The healthcare market is taxing reproduction out of existence

Opting Out of U.S. Healthcare & Insurance

• Several commenters contemplate dropping conventional insurance (or using short‑term plans / “health sharing”) and just saving cash, only buying ACA plans when something serious appears.
• People note this “last-minute signup” is why open enrollment exists; outside it, options can exclude preexisting conditions or even refuse children with prior issues.
• Critics call full opt‑out unrealistic: emergencies (e.g., car accidents) leave you unconscious and unable to “vote with your wallet”; EMTALA guarantees treatment but likely bankruptcy afterward.
• Consensus: this behavior is individually rational under current incentives but doesn’t address systemic price inflation.

Markets, Government, and Profit

• One camp blames government subsidies (Medicare/Medicaid/ACA) for destroying price discovery and driving costs up, suggesting rolling back state involvement.
• Others argue healthcare can’t function as a normal market: demand is inelastic, information asymmetric, and much care is urgent; “shop around” is often impossible.
• Strong support appears for some form of single‑payer or Medicare‑for‑All to use unified bargaining power and cut insurer middlemen and administrative bloat.
• Counterpoint: insurers’ profits are a small slice of total spending; provider consolidation, high practitioner pay, residency caps, patents, and opaque billing are major cost drivers.

International Comparisons

• Commenters from Australia, Germany, Canada, Japan and others report vastly lower birth and procedure costs, with universal or heavily regulated systems.
• Tradeoffs mentioned: wait times, “elective” surgery queues, and common use of private add‑on insurance, but far fewer medical bankruptcies.
• The claim that U.S. healthcare is “highest quality” is widely challenged with data on life expectancy, infant/child mortality, and comparative rankings; many conclude the U.S. offers world‑class care for a minority, mediocre access for most, and terrible value overall.

What the “$40k Baby” Really Represents

• Many note the headline number bundles annual family premiums plus hitting the out‑of‑pocket maximum; it’s a year‑of‑care cost, not just the delivery bill.
• Some argue premiums shouldn’t be fully assigned to childbirth, since they also insure against other risks; others reply high deductibles mean typical events (e.g., $30k surgery) get effectively no benefit.
• There is confusion and then correction over ACA rules: marketplace plans must cover childbirth and have capped out‑of‑pocket limits, but plan choice and network limitations can still be poor.
• Side debate questions whether a $200/month “participation cost” for a smartphone/internet is representative or inflated, as a symbol of rising baseline costs of modern life.

Birth Settings & Medicalization

• Multiple parents describe negative U.S. hospital birth experiences (pressure for induction, epidural, C‑section; high bills) and later positive, cheaper births with midwives at birth centers or at home.
• Advocates say home/birth‑center care with skilled midwives can be safe for low‑risk pregnancies and avoids iatrogenic harm and disempowering hospital culture.
• Opponents call home birth irrational due to the risk of sudden complications and lack of immediate surgical capacity; some tie U.S. infant mortality concerns to such attitudes.
• Overall theme: pregnancy is often treated as pathology in U.S. hospitals, with costly interventions used far beyond high‑risk cases.

Children, GDP, and Demographics

• A thread debates whether children “don’t contribute to GDP”: some emphasize they only consume; others note parental spending and that children become future workers.
• Immigration vs. natalism is framed as an economic choice: importing productive adults vs. subsidizing births.
• Additional factors depressing fertility: car‑seat and car‑size requirements, car‑dependent urban form, housing, education, and tech as growing “participation costs.”

Political & Social Fallout

• Several commenters see unaffordable healthcare and childrearing as creating conditions for extremism and potential “revolution,” with rising cynicism about corruption and “it’s a big club and you’re not in it.”
• Discussion touches on the gap between official poverty lines and realistic living‑wage calculations, and the perception that the U.S. extracts “European‑level” tax/health costs with far fewer benefits.

Workarounds and Individual Coping Strategies

• Proposed tactics: medical tourism (Mexico/Latin America), Christian health‑sharing ministries, negotiating cash discounts, moving to countries with universal care, or designing parallel non‑profit systems.
• Others stress these are patchwork solutions that may work for healthy or privileged individuals but don’t fix systemic pricing or access for the broader population.