Demographics decline - sustainability or catastrophe?

[clifp]

lol, no. The AMA wishes it has that power, lol. We have a much worse shortage in Canada where we have universal healthcare, so no, that's not it.

Medical training and funding is a complex issue.

I've heard pretty much the same thing the AMA, somewhat artificially restricts the supply of doctors. There seems to be a number of articles and papers that backup the claim.

As to the difference between US and Canada, US doctors do earn more. Although, I have to say that I was surprised that the US have 50% more doctors per capita (36 vs 24) than Canada and both numbers are on the low side for developed nations.

[deborah]

@clifp is this doctors per 1000 rather than per capita, or what?

[Metalcat]

lol, no. The AMA wishes it has that power, lol. We have a much worse shortage in Canada where we have universal healthcare, so no, that's not it.

Medical training and funding is a complex issue.

I've heard pretty much the same thing the AMA, somewhat artificially restricts the supply of doctors. There seems to be a number of articles and papers that backup the claim.

As to the difference between US and Canada, US doctors do earn more. Although, I have to say that I was surprised that the US have 50% more doctors per capita (36 vs 24) than Canada and both numbers are on the low side for developed nations.

Yeah. Everyone has heard the same thing.

As I said, the AMA does not have that authority. They are an interest group. Milton Friedman and other economists have famously made this claim that the AMA restricts the supply to protect doctors incomes and it's frequently cited as fact in articles because it's claimed by people who are seen as people who state facts. But that doesn't make it a fact.

The AMA does not and has never had that power. They are NOT a regulator and never have been. It's in the name, it's an association, their mandate is "The AMA promotes the art and science of medicine and the betterment of public health."

We have the same rumour in Canada about the CMA, which is frequently cited as fact. I know a bunch of senior folks at the CMA, they absolutely hilariously do not have that power.

What the AMA did was lobby to limit the supply to prevent oversupply of physicians. That's their job, to promote the interests of the profession.

Although some would argue that the AMA's version of "the profession" is more in service to the insurers than the doctors, but that's a whole other issue.

Like other associations, they can be very influential. They do have a lot of levers they can pull in terms of influence, but they have absolutely zero, and I mean ZERO legislative authority.

They can be told to shove it at any time by decision makers.

ETA: yes. Canada has an absolutely abysmal crisis of a doctor shortage right now that has zero to do with the CMA and everything to do with legislators playing hot potato with the problem for years.

As I said before, physician training is a complex issue because you can't just throw money at the problem and fix it quickly. Doctors are trained by other doctors in hospitals. So if you don't have the extant hospital system funding, infrastructure, and staff to train more doctors, it doesn't matter how many billions you throw at the problem, it will still take years and years to solve.

Our politicians systematically avoided dealing with it because it's a provincial issue and felt too big and too expensive to deal with. So the provinces ignored the problem and now the federal government is helpless to fix it.

[Metalcat]

The birthrate during the Depression and WWII was very low.  The 50s were a rebound.  But some of the people setting policy now (especially in the US where so many of their politicians are so old) didn't live through the Depression but they were alive during the 50s.  What we experience in our childhoods tends to live on in our minds as the norm, even it it was really an aberration.   I've talked with people who grew up in Sudbury during its moonscape years, and to them that is what the landscape "should" look like.  They know in their heads it was not normal, but in their hearts it was.

Major changes cause major social changes.  The loss of population in medieval Europe (the Black Death is thought to have killed roughly 1/3 of the population, higher in some areas) made labour more valuable and the social order changed.  Industrialization threw people off the land.  Even WWI and the Spanish Flu caused social changes.

It is hard to live through times of major change, but in the long run people adjust.  I would personally rather see people adjusting to a smaller and declining population for a while than the worst of the predicted possible effects of a warming planet.  Of course the worst possibility is both happening concurrently.

So, the statement "birthrate during the Depression and WWII was very low.  The 50s were a rebound...." is a bit off. During WWII birth rates for women were about 2.4, well above the replacement rate of 2.1. Curent 2023 US birth rates are around 1.8, well below the replacement rate of 2.1. There was a dip due to COVID but that should be over.

During the great depression  birth rates were around 2.2-2.3 so also nothing like what we have now which is not a reaction to a major external force (war, disease, etc) but more of a cultural and economic shift whereby men and women are realizing that having children is very difficult to justify with todays numbers and scenarios. Im 45 and my parents generation was totally different, women and men both worked less. grandparents were more likely to live nearby and be involved in upbringing, daycare, college costs and healthcare costs have skyrocketed well in excess of inflation. Daycares now typically charger $20,000 ore more for part time care but they cant hire enough employees so not everyone can go, either the husband or wife will have to walk away from a career they spent $100k or more on. From a logical perspective, its a big no brainer F-&^ NO! So, the parents are pretty dedicated and they need to be cuz parents and families just get beat up more and more every year. COVID resulted in loss of hours at daycares, snacks at daycares, and massive price increases. Now daycares are opening as "diaper free" centers for 2 year olds. Not all kids will be potty trained at 2 due to their personalities. So, you pay full price and if your child has accidents you are out, you have to continue to pay to hold your spot even though your child cant attend. YOu still dont want to give up your career so u hire nannies at $25 an hour ($48,000 year). NOw you're paying nannies with retirement savings. The only people ever sign up for this shit is due to severe hormonal imbalances, the treatment of such may be helping to bring birth rates down.

The part about immigration is funny to me because its a good example of how people read a few headlines and extrapolate that to solution to a complex problem ignoring all of the details. Immigrants typically aren't college educated and ready to serve in professional positions. That's not totally bad, we need immigrants that speak little English and are not used to the country to do many unskilled jobs in the service sector. But immigration is not a solution to low national birth rates. I was interested in immigration and had a few interesting conversations with some locals in Mexico a few years ago and basically asked them why they haven't immigrated to the US. All said basically the same thing: they are happy in mexico and do not want to leave. Even though they know they can make more money for the same work in the US there are other factors to consider and its not worth it for them to leave Mexico. They all said that the people crossing the border illegally are completely desperate with no or extremely little savings and no way to earn money in their home countries (most are from poor Latin American countries but come thru Mexico for the land border). This why manufacturing and agricultural companies, especially want more immigrants, there are few Americans that have less than a high school education and no professional education, few Americans that will work for minimum wage away from their home, etc. Those ag jobs are kind of a perfect fit for non skilled immigrants.

Okay...but your country can develop policy to specifically bring in educated immigrants.

Up here in Canada, it's very common for immigrants to be highly educated and English speaking because we have designed our policies to attract those immigrants. We literally just made our policies even more attractive to highly trained immigrants and are fast-tracking them.

