An almost fail

When I came home last night from refereeing a good soccer game, my son was still up.  It was way past his bed time. He was busy being a happy but tired toddler when he saw me.

“Daddy home, JayJay bunny, bunny jumping on Mommy and Daddy bed,  Daddy home!”

He does know how to be adorable as he attempted to avoid brushing his teeth.  The offer to join him in being a bunny was his best alternative to brushing teeth.  Unfortunately, I’m usually  a responsible parent, so the tempting offer was declined. We brushed teeth, sang a song, and he went to sleep fairly quickly.

On a typical night, this would be unexpected only for the time of night. Last night, it was unexpected because he had been sent home from daycare for throwing up, a fever, and odd breathing sounds.  I thought he just had daycare crud.  Daycare crud’s typical treatment is rest, hydration and lots of lap time.   I picked him up after I left work, and we spent the afternoon watching Team Umizoomi, napping, and drinking apple juice. 

And then my wife had several points of near failure in the medical system last night.

We had talked to the pediatrician’s nursing line, and the nurse listened to our symptoms and concerns. She agreed it sounded like a mild viral infection, so rest and apple juice was a good regimen.  We were attempting to utilize the lowest level of care that was appropriate.  However, his breathing became more labored in the early evening, so my wife texted me to confirm that there was a $50 co-pay for any urgent care visits.  Our ER co-pay is $75 and it is waived if there is an admission.   

She made it to the urgent care with 20 minutes to spare before it closed for the night.  She checked in, and within thirty seconds, the nurse had JayJay going to a treatment room as well as getting the physician assistant out of a strep throat examination and hauling ass down the hallway.  Evidently, JayJay was in significant respiratory distress as the day care crud was actually a slow moving mass asthma attack. 

There was a shot, screaming, a promise of ice cream, a nebulizer therapy session, a dose of steroids and a big list of prescriptions.  The doctor told my wife that if JayJay did not respond favorably in the first couple of minutes to the shot and the steroids, he would have called an ambulance for an emergency admission to the local pediatric hospital.  JayJay thankfully responded well and started to play while hooked up to the nebulizer. 

When my wife picked up the prescription list, she was supposed to get a one way valve chamber for the inhaler as a 2 year old can’t use an inhaler well.   She did not receive it.  The pharmacist never asked about it, and my wife thought that she had received everything she needed and brought the kids home with her. I arrived home shortly after that.

His treatments at the urgent care will probably cost my insurance $400 or $500 and the prescriptions another $150.  We’re just responsible for the co-pay as urgent cares are seen as an emergency room diversion, so they don’t count to deductible for my company.

As I was putting the kids to bed, my wife was on the phone trying to get the one way valve chamber from the same pharmacy where we got three prescriptions forty minutes ago.  Finally, the pharmacist realized the one way valve chamber was on a different page of the electronic prescription screen, and said it would be available for pick-up, so out the door my wife went. 

JayJay slept well enough overnight, even as he received two treatments while he was still asleep.  He’ll stay home today and see his regular pediatrician by lunchtime and then get his ice cream and playtime with mommy.

Besides hooking myself up to a caffeine drip this morning, I realized how lucky we were last night as there were at least two points of near failure in the problem of delivering appropriate, effective and reasonably priced care to my son. 

The first point of near failure was the co-pay almost deterred my wife from taking him to the urgent care clinic.  $50 is something that we can handle, thankfully, but it is a strong stop and think number.  $50 means, for us, we don’t take the kids out to dinner this week, it is not a budget breaker and it is not a crisis.  Three years ago, $50 was a painful choice, and five years ago when I was unemployed, $50 was a potential crisis.  Trying to save $50 probably would have led to an emergency room visit later last night as he would have started to turn colors.  Once everything was done for him at the ER, we would probably be looking at $2,000 in contracted rate charges.  Waiting and seeing would have been a $1,000 bill between deductible and co-insurance for us, and a $1,000 charge for my company.   

