I want to push back on the idea that a school and or an obstetric unit disappears because it "no longer makes any economic or practical sense for a community." A hospital closing its maternity ward because it doesn't turn enough profit, or because Republicans decided to strip too many of the patients of their health insurance, is not about what makes sense for the community. It's about what makes "economic sense" for other people, namely screwing that community over.
My impression is that L&D wards are not major profit centers for hospitals so they're less salient to administrators than other kinds of specialities, and if they're serving a small number of births per year, then the level of staffing and resources they require to be ready makes them hard to sustain.
You *can* say, we just want to have them no matter what, and either the hospital or the government should commit to subsidizing this essential service.
But I think you run into the same problems with e.g. the elementary school. If a school built for two classes per grade of ~25 kids each is now expected to serve one class per grade of 15-18, then the capital costs to maintain the building don't work, and neither do teacher salaries.
I understand it's difficult to sustain; my point is that the decision to close it is not based on what makes sense *for the community* but rather on what makes sense for the shareholders or the foundation or the private equity company or whatever (depending on the type of hospital).
I agree with your baseline assessment, these decisions are not made with the community needs in mind. But in addition to finances, it's also a matter of risk management. OBGYNs have high malpractice insurance and need to keep up their skills, and it's hard to do that with a low volume of births. Most OBGYNs also don't want to live in rural communities, and without a few doctors to share the load they end up taking long shifts or on-call rotations which can lead to burnout. So even if communities want to keep their L&D wards, the system is really stacked against them in multiple ways (which I think they also use as a cover for their profit-driven decisions!) It reminds me of Leah's recent piece on SROs; we've eliminated the option for a family doctor to be trained to deliver babies without surgical backup, which means everyone has to go to the large regional care centers just in case they need a C-section. If that care center is a 3 hour drive away? Guess that's just the price you pay for living in a rural area, too bad for you! Hope you don't have a speedy labor!
its easy to underestimate the scale of this and how long it can drag on. But at some point it’s not even a "decision" anymore, it's just unaffordable. Japan’s been consolidating schools, OB-GYN wards, and more for like 25 years now, and it’s still going.
"by 2040, Machida city in western Tokyo plans to reduce the number of elementary schools to 26 from 42 currently, and the number of junior high schools to 15 from 20. Many other cities have similar plans."
That’s another 40 percent drop just at the elementary level. Half-empty schools are super expensive and bad for everyone. Consolidating is way better than burning out a skeleton staff or doubling property taxes on retirees.
California is looking at a 30 percent drop in K-12 enrollment over a similar time frame and we might be able to afford something besides consolidation if really wanted to. If we follow Japan’s path, it doesn’t just stop there though. It can keep going until it’s no one’s choice.
One thing I do see people my age thinking about in their planning for this reality is that they do not factor social security into their retirement plans as heavily as previous generations. Millennials and later seem to realize in greater proportions that social security is a Ponzi scheme dependent on population growth and that the government is headed toward insolvency.
The techno-optimists hope we can make up for this through increased productivity. For me, I lean toward the belief that population may be the sort of thing that works under a negative feedback loop instead of a positive one. If the population begins to decrease, I am hopeful that we will see a meaningful decrease in housing prices that makes younger generations more open to having more children. It will be hard and take a great deal of dedication, however, to overcome the parenting knowledge gap and helicopter culture that is created by small families where teenagers don’t have the conventional experience of helping with small children. (Speaking from experience on that one, as my husband and are both basically only children raising 3+ kids.)
> If the population begins to decrease, I am hopeful that we will see a meaningful decrease in housing prices that makes younger generations more open to having more children.
Sadly, we can look at Japan, about 25-30 years ahead of us on this. Even with a falling population, so far housing prices in cities haven't really drop. Instead, there has been more consolidation, many areas were left behind, and births kept falling. :(
It’s true that there has been consolidation and many areas left behind, but my understanding is that Japanese housing is quite affordable relative to other developed countries when comparing populations density and so on.