These policies are under scrutiny because we have a housing shortage at the same time, which is another issue that has been hit potatoed into a national crisis. But that doesn't take away from the point that immigration doesn't have to equal only unskilled workers.

[Kris]

The birthrate during the Depression and WWII was very low.  The 50s were a rebound.  But some of the people setting policy now (especially in the US where so many of their politicians are so old) didn't live through the Depression but they were alive during the 50s.  What we experience in our childhoods tends to live on in our minds as the norm, even it it was really an aberration.   I've talked with people who grew up in Sudbury during its moonscape years, and to them that is what the landscape "should" look like.  They know in their heads it was not normal, but in their hearts it was.

Major changes cause major social changes.  The loss of population in medieval Europe (the Black Death is thought to have killed roughly 1/3 of the population, higher in some areas) made labour more valuable and the social order changed.  Industrialization threw people off the land.  Even WWI and the Spanish Flu caused social changes.

It is hard to live through times of major change, but in the long run people adjust.  I would personally rather see people adjusting to a smaller and declining population for a while than the worst of the predicted possible effects of a warming planet.  Of course the worst possibility is both happening concurrently.

So, the statement "birthrate during the Depression and WWII was very low.  The 50s were a rebound...." is a bit off. During WWII birth rates for women were about 2.4, well above the replacement rate of 2.1. Curent 2023 US birth rates are around 1.8, well below the replacement rate of 2.1. There was a dip due to COVID but that should be over.

During the great depression  birth rates were around 2.2-2.3 so also nothing like what we have now which is not a reaction to a major external force (war, disease, etc) but more of a cultural and economic shift whereby men and women are realizing that having children is very difficult to justify with todays numbers and scenarios. Im 45 and my parents generation was totally different, women and men both worked less. grandparents were more likely to live nearby and be involved in upbringing, daycare, college costs and healthcare costs have skyrocketed well in excess of inflation. Daycares now typically charger $20,000 ore more for part time care but they cant hire enough employees so not everyone can go, either the husband or wife will have to walk away from a career they spent $100k or more on. From a logical perspective, its a big no brainer F-&^ NO! So, the parents are pretty dedicated and they need to be cuz parents and families just get beat up more and more every year. COVID resulted in loss of hours at daycares, snacks at daycares, and massive price increases. Now daycares are opening as "diaper free" centers for 2 year olds. Not all kids will be potty trained at 2 due to their personalities. So, you pay full price and if your child has accidents you are out, you have to continue to pay to hold your spot even though your child cant attend. YOu still dont want to give up your career so u hire nannies at $25 an hour ($48,000 year). NOw you're paying nannies with retirement savings. The only people ever sign up for this shit is due to severe hormonal imbalances, the treatment of such may be helping to bring birth rates down.

The part about immigration is funny to me because its a good example of how people read a few headlines and extrapolate that to solution to a complex problem ignoring all of the details. Immigrants typically aren't college educated and ready to serve in professional positions. That's not totally bad, we need immigrants that speak little English and are not used to the country to do many unskilled jobs in the service sector. But immigration is not a solution to low national birth rates. I was interested in immigration and had a few interesting conversations with some locals in Mexico a few years ago and basically asked them why they haven't immigrated to the US. All said basically the same thing: they are happy in mexico and do not want to leave. Even though they know they can make more money for the same work in the US there are other factors to consider and its not worth it for them to leave Mexico. They all said that the people crossing the border illegally are completely desperate with no or extremely little savings and no way to earn money in their home countries (most are from poor Latin American countries but come thru Mexico for the land border). This why manufacturing and agricultural companies, especially want more immigrants, there are few Americans that have less than a high school education and no professional education, few Americans that will work for minimum wage away from their home, etc. Those ag jobs are kind of a perfect fit for non skilled immigrants.

Okay...but your country can develop policy to specifically bring in educated immigrants.

Up here in Canada, it's very common for immigrants to be highly educated and English speaking because we have designed our policies to attract those immigrants. We literally just made our policies even more attractive to highly trained immigrants and are fast-tracking them.

These policies are under scrutiny because we have a housing shortage at the same time, which is another issue that has been hit potatoed into a national crisis. But that doesn't take away from the point that immigration doesn't have to equal only unskilled workers.

Or pass legislation to make the ones who are already here able to get jobs.

I know several immigrants just in my own extended social circle with advanced medical degrees, including a couple who were high-powered researchers in their home countries. But they are deemed not qualified to exercise their professions here. One is literally a physician who is doing assembly line work.

Ask a hundred immigrant cabbies in your city what their profession was in their home countries.

[Metalcat]

Or pass legislation to make the ones who are already here able to get jobs.

I know several immigrants just in my own extended social circle with advanced medical degrees, including a couple who were high-powered researchers in their home countries. But they are deemed not qualified to exercise their professions here. One is literally a physician who is doing assembly line work.

Ask a hundred immigrant cabbies in your city what their profession was in their home countries.

Yeah. This is a whole other issue.

Because although the AMA doesn't make the rules, the state licensing bodies do, and they are independent of government. They're self-regulated.

So the government can't just directly decide to fast-track the licensure of foreign-trained doctors.

And again, that comes back to how complex the whole funding and licensing issue is. We're in this deadlock in Canada right now, we're fast tracking medical professionals into the country like crazy, but you can't just give someone a license because they went to what another country calls "medical school."

If foreign medical training is not considered equivalent, the foreign doctor still needs to be able to get in to a residency program here to make sure that they are trained to the same level as domestically trained MDs or equivalents.

Then we still have the issue of residency spots.

But yes, the government in Canada is putting enormous pressure on the provincial licensing bodies to speed up this process, especially for nurses and other licensed allied health professionals.

They did for dentists about a decade ago. The government pushed very hard on the licensing bodies to make it easier for foreign trained dentists to get licensure. They used to have to do 2 years of dental school in Canada but they changed it to a series of exams.

We now have a massive oversupply of dentists, and still have a major distribution problem because dentists don't want to work where they're needed, so instead of solving a problem, it created one. Because overhead is so high in dentistry, you can't safely cut prices, so the race to the bottom is actually lowering the standard of care in cities and the rural, underserved communities still don't have care.

There was a total failure to develop policy to incentivize working in underserved regions. So that was a fuck up. But that was a policy from a conservative government that thought that simple supply and demand would solve the problem. It did not.

Medicine is far more complex. Far, far more complex. A major issue is that it's a Frankenmonster of public and private design. Contrary to popular belief, we do not have a fully public medical system, we have public hospitals and a public insurance program, but the majority of medical professionals are self-employed private business owners who bill the public insurance. They don't work for the state, so the state has no say over what kinds of doctors we have, how many, what populations they serve.