The second point of failure was a miscommunication between the provider and the pharmacy.  We should have received the one way valve chamber device initially, and it was prescribed initially.  We got it as my wife was able to drive 20 minutes at 11:00pm and get it.  If we did not have a car, we would have been screwed as JayJay would not have received anything close to an effective dose on his overnight treatments.  The lack of a $14 piece of plastic could have led to a $2,000 ER visit. 

We got lucky last night.  We have resources of money, a working car, and shared parenting so one of us could get the kids asleep while the other one spent an hour fixing a mistake.  A high first dollar health plan (which is where the entire US system is going) for parents’ who lack one of the above conditions would have made a scary but very fixable situation into a significant crisis on the medical and financial side. 

 

107 replies
  1. 1
    Betty Cracker says:

    Glad the kid is okay! And yeah, every time I’ve had to deal with similar incidents, I thank my lucky stars for the resources I have and remember how much harder it was for my mom, a single parent who was broke most of the time, to deal with minor and major crises.

  2. 2
    aimai says:

    Thanks for posting this. I had the same experience, years ago, and had to take my then very young daughter (maybe three?) first to the ER and then by ambulance to Children’s Hospital. A very chaotic, frightening, and costly event which I didn’t even bother to cost out in advance and which included, over several days and the actual hospital release, some major points of incoherence in the system. Including the fact that the Hospital releases you with a prescription (and everyone gets the same prescription) which the pharmacies *don’t carry* so you can’t easily get it right away. Single moms, people without cars, people without extra money, are screwed right at the moment that their children are most vulnerable to relapse.

    A new mother in my new mother’s group just had her 11 month old end up in the ER with peanut allergy. They are in a high deductible plan and her *&^% husband is refusing to meet with the pediatrician to discuss the allergy issues going forward because it will “cost too much.” Its crazy that infant and child care comes under these deductibles at all. It would be more cost efficient to deal with the occasional over-user of medical personell with counseling than to force everyone to penny pinch and make their own diagnoses. This baby girl, with the peanut allergy, could die because her father can’t/won’t inform himself of the issues.

  3. 3
    aimai says:

    This also makes important reading with the Radley Balko article in the WaPo about the criminalization of being poor and black in Missouri. Basically when people are forced to live so close to the poverty line, and transportation (cars and public areas) are turned into possibilities for criminalization by the authorities people are going to be fined out of existence by unexpected costs like 1) driving to the hospital ER and 2) needing to fix errors by driving twice to the place where people go to buy stuff that the computer is moderating me for mentioning.

  4. 4
    horatius says:

    But you are forgetting how the system would have taught you the vale of hard work and pulling yourself up by your bootstraps. Or something.

  5. 5
    JPL says:

    Hopefully, today your son will feel better. The working poor have trouble putting food on the table, never mind paying for out of pocket health care expenses. The governors who blocked medicaid expansion in their states, are often the same who are worried about the poor little fetuses. Once you are a toddler, you are on your own.

  6. 6
    Tommy says:

    First happy your child is OK. You said:

    We got lucky last night. We have resources of money, a working car, and shared parenting so one of us could get the kids asleep while the other one spent an hour fixing a mistake. A high first dollar health plan (which is where the entire US system is going) for parents’ who lack one of the above conditions would have made a scary but very fixable situation into a significant crisis on the medical and financial side.

    I am so happy you and others write about these things. I tell this story. My mom was in the ICU for a month last year. Three operations. Guess what my parents paid in medical bills. Zero. Oh and his health care is government provided via his military service of 30+ years.

    I noted to my Republican (although pretty moderate) father isn’t this something everybody should have? What would be the cost to somebody that didn’t have the stellar insurance you have. $100,000. $250,000. Or more.

  7. 7
    WereBear says:

    @JPL: The governors who blocked medicaid expansion in their states, are often the same who are worried about the poor little fetuses.

    That’s because, and they say this out loud, those fetuses are the consequences of SIN and they don’t want to pay for it.

    See, there isn’t any morality operating there at all. It’s about power, which translates into money, and if you don’t have any, they don’t think you should live.

