The Kids Aren’t Alright – The Health Care Blog


By KIM BELLARD

America, like most cultures, claims to love and value children, but, gosh, the reality sure seems very different. Three recent reports help illustrate this: The Pew Research Center’s report on the expectation of having children, Claire Suddath’s searing look at the childcare industry on Bloomberg, and a UNICEF survey about how young people, and their elders, view the future.   

It’s hard to say which is more depressing.

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Pew found that the percentage of non-parents under 50 who expect to have children jumped from 37% in 2018 to 44% in 2021. Current parents who don’t expect to have more children edged up slightly (71% to 74%). The main reason given by childless adults for not wanting children was simply not wanting children, cited by 56% of those not wanting children. Among those who gave a reason, medical and financial reasons were cited most often. Current parents were even more likely – 63% – to simply say they just didn’t want more.

This shouldn’t come as a huge surprise. Earlier this year the Census Bureau reported that the birthrate in America dropped for the sixth consecutive year, the largest percentage one year drop since 1965 and the lowest absolute number of babies since 1979. It’d be easy to blame this on the pandemic, but, as sociologist Phillip N. Cohen told The Washington Post: “It’s a shock but not a change in direction.” 

In many ways, having children seems like ignoring everything that’s going on. We have a climate change/global warming crisis that threatens to wreak havoc on human societies, we’re still in the middle of a global pandemic, and our political/cultural climate seems even more volatile than the actual climate. One Gen Xer told The New York Times: “As I think of it, having a child is like rolling dice with the child’s life in an increasingly uncertain world.”

Yikes.

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The mess that is America’s child care industry (nurseries, daycare, preschool) may help explain why people are reluctant to have kids/more kids.  If you’ve had a child or known people who have, you’ve heard the complaints about child care. It’s hard to find good ones, harder to get into them, and harder still to pay for them. The people who work in them are, for the most part, wonders, but there are too few of them and they’re woefully underpaid…despite how expensive the child care is.

Ms. Suddath writes: “Child care in the U.S. is the rare example of an almost entirely private market in which the service offered is too expensive for both consumers and the businesses that provide it.” She quotes Treasury Secretary Janet Yellen: “The free market works well in many different sectors, but child care is not one of them.”

At least in healthcare, some people are making money.

The workers are paid less than they’d make at Amazon or Walmart, but, between staffing ratios and other regulatory requirements, the costs can approach college tuition levels. It keeps many women out of the workforce, hampering both their careers and our overall economic development. Even worse, lack of preschool has lifelong impacts on children’s development. She quotes Catherine Wolfram at the U.S. Treasury: “There’s very robust, strong economic literature that documents the positive effects of early childhood education. Educating kids has all these benefits for the rest of society.”

The Build Back Better Act is supposed to address some of the child care issues, such as limits on how much parents have to spend on it and improving wages for the workers, but Ms. Suddath warns, not so fast.  The bill is, she suggests, more aspirational than prescriptive:  

States can decide to take money for preschool but reject additional funds to subsidize other forms of child care. Or a state could call all this communism and do nothing.

Beyond that, there’s not a lot of detail in the bill. States have no guidance on how to help child-care businesses pay higher wages, for example.

Think all those Red states that have defied masks/vaccine mandates/Medicaid expansion are going to rush into fixing the child care problems?  

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The UNICEF survey, which included respondents from 21 countries, found that, overall, young people (15-24) thought children in their country would be better off than their parents – but, in the U.S., only 43% thought so, with 56% disagreeing. It could have been worse; the “worse off” percentages were worse in many other developed countries. The older respondents were even more pessimistic (64%). 

Laurence Chandy, the UNICEF official who oversaw the survey, said: “In a lot of the developing world, there is a bit more optimism that yes, with each generation our living standards are improving.  But there’s a recognition in the West that’s stopped happening.”  In point of fact, U.S. children born in 1980 or later are no longer likely to earn more than their parents, a startling reversal of the trends from 1940 to 1980.  

Young Americans still cite “hard work” as the key to success, but just narrowly edging out “Family wealth or connections,” which is in contrast to their elders, who are much more likely to still believe in hard work.  Education is a distant third. 

We’re supposed to be the country where success is about getting a good education and working hard, not about who your family and friends are. We’re not that country anymore.

No wonder our young people are pessimistic about their futures. 

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When it comes to children’s health, of course, the U.S. should hang its head. We have too many children in poverty, too many children going hungry, too many children without health insurance. Our infant (and maternal) mortality rates are positively third world. Compared to other developed countries, our kids are too overweight, too likely to have diabetes, too likely to get pregnant, too likely to use illegal drugs. 

We have some of the best children’s hospitals in the world, but we pay pediatricians lower than any other physician specialty, and, as a result, have a shortage. It’s similar to those child care workers or elementary school teachers: we say we want the best for our children, but we don’t seem to be willing to pay for the best. And it shows.

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I wish I had some good news. I wish I had some solutions. When I look at the young people in my life I admire their spirit, but I fear for their futures. Why politicians fight things like universal preschool, affordable childcare, or paid family leave – each of which is undeniably good for children – I’m at a loss. 

We can do better for our children. We must.

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor.



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