They have virtually zero control over the supply and distribution of doctors, especially primary care providers. It's a legislative clusterfuck.

That's why politicians have avoided the issue as much as possible because it's arcane as fuck. Which is why it's now an essentially unfixable disaster. Despite everyone seeing it coming for decades.

It's not like climate change, no one has questioned it as a problem. 20 years ago when I was applying to med school it was a well-established problem. We just...did nothing about it except actively make it worse. Lol.

Policy makers have enormous power to influence the makeup of the professional landscape of a country. The challenge is that a lot of those policies won't get you elected.

[RetiredAt63]

The birthrate during the Depression and WWII was very low.  The 50s were a rebound.  But some of the people setting policy now (especially in the US where so many of their politicians are so old) didn't live through the Depression but they were alive during the 50s.  What we experience in our childhoods tends to live on in our minds as the norm, even it it was really an aberration.   I've talked with people who grew up in Sudbury during its moonscape years, and to them that is what the landscape "should" look like.  They know in their heads it was not normal, but in their hearts it was.

Major changes cause major social changes.  The loss of population in medieval Europe (the Black Death is thought to have killed roughly 1/3 of the population, higher in some areas) made labour more valuable and the social order changed.  Industrialization threw people off the land.  Even WWI and the Spanish Flu caused social changes.

It is hard to live through times of major change, but in the long run people adjust.  I would personally rather see people adjusting to a smaller and declining population for a while than the worst of the predicted possible effects of a warming planet.  Of course the worst possibility is both happening concurrently.

So, the statement "birthrate during the Depression and WWII was very low.  The 50s were a rebound...." is a bit off. During WWII birth rates for women were about 2.4, well above the replacement rate of 2.1. Curent 2023 US birth rates are around 1.8, well below the replacement rate of 2.1. There was a dip due to COVID but that should be over.

During the great depression  birth rates were around 2.2-2.3 so also nothing like what we have now which is not a reaction to a major external force (war, disease, etc) but more of a cultural and economic shift whereby men and women are realizing that having children is very difficult to justify with todays numbers and scenarios. Im 45 and my parents generation was totally different, women and men both worked less. grandparents were more likely to live nearby and be involved in upbringing, daycare, college costs and healthcare costs have skyrocketed well in excess of inflation. Daycares now typically charger $20,000 ore more for part time care but they cant hire enough employees so not everyone can go, either the husband or wife will have to walk away from a career they spent $100k or more on. From a logical perspective, its a big no brainer F-&^ NO! So, the parents are pretty dedicated and they need to be cuz parents and families just get beat up more and more every year. COVID resulted in loss of hours at daycares, snacks at daycares, and massive price increases. Now daycares are opening as "diaper free" centers for 2 year olds. Not all kids will be potty trained at 2 due to their personalities. So, you pay full price and if your child has accidents you are out, you have to continue to pay to hold your spot even though your child cant attend. YOu still dont want to give up your career so u hire nannies at $25 an hour ($48,000 year). NOw you're paying nannies with retirement savings. The only people ever sign up for this shit is due to severe hormonal imbalances, the treatment of such may be helping to bring birth rates down.

The part about immigration is funny to me because its a good example of how people read a few headlines and extrapolate that to solution to a complex problem ignoring all of the details. Immigrants typically aren't college educated and ready to serve in professional positions. That's not totally bad, we need immigrants that speak little English and are not used to the country to do many unskilled jobs in the service sector. But immigration is not a solution to low national birth rates. I was interested in immigration and had a few interesting conversations with some locals in Mexico a few years ago and basically asked them why they haven't immigrated to the US. All said basically the same thing: they are happy in mexico and do not want to leave. Even though they know they can make more money for the same work in the US there are other factors to consider and its not worth it for them to leave Mexico. They all said that the people crossing the border illegally are completely desperate with no or extremely little savings and no way to earn money in their home countries (most are from poor Latin American countries but come thru Mexico for the land border). This why manufacturing and agricultural companies, especially want more immigrants, there are few Americans that have less than a high school education and no professional education, few Americans that will work for minimum wage away from their home, etc. Those ag jobs are kind of a perfect fit for non skilled immigrants.

afox, you are looking at things only from a USian view, not the broader picture. 

Others have discussed the immigration issue. 

Look at the  first graph on this website and you will see why I said the 50s (and late 40s) were a bump in the trend to smaller families?  I don't know why the trend deepened in the 1920, but it may be partially due to the Spanish flu killing young adults disproportionately.  Certainly my grandmother only had 2 children, because she died of the Spanish flu while pregnant with her 3rd.  And of course we lost a lot of young Canadian men in WWI (we declared war in 1914) so they never got to be fathers.

Re family being close, my Dad once said that we were typical Canadians, family in 7 provinces and the US.  That sure doesn't imply we were all living next door to our families.  I know in both sides of my own family that people were often several provinces away from family, so no easy family child care.

The rest of your issues are very USian ones  I suggest you read The Nordic Theory of Everything: In Search of a Better Life by Anu Partanen.

[Metalcat]

The rest of your issues are very USian ones  I suggest you read The Nordic Theory of Everything: In Search of a Better Life by Anu Partanen.

Such a good book. Really gave me enormous insight into American culture.

[RetiredAt63]

The rest of your issues are very USian ones  I suggest you read The Nordic Theory of Everything: In Search of a Better Life by Anu Partanen.

Such a good book. Really gave me enormous insight into American culture.

We (Canada) look so good for things like health care and maternity leave and so on compared to the US, but reading that book made me realize how much better we could do.

[Metalcat]

The rest of your issues are very USian ones  I suggest you read The Nordic Theory of Everything: In Search of a Better Life by Anu Partanen.

Such a good book. Really gave me enormous insight into American culture.

We (Canada) look so good for things like health care and maternity leave and so on compared to the US, but reading that book made me realize how much better we could do.

Our healthcare looks like dogshit right now.

Americans get charged up the woohoo for care but we have fully insured people dying in cities because ERs are too packed to take them.

As medical frequent flyer, I've just kind of accepted that we're fucked.

We have zero leg to stand on these days when it comes to healthcare smugness.

[afox]

Doctors make significantly more in the US than in any other country in the world. I think this is partly because the education costs are so high in the US. In other countries becoming a doctor does not leave someone several hundred thousand dollars in debt like it does in the US. Its an awesome geographic arbitrage to get a public and free md education in India and come to the US to practice! If Canada wanted more doctors they could pay them more than they make in the US but that would be extremely expensive.