  8. 8
    Patricia Kayden says:

    Happy to hear that your son is okay. I feel you about the co-pay. My co-pay is so high now that I delay getting prescriptions filled. I’m definitely going to get a different insurance at the end of the year.

  9. 9
    Elmo says:

    When my wife and I first got together she was a single parent to an asthmatic child. One day the child’s school decided it would be a good idea for the children to run laps, even though there was a wildfire burning close enough that the air was thick and brown with smoke.

    That night when she turned blue, I became the ambulance driver taking her to Children’s, because my then-gf’s car wasn’t reliable and probably wouldn’t have gone fast enough.

    The child was in Children’s ICU for four days. Naturally my gf lost her job, because this was before FMLA. They ended up moving in with me, because no job meant no rent money.

    I didn’t mind, of course, and we had talked about doing so anyway – but if they hadn’t had me to fall back on?

  10. 10
    Betty says:

    The system is broken – period!

  11. 11
    Betsy says:

    I agre with all that has been said and I believe we live in a ridiculous society for parents and children.

    Having said that, people do bear some responsibility for trying — at least trying — to delay having children until they have a car, a job, and some money in the bank.

    Disasters, bad luck, bad health, and calamities happen, and we absolutely shouldn’t be a society where bad luck or sick kids means household disaster.

    Having said that, people should hold off having even one child until they have completed their education or job training, have a stable job, and some emergency money in the bank.

    If we do this, we might get frustrated at the lack of good stable jobs, and the lack of good public education and job training, and the way that the bankers rip us all off — but maybe we would have a nation of activists and union members, if instead of popping out kids they have no hope of supporting, people would use their time and energy to militate for better conditions for workers and families.

    I’m a flaming, bolsa-familia supporting, socialist liberal, AND YET, people should not be idiots and have children they can’t afford.

    I realize there are exceptions, unforeseen disasters, and financial crises that catch the best planners, and many mediocre planners.

    But I know plenty of households whose BIGGEST problem is preventable, which is that they furnished themslves rapidly before age 25 with four children, not the first of whom they could afford to rear.

    Let the pushback on my comment begin.

  12. 12
    Schlemizel says:

    @WereBear:
    According to the Bible all sickness is the result of sin! We really should outlaw the practice of medicine and replace it with a laying on of hands & anointing with oil. Doing otherwise is violating Gods will it seems to me.

    Few things scarier than your kid being seriously sick. I was a trained first-responder but still when my baby had a fevoral seizure I was panicky. Glad things went so well for you & yours RM.

  13. 13
    I'mNotSureWhoIWantToBeYet says:

    @Betsy: Real life isn’t a theory.

    :-(

    My wife and her twin were born when her mother was 42. She (J) spent a month in an incubator. Growing up, she worried about her parents constantly because “they were so old”. But they were Ok financially.

    There’s (almost) never an ideal time to start a family. When the body is most suitable, there’s little money and security. When there’s money, there’s little time and energy.

    People do the best they can with the lives they’ve got. Even when they make what might seem to be stupid choices, it doesn’t mean the result would have been better had they chosen differently.

    “… other man’s shoes…” comes to mind.

    My $0.02.

    Cheers,
    Scott.

  14. 14
    MomSense says:

    Wow this brings back bad memories of a trip to FL and a bad asthma attack that meant our then 5 year old spent half if our vacation in the hospital. The pharmacist there also filled a prescription incorrectly and if I hadn’t been paying attention would have given him enough of a steroid dose to cause heart failure.

    Until then we had been very spoiled because the pediatrician lived down the street. He would come over and treat my son and watch star wars with the kids while I supplied chocolate chip cookies hot out of the oven. Hope your little Bunny feels much better and you can all get some rest today.

  15. 15
    OzarkHillbilly says:

    Glad the boy is OK.

    How well I remember the fears and choices of being poor with children, especially when one is asthmatic. That younger one like to kill me with his health issues. First the asthma, then he got run over by a car (out of the hospital before the car was out of the shop), almost lost his leg to a MRSA in his femur (4 days ICU/isolation) etc. Fortunately, by the time he was 4 I was working union and had insurance. The bills for the MRSA (the bad old early days when they knew next to nothing about it) was well over half a million, I am sure, as the antibiotic alone was $60,000 a week for 6 weeks and was administered thru a PIC line.

