fairy by d like it would be like social security. This is what you get for, being apparent, but but stone calculates based on the experience of of some different european countries that, like that, is enough money to generate you know an extra half, a child or so out of typical people, and that's important, like that's. A healthy chunk of change, see now, and I think it's worth thinking about universe, was in that regard, not just as a political gimmick right because you get into a sort of dilemma as a progressive of you well we have an acute social problems and we should have a targeted solution and then like well. Targeted solution might not be populaires, let's make a universal but then like. Oh, the universal solutions are really expensive, so maybe, let's make it shitty
and you're sort of spinning around in circles. But if we think no, ok, we don't have a targeted problem. We have actually general problem like the general problem. Is that having in raising children is expensive? and the like, that's the reason why we have a universal solution. Then it doesn't look that expensive, I'd because the question is is like or we wasting billions of dollars on an uncharted anti poverty intervention just for the sake of a political talking point or are we know? Are we like spending all this money, because it is an important problem because nobody says right like when conservatives talk about the Trump tax that you know they might hungry budget. Is it too much is too little, but nobody says, like oh, it's poorly targeted like its expense.
Because its universal, its universal, because they think, like the general problem, is everybody's taxes are too high, so they make everybody's taxes lower, which is a lot of money. But it's like a serious problem and if you think look almost everyone in America struggles to an extent with the expense burden of children, because this is what Craig right is like. If you- we'll get something like a Hillary Clinton Childcare Plan, which is was based on a sort of normal liberal targeting and mean setting programme Jonathan, you look like a mad Iglesias or Sarah Cliff and you'll like while objectively like these are reasonably affluent people like they could afford the kind of child care that we are thinking of providing to low income people without special assistance. So, like me, you get nothing grape. So fine, but then you ask anyone like an apple. A middle class person and you're like oh, is having a child expensive and they will tell you yes right
not like. No, I have a good job, so it's no problem right, like is still a big burden and like, if you want as normalized human behavior like married couples who enjoy kids to like have a couple. Then you know you that's a case for universal programme yet interested when I think of like what would be the political, call listen that would get behind this, because I do see from the liberals. I think I could see them going very much behind the anti poverty side of this right, an idea that we need to keep kids out of poverty like this, the good safety net and, like you said that that is how the is formulated at the same time it it seems a good hard for me to envision democratic. Like this our plan to get people to have more kids either could certainly see it framed you want if you choose to like have a child, that we want this to be a good place, that the United States to be a good place for you to make that decision, and we want to have paid leave for both parents.
It's because you know that's the thing we should do to accommodate people. I guess I get Making. That argument like this is a policy that we want to encourage people to have kids like almost feels that goods be something that would come from the from right away like piano in arguing that this that links ITALY's stating like that is the value behind a policy like this. Why, and even even if you're talking about the exact same policy. Like a weird coalition that goes on there, Don't think it's exactly that you want to encourage people to have kid. I guess liberal, that's how I wish is it. You want to take seriously the role of parents in I am you want to say that having in raising children is not the same as collecting classic automobiles or viz during every parent sanctuary in the world right,
you don't does. I know a lot of things that, like a economically secure couple, might choose to do with their money, and the american policy right now basically treats children for the poor. as like a denominator issue, we let you get poorer. The more mouser ardor feed, though we give you not poor, having children, is treated as a discretionary, personal expense. Right like you might want to go on vacation more or you might want to have a second child and like we're indifferent right, and I think there is a good case to be said, it's other. We need to like encourage you to have unwanted children, because that would be ridiculous, but to say a that like just as we have policies to facilitate retirement savings and policies to facilitate the acquisition of higher education, that, like really know, we always policies, because we think it makes sense for people like. I think it's worth semantic like we're. Training, courage,
pull to save for retirement. We make all these policies that make like more financially beneficial to to make that decision, and I mean it is demanding, but like that's where we're talking about words, unanimity and like I just. I think that it is just like look like we have public schools spray, like. We already are like largely on the idea that, like peril, should have their exotic lifestyles somewhat subsidized at public expense, because the work of parenting is vital to the continued existence of our society, and just like, I think that, like that is an idea that liberals can embrace and it does not occur incidents. You know you were saying we see this trend everywhere, but what one place we don't see, this trend is France, which is very all in on family policy. Despite Ottoman say they haven't non generous over a welfare state.