[Metalcat]

Doctors make significantly more in the US than in any other country in the world. I think this is partly because the education costs are so high in the US. In other countries becoming a doctor does not leave someone several hundred thousand dollars in debt like it does in the US. Its an awesome geographic arbitrage to get a public and free md education in India and come to the US to practice! If Canada wanted more doctors they could pay them more than they make in the US but that would be extremely expensive.

Those two things are entirely unrelated. The cost of med school has no impact on the wages for MDs.

Here in Canada the cost of dental school has risen dramatically while the salaries have plummeted. Our dental industry is private, so that is pure market forces at play.

Raising physician salaries likely wouldn't do all that much for our MD numbers. The government is already throwing money at the problem, so willingness to spend is not the issue. The issue is supply.

And as I already explained, you can't just solve the supply issue overnight. We need more residency spots, and you can't just make a residency program out of cash and thin air.

[afox]

The cost of med school does impact salaries. No-one would become a doctor if it cost $200,000 and 7 years in schooling and paid $100,000 a year.

The salary and costs of med school are just a return on investment decision for people to go into the career or not.

I definitely dont disagree that it takes more than money to turn out qualified doctors but when they can move to the US and get paid 50% more many of them will.

[Metalcat]

The cost of med school does impact salaries. No-one would become a doctor if it cost $200,000 and 7 years in schooling and paid $100,000 a year.

The salary and costs of med school are just a return on investment decision for people to go into the career or not.

I definitely dont disagree that it takes more than money to turn out qualified doctors but when they can move to the US and get paid 50% more many of them will.

Really? Because a whole bunch of dentists in Canada are paying over 300K to struggle to make much more than 100K after graduating while working evenings and weekends.

Yes, at a certain point, the salaries would be too low for many people to want to do the job, but we have absolutely NO shortage of people who want to be doctors.

Even with our lower salaries, we have thousands upon thousands of students with straight As getting rejected every year from Canadian medical schools. Many of them doing insane shit like PhDs just to be more competitive.

Tons and tons of them are going to med schools in other countries and then are not able to return because there are no residency spots for them.

I'm sorry, but your original point that we would have enough doctors in Canada if we just paid them more is simply not true.

I'm not guessing at this shit, I've attended national conferences on this very issue. It is very complex and not easily solved.

You can't just undo decades of horrible policy impacts overnight. Not in such a massive, complex system that's so dependent on extant systems for expansion.

We could add thousands of med school spots tomorrow and be able to fill all of them with straight A applicants even if they were all told that they would have to take a major paycut.

I lived in that world, 99% of them would do it.

But we would have no residencies to put them in after 4 years. The residency spots are the bottle neck. They are always the bottle neck, and those are not easily expanded.

We have tons and tons of Canadians leaving every year to train in Ireland and the Carribean, if we could magically make more residency spots, we could call almost all of them back.

But we can't. We just can't.

[afox]

 A quik google search reveals that dentists are paid much more in canada and pay much less to go to dental school than you write.

I did not mean to imply that you could increase the supply of dentists or doctors simply by paying them more. Sorry if thats what I wrote or what you interpreted but I know it is not that simple.

[Metalcat]

A quik google search reveals that dentists are paid much more in canada and pay much less to go to dental school than you write.

I did not mean to imply that you could increase the supply of dentists or doctors simply by paying them more. Sorry if thats what I wrote or what you interpreted but I know it is not that simple.

There are no stats online that show accurately what new grad dentists are making. When I'm asked what a new grad dentist can expect to make, I sign and say "it depends" and then go into a long explanation about why the answer isn't a simple number.

This is literally the area I worked in, I worked for a financial firm that catered to medical professionals. I am also a medical professional in Canada.

Many new grad dentists in over saturated markets are struggling to make good incomes because they are struggling to be fully booked.

A fully booked dentist can easily make 200K working 5 days a week, but to get fully booked takes a lot of time and sometimes never happens in oversaturated markets like Toronto or Vancouver. They are often stuck taking on a lot of government assistance cases which don't even cover the overhead for the chair time, but are better than nothing.

I have personally worked with many new dentists who graduate with over 300K in student loans and are struggling to make over 100K in their first few years.

Their loans are from tuition, plus materials, plus living costs for 4 years in locations that are typically expensive because it's virtually impossible to work during those programs.

[afox]

And Now you quality it by new grads?

see ya, Have fun proving to yourself how smart you are.

[Metalcat]

And Now you quality it by new grads?

see ya, Have fun proving to yourself how smart you are.

lol, sorry if I wasn't clear, but I was always talking about new grads.

My bad if I was unclear about that.

As for how much dentists make later in their careers, the range is enormous, so it's really hard to pin down, but a lot of them are struggling in saturated markets especially since the price of clinics inflated so much.

It's really not a great economic situation for dentists, certainly not as good as folks think it is.

ETA: to be very clear, the point I was trying to make was that increasing debt for dental students has not made their incomes higher, which was a point you made about medicine earlier.

[SunnyDays]

Regarding MDs, it seems to me that a fairly quick improvement in the system would be to train more Physician Assistants.  It would likely be possible to cut GPS caseload in half by having simple cases handled by them.  Leave the doctors to take the more complex, serious problems.  It appears to be more common in some areas, mostly due to physician shortage, but why does it need to come down to that for more PAs to be trained?  It would make more economic sense as well.

ETA: in my province, pharmacists can now assess conditions like UTIs, conjunctivitis, acne, eczema, etc, so that’s a start, but a PA would be another step up.

[Metalcat]

Regarding MDs, it seems to me that a fairly quick improvement in the system would be to train more Physician Assistants.  It would likely be possible to cut GPS caseload in half by having simple cases handled by them.  Leave the doctors to take the more complex, serious problems.  It appears to be more common in some areas, mostly due to physician shortage, but why does it need to come down to that for more PAs to be trained?  It would make more economic sense as well.

Now that is where the lobbying comes in. The associations have lobbied hard to prevent encroachment into the medical profession by allied health professionals.

It's definitely an issue. And again, one that well crafted policy could solve.

Which is really where this whole MD convo started. I only brought up the complexity to counter the point that fewer people means fewer doctors. It really doesn't, because we have policy levers we can pull to make a lot more doctors than we already have. They're just complicated and difficult and require multi-level, multi-organization cooperation, which is...difficult.

[SunnyDays]

Regarding MDs, it seems to me that a fairly quick improvement in the system would be to train more Physician Assistants.  It would likely be possible to cut GPS caseload in half by having simple cases handled by them.  Leave the doctors to take the more complex, serious problems.  It appears to be more common in some areas, mostly due to physician shortage, but why does it need to come down to that for more PAs to be trained?  It would make more economic sense as well.

Now that is where the lobbying comes in. The associations have lobbied hard to prevent encroachment into the medical profession by allied health professionals.