  16. 16
    Orphos says:

    @Betsy Give everyone free birth control that is _completely_ accessible, abortion-on-demand that is locally accessible, and proper non-shaming of rape victims before we start blaming people for having kids?

    (I’ll also be accepting a pony.)

  17. 17
    Patricia Kayden says:

    @Betsy: How about if we become a country where everyone has access to affordable healthcare and don’t have to worry that a sick child could lead to a financial crisis? I grew up in Canada and was a chronic asthmatic — some nights my parents had to take me to Emergency more than once. But because of Canada’s wonderful “socialist” healthcare system, my parents were never financially harmed by my illness.

    My sister has two children with disabilities and lives in Canada. No financial crisis due to their illnesses. That’s how civilized countries should operate.

  18. 18
    Cervantes says:

    @Betsy:

    Let the pushback on my comment begin.

    I don’t really see why there should be any.

    (I suppose one should throw in a caveat or seven about the availability of sex education, contraceptives, abortion, pre-natal care, and the like.)

  19. 19
    rikyrah says:

    Glad the baby is ok.

  20. 20
    Cervantes says:

    @Patricia Kayden:

    How about if we become a country where everyone has access to affordable healthcare and don’t have to worry that a sick child could lead to a financial crisis?

    Sure, but children require not only health care but other things as well, many of which cost money. A little family-planning will not avert every financial crisis but it can help.

    Of course, one could ask how many children really are unplanned — I don’t have useful numbers at hand.

  21. 21
    Tommy says:

    @Betsy: I actually kind of agree with you. My parents 48th wedding anniversary was the other day. I call them to congratulate them. I joke to my father they waited four years to have me. Said what was up with that. He said, and this is a direct quote, “we didn’t have any money.”

  22. 22
    Omnes Omnibus (the first of his name) says:

    @Betsy: Define “can’t afford.”

  23. 23
    OzarkHillbilly says:

    @Cervantes: My mother had 7 children (like a good Catholic) Only one of them was planned.

  24. 24
    From Both Sides of the Pond says:

    @Betsy: Given the nature of today’s economy, a shockingly high percentage of our society would never qualify for what seems to be a common-sense prescription here. Given the efforts of many employers to keep their employees stuck on just-getting-by wages, is it really fair to demand people wait the 5, 10, 15, or 20 years it might take to gain a financial stability that our economy may not make possible? My wife and I waited until our mid-thirties to have kids for just that reason – and doing so not only put us at higher risk of health problems for our kids, but destroyed my wife’s health due to having our second child so late. The irony is that that financial stability in my line of work (academia) never did arrive, though certainly not for lack of trying.

  25. 25
    Schlemizel says:

    @OzarkHillbilly:
    I’m an atheist with 3 kids, 1 of which was planned, 1 is an IUD baby & 1 arrived after the vasectomy

    There is an old Prussian military saying:
    “All planning is for not when an angel pisses in the touch hole of your musket.”

  26. 26
    raven says:

    So glad the little dude is ok.

    I guess I should feel guilty that we have health insurance on Bihdi the dog and they are going to pay 80% of a broken tooth extraction tomorrow.

  27. 27
    Roger Moore says:

    @Betsy:

    Having said that, people do bear some responsibility for trying — at least trying — to delay having children until they have a car, a job, and some money in the bank.

    Great, but that means you’d damn well better mandate contraceptive coverage as part of the healthcare system.

    ETA: @Cervantes:

    Sure, but children require not only health care but other things as well, many of which cost money.

    Sounds like we also need to make sure of the availability of an honest day’s pay for an honest day’s labor. Time to raise the minimum wage and start fighting to make sure that employees actually get 40 hours a week.