The french state is a little bit less generous than nordic welfare state overall, but more specifically generous towards parenting. But this has been like decades worth of french public policy has gone into this idea that they don't want to be dominated militarily by Germany, so they wanted, like think about family policy in very serious way. You know I wouldn't make pitch exactly in the United States, but like it's true that, like if we all go, collecting exotic parents like there's gonna, be a problem right ultimately like even for the parrot keepers and now so to the extent that you can like make it financially reasonable for people to have historically normal numbers of children in changing economic circumstance. since, like that, that seems to me for years so here's the thing that surprises me is that we don't actually see I don't see it strong movement among Democrats, they think about twenty eight
in twenty into like make this there is feel I have to to a lot, the Senate Democrats, for example, who really want to revisit the healthcare fight and unite. Ask them. Questions like do you think you guys need to come back to healthcare honestly, expecting the answered me like policy and like the answer is yes We need to have this healthcare fight again because its clear Obamacare sabotage there's all its energy around public? options and by ends and single payers, and so he plans Xxix different Senate plans that are flying around right now, that are different versions of how you could get closer to universal coverage. There does not seem to be that energy around like the thing we are talking about, like being like: ok, the pie in the sky option. You have a different line. You have you know they're, there are not the same: half dozen plans around. Ok, we are facing this problem that people in it
I find it too difficult to have children and like there are things that government could do to ease that burden. To some level, which seems like an sue that would appeal Pino, pretty widely and not be quite, is contentious as health care, and I don't have a good answer me with a weird legacy of twenty. Sixteen right, if Hillary Clinton was president, then instead of like doing, Regulatory staff to undermining destabilize Obamacare would be quietly working away and turn make it work better Both states should be expanding Medicaid the most. Left wing members of Congress would be saying like we need Medicare for all, but leadership would be ignoring them and we would have a lot of action. I mean I don't think Congress would be passing ambitious family policy ideas, but by killer Clinton was definitely into family policy. As a topic, a lot of the people on her team were very into it. As a topic, we'd be doing articles about how Patty Murray was arising, force in the Senate, democratic carcass and like there's a big issue of hers
I still remember I have my transition folder of diet. Events at all is I was working on further the DE winter of twenty six, twenty thousand ash. I had a big. I had a big thing about this. Heather bushy was the chief economist for the country's Isn t. She is a book called finding time without work. Life balance, on earth to that's what's happening. The one where, like back into the Medicare More- and I personally find it both understandable and unfair,
However, the majority so far of candidates Democrats have nominated for Congress in a new candidates are women, and I believe I recall Oldster Cliff article, which say that if the share of women in the legislature goes up a lot, you tend to see more legislation introduced on family policy to an extent. I think the like healthcare hang up is like, like a legacy of deeds elected oftentimes decades ago, still trying to talk about like the last frontier and that there will be some change in this right and you could see, lay Gaeta. Maybe it's a lot more realistic that use the state legislature may be somewhere in the West Coast. Like I, don't know, Washington, California s organs the affair, but on the West Coast These are taking up something like as in getting out ahead of where Congress is real,
to go at this point, and I think that's a fair point that if you do end up with more women in Congress that you're more likely to see more attention paid to these issues seems so back burner. Having also I mean, there's been a lot of state level action on Lee Parental Leave, which I think is here's my totally unfounded speculation. But I think that the european family of programmes are counterpart Fifthly, generous in what way, I think that, given the new mom, three or four months of paid leave is like really nice, and this really help for family supportive thing. I think they're, giving a new mom There is also the gender balance issue, which is important, but I think, regardless of how its allocated with your mom and dad, I didn't giving people a full year of leave it like puts you under the gun to take it, and I think a lot of people don't actually want to take a full year out of their work and be
full time at the Tokyo provide Smart was an interesting question. You can combined with other policy levers like, I think, a world where you know in the United States, you have no subsidized childcare, like a full year of leave, seems better than like a few months ago. Zero leave, even like a few months of leave, coupled with tens of thousands its of dollars spent on child care here says. You know it's some kind of thoughtful the nation of leave, plus subsidized childcare to kind of like pair those, because as things should there, often talked about his two separate, partially buckets. There are two different benefits, but they, actually I mean it's all just about taking care of kit rest I think the optimal policy is like this, like a man, looks like
creating supply of child care provider Scrite, who are like decent and you might wanna, go to giving money to people so that they can either like afford that child care or can afford to work part time or stay at home. If that's the one or just like invite shoes, the cause which is insane and then choose yes, how other wild find a friend to get some handed? and then you know and then like gleam in the mix, but like I do think that this something very like European Centre right about, like ok, mom like just to stay home forever and like the government will pay. You
like the guy I mean I think, but leave is good. I don't want to be like the anti we ve guy, but it is also worth having some like some we'll talk about like exactly how much leave people really want versus like support with the whole thing you can like what have we like dismantle public schools and then just gave everyone eighteen years paper. He rightly we would think, though it that's a bad idea right, like this, a there's, an appropriate balance and there's a tipping point at which, like your family, supportive palace they actually becomes a little bit of alike isolating for parents, and I think some of the european countries have like gone to the other, the other side of that and what we really need is peaceful, must reach about another policy, that's good for kids! Let's, like Senate Democrats, let's talk about healthcare, ok, reintegrate break known, come back!