It's definitely an issue. And again, one that well crafted policy could solve.

Which is really where this whole MD convo started. I only brought up the complexity to counter the point that fewer people means fewer doctors. It really doesn't, because we have policy levers we can pull to make a lot more doctors than we already have. They're just complicated and difficult and require multi-level, multi-organization cooperation, which is...difficult.

I have no sympathy for lobbyists.  If government had any balls at all, it would override these efforts.  It’s unethical to restrict access to healthcare and make people suffer and die from their greed.

[bmjohnson35]

Shrinking population is more of a short term issue.  How long is short term.......I don't know.  I also agree that relying on never-ending growth is a flawed longterm strategy, for the reason already identified.

[vand]

Fairly serious stuff when you extrapolate the trend out:
That chart of the birth rate decline over the last 40 year is absolutely terrifying and how there doesn't seem to be any floor on it.

https://www.bbc.co.uk/news/world-asia-china-68002803.amp

[Askel]

So I haven't read this whole thread, but a brief look didn't see it mentioned.  In the US at least, the 'demographic decline' is almost entirely due to a rapidly falling teenage pregnancy rate.   

Picked up from Jeremy Horpedahl who often has some really interesting insights into statistics.  https://twitter.com/jmhorp/status/1722669091662471249

[vand]

So I haven't read this whole thread, but a brief look didn't see it mentioned.  In the US at least, the 'demographic decline' is almost entirely due to a rapidly falling teenage pregnancy rate.   

Picked up from Jeremy Horpedahl who often has some really interesting insights into statistics.  https://twitter.com/jmhorp/status/1722669091662471249

This is compatible with what we know about Western women not only having fewer children, but having them later in life, too - the average age a woman has her first child has gone from around 21yo to 27yo in the last 50 years.   I don't think you can interpret the falling pregnancy rate in teens as a victory in that sense - there are no women getting married at 18 and kids at 18/19 happening these days.

[RetiredAt63]

So I haven't read this whole thread, but a brief look didn't see it mentioned.  In the US at least, the 'demographic decline' is almost entirely due to a rapidly falling teenage pregnancy rate.   

Picked up from Jeremy Horpedahl who often has some really interesting insights into statistics.  https://twitter.com/jmhorp/status/1722669091662471249

This is compatible with what we know about Western women not only having fewer children, but having them later in life, too - the average age a woman has her first child has gone from around 21yo to 27yo in the last 50 years.   I don't think you can interpret the falling pregnancy rate in teens as a victory in that sense - there are no women getting married at 18 and kids at 18/19 happening these days.

It's good for the mothers - they can finish growing up and getting their lives together.  A lot of the teenage pregnancies would have been unplanned and unmarried.   And younger than 18/19.

[Michael in ABQ]

So I haven't read this whole thread, but a brief look didn't see it mentioned.  In the US at least, the 'demographic decline' is almost entirely due to a rapidly falling teenage pregnancy rate.   

Picked up from Jeremy Horpedahl who often has some really interesting insights into statistics.  https://twitter.com/jmhorp/status/1722669091662471249

That graph is awful because it's based on a logarithmic scale that makes it very misleading. What percent of woman of child-bearing age is teenagers? If they only make up 10% having the birth rate get cut in half for that group makes little difference overall.

The actual data for 2021 shows 3,664,292 births with 15-19 making up 146,973 or just 4% overall.
https://www.cdc.gov/nchs/data/nvsr/nvsr72/nvsr72-01.pdf

[Blackeagle]

NYT articles on China's birth rate:
https://www.nytimes.com/2024/01/16/business/china-birth-rate-2023.html
https://www.nytimes.com/2023/02/09/upshot/china-population-decline.html

While the first article focuses on China, the second also goes over some of the measures that other countries have taken to try to increase birth rates.  The conclusion seems to be that the incentives that have been tried thus far can lead to a short-term increase by influencing the timing of people's childbearing decisions.  Long term, however, the incentives don't seem to have much effect on the total number of children that people plan to have.

[mistymoney]

The asinine idea that the world has too many people to sustain - which tends to pervade FI circles where people are aware of the about the financial impact of raising a family - needs to be challenged, called out, and destroyed.... because the logical extension of this ideology is terrible for everyone.
.......

/ Lots to unpack here... discuss...

I disagree with your premise. Why would I even bother to discuss this with you?

[RetiredAt63]

The asinine idea that the world has too many people to sustain - which tends to pervade FI circles where people are aware of the about the financial impact of raising a family - needs to be challenged, called out, and destroyed.... because the logical extension of this ideology is terrible for everyone.
.......

/ Lots to unpack here... discuss...

I disagree with your premise. Why would I even bother to discuss this with you?

Well, you and I might gently point him to a discussion of population dynamics and r and K type species.  He wants us to be an r type species.  It seems that you and I would like humanity to be a K type species.

[Blackeagle]

Mean to edit my previous post, not quote it.

[MarcherLady]

So I haven't read this whole thread, but a brief look didn't see it mentioned.  In the US at least, the 'demographic decline' is almost entirely due to a rapidly falling teenage pregnancy rate.   

Picked up from Jeremy Horpedahl who often has some really interesting insights into statistics.  https://twitter.com/jmhorp/status/1722669091662471249

This is compatible with what we know about Western women not only having fewer children, but having them later in life, too - the average age a woman has her first child has gone from around 21yo to 27yo in the last 50 years.   I don't think you can interpret the falling pregnancy rate in teens as a victory in that sense - there are no women getting married at 18 and kids at 18/19 happening these days.

I think that fewer teenage pregnancies is a victory by any interpretation. You have a daughter don't you @vand, is marriage and children before she is 20 the life path you would advise her to take?

[FireOnTheMuffin]

I've been thinking a lot about this topic... Definitely is hard to anticipate how people will react in a world of rapidly reducing population, and an older and older demographic skew.  I don't want to couch in it such dire terms as @vand, but I do think the loss of human capital could mean fewer innovations, and difficulty in maintaining infrastructure.  Of course, it's impossible to know for sure, and maybe we'll have developed technology along the way to solve at least the infrastructure problems.  And... MAYBE there will come a time when people (women) magically decide we/they want to have more kids after all.  I just kind of doubt it. 

As a child-bearing age woman with very young kids right now, no amount of money would make me want to have more kids.  The only person who can twist my arm to do so is my husband, and he is definitely trying... When we imagine a government provided full child-care, before and after school care, etc... At that point, you're barely raising that child.  So, I don't want that either, but taking care of more kids is an exhausting prospect even though I don't work anymore!  I think what has changed is not just financial, but the societal norms/expectations involved in raising kids.  Everyone wants to do intense parenting.  MMM himself was an intense-parenter.  He and his wife gave up all work to focus on parenting 1 child.  If that is what everyone wants to do, nobody will want to put in more effort on a 3rd+ child or reduce the amount of time they are giving to the first/second child. 