  28. 28
    Scratch says:

    It seems to me as far as the idea of people waiting to have babies until they are financially secure enough, that’s something that should be covered as a topic in a good sex education program at schools, with a unit about the costs of having a baby and raising children. Then provide free or low-cost birth control to people who wish to be sexually active.

    People aren’t too likely to stop having sex. We need to find reasonable ways of education and material supply to help people actually have reasonable options to have sex and not have babies until they are financially secure.

  29. 29
    big ole hound says:

    @Betsy: Absolutely. I wonder at the 9 months after disaster birth surge too. I guess when we huddle together the idea of contraceptives escapes way too many.

  30. 30
    Barbara says:

    @Betsy: There’s a fair bit of sociological research on why teen girls living in poverty might want to have babies even though they don’t have a husband, money, or a job. In many respects, it can actually make some sense.

    As I remember it, one of the reasons was that their mothers (the grandmothers) were more likely to step in and help with the child-rearing if the mother was a teen than if the mother was older; another reason was, having a baby doesn’t prevent you from going to college if you weren’t going to go to college in the first place. There were other reasons but I can’t recall them. I imagine they are easily googled.

    We have a huge number of poor people in this country, considering we are industrialized and developed. Something like almost a quarter of our children live in poverty. It’s a feature, not a bug, of how we have things set up (Please note that I am not endorsing this set-up, just describing it).

    Even if we could wave a magic wand, and every person in poverty immediately adopted middle-class values, they would still have very few resources and very few prospects. To be a twenty-four year old working poor mother isn’t going to be better than being a sixteen year-old mother, and probably worse in ways if you don’t have your mother as your right-hand.

    I agree that we should be all fighting to make things better but I think you put the cart before the horse. Make things better (as the example of families in Canada not having to worry about providing their children with health care) first, then see how things shake out.

  31. 31
    MomSense says:

    @Schlemizel:

    Yup I’ve got a birth control pill baby myself. It happens.

  32. 32
    MomSense says:

    @Barbara:

    Another feature not bug of our society is that people are not as solidly middle class as they think. You can be humming along raising your kids and a couple of bad things happen and blammo you are now scrambling and raising kids without adequate financial resources.

  33. 33
    raven says:

    @Barbara: I agree. My bride works at the health department with the WIC program and breastfeeding. The issues surrounding teen moms are very complex and don’t lend themselves to scolding.

  34. 34
    D58826 says:

    @Betty: The system isn’t broken, the people who control it are mortally bankrupt. Since by good fortune they have the resources necessary to smooth out life’s speed bumps they assume every one else does. Anyone w/o those resources is obviously defective in some way and they are simply getting what they deserve. While waving their Bibles they have obviously not read the part where Jesus’ said ‘what you do to the least of my brothers you do to me’.

  35. 35
    maurinsky says:

    I got pregnant while using birth control when I was 18, and still Catholic enough that I couldn’t consider abortion. I thought about adoption, but Catholic Services treated me so shabbily that I couldn’t conceive of letting them decide where to place my child. I didn’t have enough money, I had a job, but nothing in the bank, and no insurance, either. I left the hospital with over $7000 in medical bills, which is probably a lot less than it costs to have a baby these days. It took me 8 years to pay it off, which I did, and I finished paying for it while I was pregnant with my planned 2nd pregnancy.

    I most certainly did not want to get pregnant, but I did, as do plenty of other people who are using contraception. In my case, the same doctor who prescribed my bcp also prescribed me an antibiotic without telling me that it could render the birth control ineffective. (She emphasized that I should not stop taking it when I felt better). It was my responsibility to read the whole packet, but I skimmed it, like so many people do. I made the best of things. It was not easy, but it was not a disaster, either. My daughter was and is awesome, she was a great student, she got a very close to full tuition scholarship to college, and is now teaching and writing.

    I believe that we as a society have to have a contingency plan because you can’t stop people from having sex, and we can’t mandate that people have common sense, either. Plenty of people with plentiful financial resources are crappy parents, and we have to have the common sense to deal with the reality that people will sometimes have children at the not most advantageous point in their life, and have a system that will ensure that the crisis described in the post doesn’t turn into a disaster. Are we willing to throw the lives of children away because someone didn’t exercise common sense every minute of their lives?

