Missing children: can America duck the worldwide baby bust?

Washington Monthly, Dec, 2004 by Phillip Longman

The same is true of American Indians and Asian Americans. Moreover, recent immigrants are also producing fewer and fewer children. They tend to be much better educated than in the past, and to be drawn from countries that are themselves experiencing rapid plunges in fertility.

All this is good news in itself. Fertility correlates strongly with economic opportunity. The more economic opportunity you have, the more you give up if there is a baby on your hip. As more and more members of historically disadvantaged groups get a chance to finish high school or go to college, it's to be expected that their average family size would drop. But there's just one problem. As the trend unfolds, U.S. fertility rates will drop further and further below replacement levels, causing rapid population aging and eventual population decline.

Is the United States prepared to meet this challenge? In many ways, we are more vulnerable to population aging than the oldest nations of "Old Europe." That's primarily because of the extraordinarily high cost and inefficiency of the U.S. health-care system. For example, in the United States, health-care spending per person 65 and over is more than double what it is in Japan, and more than three times what it is in Great Britain. For all this extra spending, U.S. seniors don't enjoy any advantage in health and well-being. Indeed, at age 60, American women can look forward, on average, to 3.8 fewer years of healthy life than their counterparts in Japan, while American men at the same age share nearly the same disadvantage. Says Christopher Murray of the World Health Organization: "Basically, you die earlier and spend more time disabled if you're an American rather than a member of most other advanced countries."

This means that America faces a huge comparative disadvantage when it comes to aging. Only 12 percent of the population of the United States is 65 or older, yet the cost of their health care already amounts to 5 percent of GDP. That's far more than we spend on national defense and equal to about one-quarter of all federal spending. By contrast, in Great Britain, where nearly 16 percent of the population is 65 or over, the cost of their health care consumes only 2.8 percent of GDP. Going forward, this means that the United Kingdom can "afford" far more seniors than the United States can--at least, that is, until the United States adopts something like the British health-care system, which for now seems unlikely.

Wattenberg and I also diverge on what, if anything, should be done to keep U.S. fertility rates from declining further. Wattenberg's roots are in neoconservativism, so one might expect him to have an ideological objection to government programs that would ease the strains on young parents. But instead his objection is practical. "Such programs may indeed be good on their own merits," he writes. "But the fact of the matter is that pro-natalism as a means of seriously boosting fertility has not worked well." But that's not quite right. In Europe, the countries with the most generous family allowance and paid maternity leave such as Sweden, Norway, and France, have much higher fertility rates than countries that offer parents few if any breaks, such as Spain and Italy. Moreover, the idea that government policy can do nothing to influence how many children people have flies in the face of the American experience.