So if we assume this rapid population decline is inevitable, a relevant question for this forum is, how does that affect investments?  E.g., many of us have real estate, both homes and rentals.  After peak population in 2080/2100 do we start (or tell our kids to) sell?  Real estate ownership may no longer be a path to wealth.  With population decline and lowering rates of innovation, what will happen to the stock market?  All portfolio calculators are based on the period of rapidly growing population...  Will FIRE be possible in that future?

[roomtempmayo]

As a child-bearing age woman with very young kids right now, no amount of money would make me want to have more kids. 

We have one, and we're almost certainly done.

But I suppose we might be nudgable by policy, it's just that the amount of money it would take for it to matter to us is totally off the table.  The costs are just huge (daycare or lost earnings, healthcare, college, activity fees, and on and on), and far beyond what even a country like Hungary is trying.  A couple thousand bucks isn't even a drop in the bucket, and of course it isn't going to change behavior.  Direct and indirect subsidies of $500k+ over a child's first 22 years might, but there's zero chance that will ever happen, anywhere.

[Metalcat]

As a child-bearing age woman with very young kids right now, no amount of money would make me want to have more kids. 

We have one, and we're almost certainly done.

But I suppose we might be nudgable by policy, it's just that the amount of money it would take for it to matter to us is totally off the table.  The costs are just huge (daycare or lost earnings, healthcare, college, activity fees, and on and on), and far beyond what even a country like Hungary is trying.  A couple thousand bucks isn't even a drop in the bucket, and of course it isn't going to change behavior.  Direct and indirect subsidies of $500k+ over a child's first 22 years might, but there's zero chance that will ever happen, anywhere.

If you paid me a few million I would adopt a child and pay someone else to raise it, lol. But no, there is no policy that could nudge me to have kids.

[Michael in ABQ]

As a child-bearing age woman with very young kids right now, no amount of money would make me want to have more kids. 

We have one, and we're almost certainly done.

But I suppose we might be nudgable by policy, it's just that the amount of money it would take for it to matter to us is totally off the table.  The costs are just huge (daycare or lost earnings, healthcare, college, activity fees, and on and on), and far beyond what even a country like Hungary is trying.  A couple thousand bucks isn't even a drop in the bucket, and of course it isn't going to change behavior.  Direct and indirect subsidies of $500k+ over a child's first 22 years might, but there's zero chance that will ever happen, anywhere.

If you paid me a few million I would adopt a child and pay someone else to raise it, lol. But no, there is no policy that could nudge me to have kids.

We're on the other end of the spectrum with #7 on the way and any financial incentives (child tax credit, etc.) are an afterthought. I'll take the money but if the child tax credit doubled or tripled it wouldn't really make a difference to our decision to have more kids.

[wenchsenior]

As a child-bearing age woman with very young kids right now, no amount of money would make me want to have more kids. 

We have one, and we're almost certainly done.

But I suppose we might be nudgable by policy, it's just that the amount of money it would take for it to matter to us is totally off the table.  The costs are just huge (daycare or lost earnings, healthcare, college, activity fees, and on and on), and far beyond what even a country like Hungary is trying.  A couple thousand bucks isn't even a drop in the bucket, and of course it isn't going to change behavior.  Direct and indirect subsidies of $500k+ over a child's first 22 years might, but there's zero chance that will ever happen, anywhere.

If you paid me a few million I would adopt a child and pay someone else to raise it, lol. But no, there is no policy that could nudge me to have kids.

LOL. My attitude exactly. Also that of my two sisters.

[ChpBstrd]

I think all this worry about the economic consequences of falling population are minor in comparison to the question of how many children never get a chance to develop or apply their talents.

For example, when a child is sent to an underfunded school, raised in an anti-educational culture, taught superstition and misinformation rather than the skills needed for productivity growth or innovation, exposed to toxins that reduce their potential, provided insufficient parental attention by caregivers who are more occupied by their screens, discriminated against because of their gender or ethnicity, etc. then that child's civilization loses their potential. This is immeasurable, so we don't pay much attention to the concept. But if you think about it, the entire future depends on it!

The setbacks described above mean that child is unlikley to cure diseases, develop new technologies, figure out solutions to our hardest problems, be a good parent themselves, become a scholar, create wealth, or even pay much in taxes to support all the services we worry about. They might end up in prison, like 1.2 million Americans whose contribution to their society might be a net negative.

So if hypothetically, the US or world wasted fewer of their children's potential, the overall reduction in potential from a falling population could easily be offset. E.g. if a country wastes 80% of its children now, but wastes only 70% of them in the future, then their population of successful people would increase even if population size was falling several percent per generation.

The solution to anxiety about the future is to invest in the kids and their environments, and that's true regardless of what population does.

[Ron Scott]

As a child-bearing age woman with very young kids right now, no amount of money would make me want to have more kids. 

We have one, and we're almost certainly done.

But I suppose we might be nudgable by policy, it's just that the amount of money it would take for it to matter to us is totally off the table.  The costs are just huge (daycare or lost earnings, healthcare, college, activity fees, and on and on), and far beyond what even a country like Hungary is trying.  A couple thousand bucks isn't even a drop in the bucket, and of course it isn't going to change behavior.  Direct and indirect subsidies of $500k+ over a child's first 22 years might, but there's zero chance that will ever happen, anywhere.

If you paid me a few million I would adopt a child and pay someone else to raise it, lol. But no, there is no policy that could nudge me to have kids.

I can live with that.

[uniwelder]

...I do think the loss of human capital could mean fewer innovations, and difficulty in maintaining infrastructure...

So if we assume this rapid population decline is inevitable, a relevant question for this forum is, how does that affect investments?  E.g., many of us have real estate, both homes and rentals.  After peak population in 2080/2100 do we start (or tell our kids to) sell?  Real estate ownership may no longer be a path to wealth. With population decline and lowering rates of innovation, what will happen to the stock market?  All portfolio calculators are based on the period of rapidly growing population...  Will FIRE be possible in that future?

By 2100, global warming will have displaced hundreds of millions, perhaps 2 billion people, around the world.  If you own real estate in a place that isn't affected, there's a good chance that a declining population won't hurt your investment.  I think future generations will have bigger things to worry about than how the stock market is doing.