    As far as waiting until you’re financially secure – I’ve been gainfully employed for 24 years now, and I’m not financially secure. I have had 3 2% raises in the past 13 years. It’s not enough. I pay my bills, don’t use credit cards, but I have enough money to do that, go to the grocery store, and have a cheap camping vacation every other year or so.

  36. 36
    Original Lee says:

    @Betsy: Emphasis on “try” and it sounds all reasonable until you look at your base assumptions, and then it starts looking uncomfortably like some other social engineering ideas of recent history. Gosh, if the working poor just wouldn’t have children, then we wouldn’t have any more poor people.

  37. 37
    David in NY says:

    God, you bring back awful memories. Our kid was 4-5 and was in distress, saying his “stomach hurt,” all day. He was just lethargic and feeling terrible. Finally, my wife hauled him off to the nearest emergency room, where, as in your case, the nurse whisked him out of her arms and said, “This boy is having a full-blown asthma attack.”

    The emergency docs were great, but the follow up by our own pediatrician in the next year or two was really awful. He was using outdated methods and medication that were hard to administer and had potential side effects and the result was repeated emergency visits. Finally, on vacation we had an episode, went to a nearby clinic in the country in Maine and were informed of modern approaches to treatment, like those your kid got. Our doc referred us to a specialist, and after a little while our boy was very well controlled and no more emergency visits, though on routine meds for quite some time. (I remember having to throw an inhaler to him as he came down the sideline on the soccer field.)

    He’s thirty now, has no routine asthma (exc. shortness of breath while riding his bike in Minnesota winters, duh), and it’s all over.

    But I feel that it was 1) really bad parenting on our part not to have recognized his distress earlier and 2) also bad not to have questioned our doc about his treatment plans (esp. given raised eyebrows at a party w/ many docs present when I explained our difficulties). All’s well that ends well, I guess, but sometimes things can get really screwed up.

  38. 38
    ThresherK says:

    I have previously lauded your coverage of healthcare here.

    Talk about a virtue born of necessity. Good for your son to have you both for this situation.

  39. 39
    David in NY says:

    Let me add to above story that this was 25 years ago, my wife and I both had full, low co-pay medical coverage, there were few if any urgent care places, the kid always got sick when the doc was away, and yet we paid nothing (that I recall) for what must have been very expensive emergency room visits.

  40. 40
    Emma says:

    @Betsy: And what about people who have the job, the house, have the kids and then lose it all? I live in Florida, the ground floor of the Great Economic Madness of the 90s and 2000s. Plenty of responsible people stranded and hurting.

    What about people who never had the opportunity for a great job and the ability to save for a $90,000 shack? Should people not have a family and a life because they work in retail, or fast food, or many many of the minimum wage jobs that seem to form the basis of the new economy?

  41. 41
    Violet says:

    So glad your son is okay! I completely agree that cost decisions will delay accessing medical care. Did it myself this year. Delayed a recommended exam because at the first of the year money was too tight. In the long run this can’t be a good way to deliver health care.

    @Barbara: I saw something recently that there seems to be a direct relationship between the advent of shows like “16 and Pregnant” and a reduction in teenage births. They think seeing what the girls have to go through is good birth control. Don’t know if that’s true or not–just what I read.

  42. 42
    Betsy says:

    @Omnes Omnibus (the first of his name): can’t provide them with food, can’t give them toothpaste or toothbrushes, can’t provide sleeping quarters, can’t provide anyplace to do schoolwork, has no working vehicle, lives 10 people to a three-bedroom house,

    @I’mNotSureWhoIWantToBeYet: I’m not talking about theory, or your parents-in-middle-age inlaws who Did Just Fine. I’m talking about the above.

    @From Both Sides of the Pond: agree. Need a revolution for jobs and security for working and Mille income people. That would go a long way. Agree that everyone should not have to wait forever.