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and it was literally impossible to win monk. So far we ve got just went from Google lip pocket and that Bodega near House, you know the one with the wheels tat. The first episode drops Wednesday May twenty third, where ever you get your party ass verge? You never heard attack, show like this. so where or abandoning childcare, to talk about healthcare, as is typical in DC these days. So the paper we wanted to talk about, it's called early life met Kate coverage and intergenerational economic mobility. It comes from Rourke, O Brien Sandra Robertson- and this is one of his number- studies. I've seen come out over the past few years. That is looking at Medicaid, not just as a thing that he's for doktor visits and hospitals days, but a thing that has pretty wide ranging economic benefits of the people who participate in it there. Oh well beyond their life expectancy. How healthy they are too really affect noooo
there, economic mobility, their ability to obtain an education that there's something this part of the safety net that I think we are learning from this body of research that is quite powerful and as quite long, lasting effects, even after people are no longer participating in the medical programme. This particular study. It looks at this period in the nineteen Eightys and Ninetys nineties when a lot of stuff its expanded Medicaid, to cover many more low income, pregnant women. So back, then, you used to see did medicate programmes going up to about fifty percent of the poverty line or so for a woman is pregnant and you saw them increase to significantly above the poverty line? Sometimes nearly twice the poverty line. So, all of a sudden, a lot more women who are pregnant were able to qualify for the medicate programmes that is different from the except In that we're seeing right now under the affordable care act, it was a very specific categorical expansion to pregnant women, and this paper
sickly looked at not what happened to those women, but what into the baby's that we're in utero or were invents when their moms gained medicate coverage and handed it keep finding they have. Is that a ten percentage point increase in Medicaid. It works out to approximately five hundred dollars more in income as an adult per year for the kids born to the most low income moms? So you seeing this pretty significant increase an economic mobility, and this is kind of five hundred dollars beyond what you would expect of a kid born to a mom this income. Otherwise you among who didn't gain Medicaid. They find that the effects are really concentrated among the lowest income and rallies and that it is really matter for kids- and I thought this is kind of an interesting surprising finding that they actually We see an effect on expansions of kids later in childhood. That is the only place where you see this income. A fact for kids were when kids, because
don't they earn more. It's for the kids who are either covered in utero or is infants. It is a lie. that hard to wrap your head around the fact. The fact that your mom had Medicaid in utero, is raising up your own economic mobility. You know twenty twenty five years later so kind of they You he wrote down a line from their conclusion, which I think really gets it. What they're saying is that these targeted inventions early in life, can effectively mitigate the deterministic power of parents, social positions on child outcome, so this kind of to this body of research that I've been seeing develop over the ass, your years, that's tracing, history and the impact of a social programme and finding some pretty white, engine results that go way outside of the health care system, and you know I mean as you
and since we ve seen a lot of medical city is now because it takes a long time to, for the long term to arrive Bullock. Medicate expansions in the nineteen eighty is did like a lot of good and I just think dislike. There's an incredible amount of denial is about this fact in american political culture. You now this dislike incredible, just like a genuinely like stingy, mentality about social assistance programmes like a lying
behind all this work, requirements, stuff and and other thing this right like an idea that, like it's really, you know like if you really need this like ok, maybe we have some obligation to ride. You help, but just like a real like, like a palpable sense that, like it's just it's really bad to be helping people out and its actions like. It's really think it's. It's really good is a really big
an offence, but I think there's a guy incredible doubt about that. You know you see a lot of people who are like a high like we ve done this whole war on poverty and it didn't reduce poverty and that's because of like the way poverty is calculated, but like the life outcomes for the children of low income, mothers improved substantially- and I like, I will wager whoever is out here they're like once. We have twenty five years worth of data on the Asian medicate expansion like we're going to see the same thing that the though these programmes is quite high networks. Ending, like one study from Oregon that look like and liver disease, or something right and giving it is an interesting question. Does I think the search on health outcomes is often not quite as strong as the research on these other financial comes. I give you that organs study from Cape Acre Navy Finkel seen one of the things you
see is that you see less credit card, dad the glass some people going into the fault you see, ensuring, this. Essentially a financial mechanism. That's pretty protecting you for some pretty serious bills that you can rack up in the medical system. Indeed, we could call it help in check and think of it as a kind of an insurance as exactly one might think of medicated that way? So, even when you know they were not showing statistically significant outcomes on health and granted. This is like we're talking about a two or three years. timeline that we're not talking about these studies the nineteen, Eightys and Ninetys expansions, and I think, most hell the kind as you know, I know, I would expect to see different long term health results if you're going out decades verses years. it still. Would you know a little bit interesting and surprising to me like how controversial the idea of expanding medicate remain there's still eighteen states that are not participating in the affordable care act. Medicatrix