I'm glad my wife and I decided not to have kids.  There are some (of those I know, mostly religious) that believe Earth was created as a place for mankind to own and control.  I believe we are supposed to exist within a small part of the world.  It's generally held true that in the animal world, the predator population is somewhere around 10% of their prey population.  It seems there is something askew when there are only 40,000 lions, 5,600 tigers, 220,000 wolves, and 50,000 orcas in the world, while there are 8,100,000,000 humans.

I think all this worry about the economic consequences of falling population are minor in comparison to the question of how many children never get a chance to develop or apply their talents.
...
So if hypothetically, the US or world wasted fewer of their children's potential, the overall reduction in potential from a falling population could easily be offset. E.g. if a country wastes 80% of its children now, but wastes only 70% of them in the future, then their population of successful people would increase even if population size was falling several percent per generation.

Thanks for saying this.  I'm not sure if it was mentioned before, but this is the most logical rebuttal to those that say less people = less innovation

[roomtempmayo]

The part about immigration is funny to me because its a good example of how people read a few headlines and extrapolate that to solution to a complex problem ignoring all of the details. Immigrants typically aren't college educated and ready to serve in professional positions. That's not totally bad, we need immigrants that speak little English and are not used to the country to do many unskilled jobs in the service sector. But immigration is not a solution to low national birth rates.

This quoted section reminds me of a subtext that often runs through these conversations, but is rarely said aloud.  What I'm about to write below is not necessarily what you're saying, and I don't want to put words in your mouth.  It's just a position that seems to be in the background of most conversations about birth rates.

When we talk about population and birth rates, it seems rare that we're actually talking about aggregate people, or about the total number of children.  If we were, immigration would be a clear solution.

Rather, we're often talking about women with certain attributes having children (often native English speakers, citizens of the United States, educated, married, in a job but not too old, with a certain amount of money to spend) and children of those women.  The right sort of women, and the right sort of children.

The anxiety over birth rates can read as anxiety over the decline of an idealized family unit headed by a male breadwinner who makes so much money that his family lives in an enormous house, drives around in a big black Suburban, and spills out to church, sports, and music lessons all funded by some unstated well of resources that will write all the checks from birth through young adulthood. 

What we lack then aren't children.  We lack those sorts of children.  And those sorts of families.  And perhaps just as importantly, those sorts of men.

Every so often the latest edition of the Gallup poll showing that people would like to see bigger families makes news.*  What doesn't make news is that what people say in the poll is that they'd like other people to have bigger families, not that they will have a bigger family themselves.  And they often don't.  We seem to think big families should exist, but they should exist in some Ralph Lauren ad fantasy world.  Not really in the world of the middle class, or the poor, or apparently for most Americans when they make their personal choices.

*https://news.gallup.com/poll/511238/americans-preference-larger-families-highest-1971.aspx

[Michael in ABQ]

The part about immigration is funny to me because its a good example of how people read a few headlines and extrapolate that to solution to a complex problem ignoring all of the details. Immigrants typically aren't college educated and ready to serve in professional positions. That's not totally bad, we need immigrants that speak little English and are not used to the country to do many unskilled jobs in the service sector. But immigration is not a solution to low national birth rates.

This quoted section reminds me of a subtext that often runs through these conversations, but is rarely said aloud.  What I'm about to write below is not necessarily what you're saying, and I don't want to put words in your mouth.  It's just a position that seems to be in the background of most conversations about birth rates.

When we talk about population and birth rates, it seems rare that we're actually talking about aggregate people, or about the total number of children.  If we were, immigration would be a clear solution.

Rather, we're often talking about women with certain attributes having children (often native English speakers, citizens of the United States, educated, married, in a job but not too old, with a certain amount of money to spend) and children of those women.  The right sort of women, and the right sort of children.

The anxiety over birth rates can read as anxiety over the decline of an idealized family unit headed by a male breadwinner who makes so much money that his family lives in an enormous house, drives around in a big black Suburban, and spills out to church, sports, and music lessons all funded by some unstated well of resources that will write all the checks from birth through young adulthood. 

What we lack then aren't children.  We lack those sorts of children.  And those sorts of families.  And perhaps just as importantly, those sorts of men.

Every so often the latest edition of the Gallup poll showing that people would like to see bigger families makes news.*  What doesn't make news is that what people say in the poll is that they'd like other people to have bigger families, not that they will have a bigger family themselves.  And they often don't.  We seem to think big families should exist, but they should exist in some Ralph Lauren ad fantasy world.  Not really in the world of the middle class, or the poor, or apparently for most Americans when they make their personal choices.

*https://news.gallup.com/poll/511238/americans-preference-larger-families-highest-1971.aspx

"These findings, from aggregated Gallup polls in June and July 2023, translate to an average of 2.7 children considered ideal."

78% answered 0-3 kids with 73% saying 2-3 kids. 

Only 16% answered 4 or more and only 4% answered 5 or more.

Looks like almost everyone thinks 2-3 kids is ideal and that's pretty much in line with what most families end up with. It may have shifted slightly upward in the last decade to more people answering 3 kids but that's not really a big family by any reasonable definition. 4 kids -probably, 5+ kids - definitely.


We choose to have a big family but I wouldn't say it's the ideal for every family to have. It's hard and it requires a lot of sacrifice. It's hard enough raising a family on two incomes but that becomes almost impossible if you have multiple young kids since the cost of childcare will quickly outstrip the opportunity cost of one parent staying home. So I've spent 15 years working a full-time job, plus a part-time career in the National Guard, and usually a couple of side hustles as well. If we had stopped at 2 or 3 kids we certainly would have been better of in financial or material terms - but that's not our priority. So we'll continue to drive 20-year-old vehicles, have kids share bedrooms, forgo buying any "toys", and cook meals at home.

[kenner]

The part about immigration is funny to me because its a good example of how people read a few headlines and extrapolate that to solution to a complex problem ignoring all of the details. Immigrants typically aren't college educated and ready to serve in professional positions. That's not totally bad, we need immigrants that speak little English and are not used to the country to do many unskilled jobs in the service sector. But immigration is not a solution to low national birth rates.

This quoted section reminds me of a subtext that often runs through these conversations, but is rarely said aloud.  What I'm about to write below is not necessarily what you're saying, and I don't want to put words in your mouth.  It's just a position that seems to be in the background of most conversations about birth rates.

When we talk about population and birth rates, it seems rare that we're actually talking about aggregate people, or about the total number of children.  If we were, immigration would be a clear solution.

Rather, we're often talking about women with certain attributes having children (often native English speakers, citizens of the United States, educated, married, in a job but not too old, with a certain amount of money to spend) and children of those women.  The right sort of women, and the right sort of children.