    Free on demand birth control would be a start

    For those who point out that Accidents Happen, i agree. I believe i mentned this in my post and that the best-laid plans oft gang agley. But I’m talking about the 80% of the problem that could be dealt with despite random accidents.

    For the one commenter who said I’m veering close to eugenics — no. Just no. Go take your slippery fucking slope somewhere else. Social engineering is when you deny women reproductive access, which is what we have now.

  43. 43
  44. 44
    Cervantes says:

    @Betsy:

    For the one commenter who said I’m veering close to eugenics — no. Just no. Go take your slippery fucking slope somewhere else. Social engineering is when you deny women reproductive access, which is what we have now.

    The concern came from a good place but the reading of what you wrote was … inadequate.

  45. 45
    Betsy says:

    @From Both Sides of the Pond: agree. I encountered a similar problem, but much worse in my case. We absolutely need a financial and social system that does not force responsible people into unwiling non-parenthood.

    The terms of ordinary employment in this country, and the stagnation of wages, are appalling.

    There are disadvantages to delaying childbearing, just as there are disadvantages to too early childbearing,

  46. 46
    Omnes Omnibus (the first of his name) says:

    @Betsy: So do you suggest that people receiving government benefits not have children?

  47. 47
    Betsy says:

    @Cervantes: ‘K, fair enough. Thanks.

  48. 48
    different-church-lady says:

    @Roger Moore:

    Great, but that means you’d damn well better mandate contraceptive coverage as part of the healthcare system.

    You do that and you dismantle the entire social resentment system wingnuts rely on for their daily emotions.

  49. 49
    Barbara says:

    @MomSense: Yes to this.

    I’m a stay-at-home mom. I wasn’t planning on not going back to work but our kid (who we waited to have until we were “ready” in Betsy’s terms) has a disability. Between having to be available for school meetings, ferrying him to his various after-school appointments, not being able to avail myself of the sorts of childcare options open to families with typically-developing kids, etc. — well, I haven’t the imagination to come up with what sort of paying gig would accommodate all that and fit my particular skill set.

    It’s always in the back of my mind, what happens if my husband loses his job and can’t find another (at his age, which is a drawback in his field). I can’t help but think of all the “Betsy” types who will be tsk-tsking the poor decision my family made when we decided my time was better spent helping our kid reach his fullest potential rather than having me work to double-insure our financial stability. Sometimes life does not hand you clear-cut good/bad options.

    That isn’t to say that I don’t know a few families that made one bad decision after another, similar to the “preventable” problems of Betsy’s acquaintance. Some of those families are now in dire straights as a result, some of them are still fine, nevertheless, because of fortuitous circumstances that let them weather their mistakes without too much long-term harm. In other words, they had dumb luck on their side, not any special virtue.

  50. 50
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  52. 52
    JordanRules says:

    I think 1%ers who can afford to have all the babies should stop cause I’m frustrated our society is so fucked up. And their kids usually make it harder for the rest of us to do “family planning”, aka common sense constructs of a society worth a damn.

  53. 53
    Betsy says:

    @Barbara: please don’t attribute or project anything to me that I did not say. Tsk tsk-ing? No.

    I’m trying to have an empirical view on the problem, not to shame or tsk tsk.

    “All the Betsy types “? In other words — you are blaming me for your unstated assumptions about a purported group that you postulate I belong in? Now *that* is unfair, as well as poor argumentation.

  54. 54
    MobiusKlein says:

    Should there be some manner that deductibles can be waived for true Urgent Care cases?

    Seems the insurance company would want you to go Urgent, rather than Emergency Room. If you can call their hotline, and they say ‘come on down, you have a real problem’, but catch it before it’s an ambulance trip, they pay less out of pocket.

  55. 55
    Aimai says:

    @Barbara: this. A necessary corrective to betseys well meaning bullshit slut/poor family shaming. People who are always going to be poor don’thave the luxury of waiting until they are upper middle class and white (or not living in missouri) to have kids. People HAVE jobs, have cars, have some assets before they have kids and kids are still at risk of pushing their parents into poverty after the original decision was made to have them. If you are financially marginal one speeding ticket rushing your kid to the hospital and having your AA husband arrested for driving while black could cost you your hard won financial independence. Get off your fucking high horse about other peoples reproductive choices and stop being so classist and judgemental. Or educate yourself about the real situation in this country. Middle class white people have all kinds of ways to cost shift family costs onto others that poor people dont from heslth insurance to the mortgage deduction to good schools, safe neighborhoods, and deference from police and medicsl professionals.