Yep, housing is much lower than in other major cities now. But that affordability began well before the population started declining in 2008, after the 1991 crash that ended Japan’s real estate bubble. Tokyo had been among the most expensive markets globally before prices collapsed. It wasn’t a happy transition, and it occurred much too early to credit population decline for the shift.
Just being a Karen here to gripe about degrowth symptoms I’ve noticed recently. Wegmans and chick fil a (chick fil a!!) are phasing out their kid friendly areas and the burger bar to have more workspace / coffee shop vibes for adults.
And baby gates (like for the top of stairs) do not fricking latch well anymore because they’re mostly for aging adult hands with low grip strength who just want to keep their incontinent dog off the carpet rather than saving a rowdy toddlers life.
We have one of the actually hard to open gates still! And we have to give secret tutorials to grandparents and babysitters... or we *did* until our 5.5yo proudly showed us she'd learned. (She's fine on stairs obviously, but they're there to protect her baby brother!)
Never get rid of it! Our old one couldn’t be opened by the seven year old or sometimes by the grandmothers haha but it couldn’t go back in after a painting project and the new one (as well as the three that the grandmothers recently bought) just do not hold up at all!
Worried we lose that sense of being around something new. The last several generations had the biggest movie ever, the most streamed song, a continuous stream of record-breaking athletes, new fields opening up, youth movements that actually moved things. The biggest companies in history appeared almost overnight, market caps and users reaching levels that would have seemed absurd not long before, only to be broken yet again by something even more unimaginable. It has felt normal to expect each year to top the last.
But how much of that was mostly from scale. Billions more people coming online, new markets opening up, a tide that kept lifting everything. If that tide goes out do the records come less often, the peaks stand longer? The great moments start drifting farther back in time, until you’re left suffocating in a quaint nostalgic village or a retirement community talking about soem past golden age?
Even the start of a plateau seems to seriously shake people’s sense of possibility. When facing a steep decline, the impact on the cultural psyche could be rather deep.
I want to push back on the idea that a school and or an obstetric unit disappears because it "no longer makes any economic or practical sense for a community." A hospital closing its maternity ward because it doesn't turn enough profit, or because Republicans decided to strip too many of the patients of their health insurance, is not about what makes sense for the community. It's about what makes "economic sense" for other people, namely screwing that community over.
My impression is that L&D wards are not major profit centers for hospitals so they're less salient to administrators than other kinds of specialities, and if they're serving a small number of births per year, then the level of staffing and resources they require to be ready makes them hard to sustain.
You *can* say, we just want to have them no matter what, and either the hospital or the government should commit to subsidizing this essential service.
But I think you run into the same problems with e.g. the elementary school. If a school built for two classes per grade of ~25 kids each is now expected to serve one class per grade of 15-18, then the capital costs to maintain the building don't work, and neither do teacher salaries.
I understand it's difficult to sustain; my point is that the decision to close it is not based on what makes sense *for the community* but rather on what makes sense for the shareholders or the foundation or the private equity company or whatever (depending on the type of hospital).
I agree with your baseline assessment, these decisions are not made with the community needs in mind. But in addition to finances, it's also a matter of risk management. OBGYNs have high malpractice insurance and need to keep up their skills, and it's hard to do that with a low volume of births. Most OBGYNs also don't want to live in rural communities, and without a few doctors to share the load they end up taking long shifts or on-call rotations which can lead to burnout. So even if communities want to keep their L&D wards, the system is really stacked against them in multiple ways (which I think they also use as a cover for their profit-driven decisions!) It reminds me of Leah's recent piece on SROs; we've eliminated the option for a family doctor to be trained to deliver babies without surgical backup, which means everyone has to go to the large regional care centers just in case they need a C-section. If that care center is a 3 hour drive away? Guess that's just the price you pay for living in a rural area, too bad for you! Hope you don't have a speedy labor!
its easy to underestimate the scale of this and how long it can drag on. But at some point it’s not even a "decision" anymore, it's just unaffordable. Japan’s been consolidating schools, OB-GYN wards, and more for like 25 years now, and it’s still going.