The anxiety over birth rates can read as anxiety over the decline of an idealized family unit headed by a male breadwinner who makes so much money that his family lives in an enormous house, drives around in a big black Suburban, and spills out to church, sports, and music lessons all funded by some unstated well of resources that will write all the checks from birth through young adulthood. 

What we lack then aren't children.  We lack those sorts of children.  And those sorts of families.  And perhaps just as importantly, those sorts of men.

Every so often the latest edition of the Gallup poll showing that people would like to see bigger families makes news.*  What doesn't make news is that what people say in the poll is that they'd like other people to have bigger families, not that they will have a bigger family themselves.  And they often don't.  We seem to think big families should exist, but they should exist in some Ralph Lauren ad fantasy world.  Not really in the world of the middle class, or the poor, or apparently for most Americans when they make their personal choices.

*https://news.gallup.com/poll/511238/americans-preference-larger-families-highest-1971.aspx

Many kudos to you for a much nicer reply to that comment than I'd have managed.  Completely ignoring the vast number of already highly-educated people outside of the US who may or may not be considering immigration as that's been addressed in a couple different places already, I've tutored refugees who escaped literal civil war (so never mind college, only two had even been able to finish secondary school), and the idea that them not speaking much English or not being used to the US would somehow make them incapable of anything other than unskilled service jobs was a pretty disgusting thing to read.  And, unfortunately, does speak to the root of the 'problem' people want to see solved.

[mistymoney]

The asinine idea that the world has too many people to sustain - which tends to pervade FI circles where people are aware of the about the financial impact of raising a family - needs to be challenged, called out, and destroyed.... because the logical extension of this ideology is terrible for everyone.
.......

/ Lots to unpack here... discuss...

I disagree with your premise. Why would I even bother to discuss this with you?

Well, you and I might gently point him to a discussion of population dynamics and r and K type species.  He wants us to be an r type species.  It seems that you and I would like humanity to be a K type species.

If someone begins a conversation thinking they know the absolute truth, the opposing view is asinine and needs to be destoyed....oh - and - let's discuss. What point is a discussion?

[Metalcat]

As a child-bearing age woman with very young kids right now, no amount of money would make me want to have more kids. 

We have one, and we're almost certainly done.

But I suppose we might be nudgable by policy, it's just that the amount of money it would take for it to matter to us is totally off the table.  The costs are just huge (daycare or lost earnings, healthcare, college, activity fees, and on and on), and far beyond what even a country like Hungary is trying.  A couple thousand bucks isn't even a drop in the bucket, and of course it isn't going to change behavior.  Direct and indirect subsidies of $500k+ over a child's first 22 years might, but there's zero chance that will ever happen, anywhere.

If you paid me a few million I would adopt a child and pay someone else to raise it, lol. But no, there is no policy that could nudge me to have kids.

I can live with that.

What a strange reply.

[RetiredAt63]

The part about immigration is funny to me because its a good example of how people read a few headlines and extrapolate that to solution to a complex problem ignoring all of the details. Immigrants typically aren't college educated and ready to serve in professional positions. That's not totally bad, we need immigrants that speak little English and are not used to the country to do many unskilled jobs in the service sector. But immigration is not a solution to low national birth rates.

You are obviously not talking about Canadian immigration policy.  We are picky as all get-out.

[partgypsy]

I think all this worry about the economic consequences of falling population are minor in comparison to the question of how many children never get a chance to develop or apply their talents.

For example, when a child is sent to an underfunded school, raised in an anti-educational culture, taught superstition and misinformation rather than the skills needed for productivity growth or innovation, exposed to toxins that reduce their potential, provided insufficient parental attention by caregivers who are more occupied by their screens, discriminated against because of their gender or ethnicity, etc. then that child's civilization loses their potential. This is immeasurable, so we don't pay much attention to the concept. But if you think about it, the entire future depends on it!

The setbacks described above mean that child is unlikley to cure diseases, develop new technologies, figure out solutions to our hardest problems, be a good parent themselves, become a scholar, create wealth, or even pay much in taxes to support all the services we worry about. They might end up in prison, like 1.2 million Americans whose contribution to their society might be a net negative.

So if hypothetically, the US or world wasted fewer of their children's potential, the overall reduction in potential from a falling population could easily be offset. E.g. if a country wastes 80% of its children now, but wastes only 70% of them in the future, then their population of successful people would increase even if population size was falling several percent per generation.

The solution to anxiety about the future is to invest in the kids and their environments, and that's true regardless of what population does.

hard agree. The people who say say us parents should have more children, are not making investments in society to care for those children. Prenatal and pediatric care, education, exposure to crap, livable communities, etc. the op stance is really, not articulated or logical. It's like a person standing under a fire alarm sprinkler in a burning building, saying it's too wet. Visit and or live in Africa, India, Asia for awhile. Then get back to us.

[vand]

So I haven't read this whole thread, but a brief look didn't see it mentioned.  In the US at least, the 'demographic decline' is almost entirely due to a rapidly falling teenage pregnancy rate.   

Picked up from Jeremy Horpedahl who often has some really interesting insights into statistics.  https://twitter.com/jmhorp/status/1722669091662471249

This is compatible with what we know about Western women not only having fewer children, but having them later in life, too - the average age a woman has her first child has gone from around 21yo to 27yo in the last 50 years.   I don't think you can interpret the falling pregnancy rate in teens as a victory in that sense - there are no women getting married at 18 and kids at 18/19 happening these days.

I think that fewer teenage pregnancies is a victory by any interpretation. You have a daughter don't you @vand, is marriage and children before she is 20 the life path you would advise her to take?

I am rather old fashioned and believe that childbirth in marriage, or at least in stable and committed long term relationship is what is best for both the child and the family unit, and the statistics of "falling teenage childbirth rates" doesn't tell us enough about what is going on underneath the surface - we know that social trends have changed and unwanted pregnancies and single parent households are more common now - these trends are obfuscated by just say "oh, that's because fewer teenagers are having children."

To unilaterally declare that declining fertility in women under 20 is a victory for everyone is rather bold. If less is better, then is zero the best? There is absolutely nothing wrong with getting married out of high school and playing tradwife at 18 if that is what a woman wants to do imo! I also support it if a woman really doesn't think having children is for her and never has children! I have always been for personal choice and acception the responsibility that goes with that.
This thread was not  intended to attack anyone's personal choices if they are fully accepting of the consequences of their choices, it's to discuss how the world will be shaped as a result of those choices. I think it's one of the most important questions over the coming generations.

[GilesMM]

I expect a deeper and more immediate economic Armageddon from AI and cyber crime than a few more or fewer mouths to feed.

[deborah]

As human brains don’t fully develop until about 25, and girls bodies don’t fully mature until about 18, I’m not sure that teenage pregnancy is a reasonable idea.