and then you know one of them right now is or taping Virginia might sign up, today and I think they're, like the last pretty wealthy stay that is not participating in medicate expansion and think about. Four hundred thousand people would gain average and Virginia if they do decide to participate and expansion, which is pretty Never again, will you look at research like this and there's a lot of you know: low income people in that group, probably not low income moms because of these expansion dishonour eightys and Ninetys, But a lot of single able, bodied adults who just don't qualify for medicate at this point, because at some point in the nineteen eighty and eighty nineties, we made the decision that. Pregnant women deserve Medicaid, because they are you carrying a child, theirs factor in their life that made them deserving of medicated but single, able bodied adults sooner. We have never really been brought into the medicate programme until now I don't know like if you know their kids
twenty years later are going around five hundred bucks more, but maybe they well that we haven't really seen. Population in Medicaid may think there is The reason for this other research or sing develop. That really looks it can born to Medicaid moms through this other expansion, to suggest that this new population were bringing in like a pro European, with the same we're talking about not fetuses in utero but like full working adults, but it seems fair to suggest
when they get this insurance products. Something is going to change, but is significantly in their lives, but also to pivot back to family policy. Right I mean I, this is obviously not conclusive, but I think it is very easy to believe that, like cash grants to young families would have beneficial impact on child development over long haul. Some of it because that money would be specifically used on supportive things, but some of it because the just like Medicaid has insurance value, like a monthly check, has insurance value. It allows you to stress four points in your life, an important moment in the child's life to be a little bit com or in a little bit more confident that, like you're gonna, be able to pay rent and you can be able to get food and, like you, don't need to be freaking out about the first time you have a job. Mishap related to your child care situation is even little bit more of a buffer, and it's not you know.
you don't know, you don't know one to be tried by bike. There is reason to believe that helping poor young families be less poor, has significant positive long run benefits? It is an interesting pause. It is a question that you raise. I give you have all this money you spend on Medicaid is their value in turning that it into just day cash crime of some sort I think I generally side know, but I think the insurance side of it is super powerful with how high medical bills could get like. If you had one of these in vents in a nick, you, like that's, like you, know, guaranteed tens of thousands, hundreds of thousands- dollars of spending. So in that way you know the dollars are buying a lot more But I think it is an interesting policy design question think about like what is the best way. You know what this money that is being spent on medicate, for particularly this population were talking about the ones
seeing the factor, the lowest income, that, as you get higher income, even within the medication relation you see, this effect disappear in terms of the increased in mobility, I don't know that difference with a cask grants or not, but it's kind of intellect, as you have these other policies when talking about floating around. It is interesting to think about, like what would it look like if we, and our money. That way, instead to me this will be the good you know if you want. Be like a right winger waving around you know, medicate skeptical stories like that would be the smart line of attack weight is like probably, if you gave every poor person a new car like that, would help them, but also at a cost benefits Does he like a bad way to help poor people? That would be a reasonable questioned. Ass quiet is like. Is this the most useful thing that you can do in terms of a large expenditure for people
Although I mean you said this, I did so. People seem to really enjoy the fact that Medicaid has this like. First dollar coverage aspect, which I think with their like social science had on, is a little questionable What do you mean my question about, like I mean I think like if the first always duties, I've always liked curtains. I ended up in the policy. The I'd be like well, ok, preventative cares, important right and catastrophic coverage is important, but like, if you just like happened to want to see the doctor. Like short, kick in five bucks. like who care, but people we will like it. I don't know he had. No really, I mean, I think, one of the reasons you see that actually Medica expansion gets higher favour. Betty from people enrolled in it than people near bomber care plans is that it doesn't cost anything to go to the doktor. It usually doesn't cost anything to catch a prescription felt too, you know access medical services and this The key divide and like many plans we are talking about before
divide between different healthcare systems, where Canada has this very anti spending anything. It's all. First are covered that super important senator Sanders as it works and his plans there's others. You know a lot of other western european countries say like here kick in a little bit like we can. You spend five bucks Jesse you like Oh, let all that's about going to the doktor. I personally think for, like that, Medicaid Popular, It just doesn't make sense. That the risks of deterring necessary care in this is a population, especially if, like we're talking about pregnant women like they there, kids, really busy. I don't think, there's a lot of like just going to the doktor. For that. That. I think there may be getting care and, like inappropriate settings, are going to New York that'll. Do you still but Sometimes you just need care and nothing else is opening up the emergency room, but for them medicate population in particular. It is popular with people in it seems to make sense policy.
Design wise like not to put up barriers. Similarly small to policy drafters but like a three dollars Co payment might be the reason someone doesn't but the doktor and I would be more worried about the negative effects of those verses, like the possible benefits of clamping down on unnecessary doktor use among medicate patients. well. What that I think I went and wrap this one up when you say, thanks to our engineering, prevent Hannah producer, Rigid Armstrong and I will be back with.
Transcript generated on 2021-09-12.