"by 2040, Machida city in western Tokyo plans to reduce the number of elementary schools to 26 from 42 currently, and the number of junior high schools to 15 from 20. Many other cities have similar plans."
That’s another 40 percent drop just at the elementary level. Half-empty schools are super expensive and bad for everyone. Consolidating is way better than burning out a skeleton staff or doubling property taxes on retirees.
California is looking at a 30 percent drop in K-12 enrollment over a similar time frame and we might be able to afford something besides consolidation if really wanted to. If we follow Japan’s path, it doesn’t just stop there though. It can keep going until it’s no one’s choice.
One thing I do see people my age thinking about in their planning for this reality is that they do not factor social security into their retirement plans as heavily as previous generations. Millennials and later seem to realize in greater proportions that social security is a Ponzi scheme dependent on population growth and that the government is headed toward insolvency.
The techno-optimists hope we can make up for this through increased productivity. For me, I lean toward the belief that population may be the sort of thing that works under a negative feedback loop instead of a positive one. If the population begins to decrease, I am hopeful that we will see a meaningful decrease in housing prices that makes younger generations more open to having more children. It will be hard and take a great deal of dedication, however, to overcome the parenting knowledge gap and helicopter culture that is created by small families where teenagers don’t have the conventional experience of helping with small children. (Speaking from experience on that one, as my husband and are both basically only children raising 3+ kids.)
> If the population begins to decrease, I am hopeful that we will see a meaningful decrease in housing prices that makes younger generations more open to having more children.
Sadly, we can look at Japan, about 25-30 years ahead of us on this. Even with a falling population, so far housing prices in cities haven't really drop. Instead, there has been more consolidation, many areas were left behind, and births kept falling. :(
It’s true that there has been consolidation and many areas left behind, but my understanding is that Japanese housing is quite affordable relative to other developed countries when comparing populations density and so on.
Yep, housing is much lower than in other major cities now. But that affordability began well before the population started declining in 2008, after the 1991 crash that ended Japan’s real estate bubble. Tokyo had been among the most expensive markets globally before prices collapsed. It wasn’t a happy transition, and it occurred much too early to credit population decline for the shift.
Just being a Karen here to gripe about degrowth symptoms I’ve noticed recently. Wegmans and chick fil a (chick fil a!!) are phasing out their kid friendly areas and the burger bar to have more workspace / coffee shop vibes for adults.
And baby gates (like for the top of stairs) do not fricking latch well anymore because they’re mostly for aging adult hands with low grip strength who just want to keep their incontinent dog off the carpet rather than saving a rowdy toddlers life.
Smh 😑
We have one of the actually hard to open gates still! And we have to give secret tutorials to grandparents and babysitters... or we *did* until our 5.5yo proudly showed us she'd learned. (She's fine on stairs obviously, but they're there to protect her baby brother!)
Never get rid of it! Our old one couldn’t be opened by the seven year old or sometimes by the grandmothers haha but it couldn’t go back in after a painting project and the new one (as well as the three that the grandmothers recently bought) just do not hold up at all!
Worried we lose that sense of being around something new. The last several generations had the biggest movie ever, the most streamed song, a continuous stream of record-breaking athletes, new fields opening up, youth movements that actually moved things. The biggest companies in history appeared almost overnight, market caps and users reaching levels that would have seemed absurd not long before, only to be broken yet again by something even more unimaginable. It has felt normal to expect each year to top the last.
But how much of that was mostly from scale. Billions more people coming online, new markets opening up, a tide that kept lifting everything. If that tide goes out do the records come less often, the peaks stand longer? The great moments start drifting farther back in time, until you’re left suffocating in a quaint nostalgic village or a retirement community talking about soem past golden age?
Even the start of a plateau seems to seriously shake people’s sense of possibility. When facing a steep decline, the impact on the cultural psyche could be rather deep.