  56. 56
    Richard Mayhew says:

    @Betsy: there is no such thing as a value free empirical argument once you connect “IS” to “should” or “could”

    We can state, value free, that the sky is blue and rain is wet but as soon as you say that someone should have an umbrella when it rains, you’re bringing in a massive set of assumptions and values to an empirical judgment that it is raining right now.

  57. 57
    Emma says:

    @Betsy: If you wanted an empirical discussion then you should have stated the problem differently.

  58. 58
    Barbara says:

    @Betsy: Okay Betsy, that’s a hugely dysfunctional family, arguably even more dysfunctional than the ones in my circles, who make me want to tear my hair out. I tried getting one of these moms to work as a respite provider for my kid — I offered her a part-time job! — and she couldn’t get it together to fill out the paperwork. It is frustrating and sometimes enraging to witness such helplessness and havoc.

    But your plan, to have everyone to behave properly, so we will see that their misfortunes aren’t their “fault” and then it will be so obvious to all that we need to raise the minimum wage (that’s my version of “shorter”), that’s not going to work. For all sorts of reasons, not everyone is going to be as functional as we would like, even people who share our middle-class values (and as I pointed out before, there are all sorts of reasons for other value systems).

    I do agree that it would be best if we could all find it in us to use our “time and energy to militate for better conditions for workers and families.” That’s what ACORN was about, and Occupy, too.

  59. 59
    Roger Moore says:

    @different-church-lady:

    You do that and you dismantle the entire social resentment system wingnuts rely on for their daily emotions.

    Cue the world’s tiniest violin.

  60. 60
    Original Lee says:

    @Betsy:

    Having said that, people do bear some responsibility for trying — at least trying — to delay having children until they have a car, a job, and some money in the bank.

    Having said that, people should hold off having even one child until they have completed their education or job training, have a stable job, and some emergency money in the bank.

    What part of these two quotes did I not read correctly? In today’s society, there are people who will never hit those benchmarks, ever, with or without kids. In the context of your entire comment, I plump for financial Darwinism, not eugenics.

  61. 61
    Cervantes says:

    @Aimai:

    People who are always going to be poor don’thave the luxury of waiting until they are upper middle class and white (or not living in missouri) to have kids.

    Sure.

    And do you think they ought to have one child? Two? Five? Ten? Does each additional kid make it harder in any way to raise those already born? Is there a point at which you’d be ready to conclude that they’d be unwise to keep having additional kids?

  62. 62
    Betsy says:

    @Emma: yes, there’s that, as my original comment noted. I didn’t say it would solve all problems, quite the opposite was my express statement.

    But reducing the number of kids born to utterly unprepared people would help the majority of situations.

    How can we do this within a framework of liberal values and a social justice economy? Is what I’m asking. We have to have something to offer.

    Lot of straw men in the responses (, though many more took my comment just as it stands). Too many starw men to rebut individually. I’m not for eugenics (for fucks sake!), and I do think we need to move forward with jobs and health care for all, etc.

  63. 63
    Violet says:

    I don’t think what Betsy is saying is all that controversial. When it happens in other countries we applaud it. From the UN:

    Higher levels of education, particularly among girls, had a strong correlation to declining fertility and better development outcomes, delegates and experts said today as the Commission on Population and Development continued its forty-fourth session.

    “More education translates into better health outcomes in all societies,” said Abulkalam Abdul Momen ( Bangladesh), Vice-President of the United Nations Economic and Social Council, as he opened the Commission’s general debate on the contribution of population and development issues to the theme for the Council’s 2011 Annual Ministerial Review. He added that educated women were better able to plan their families and more aware of employment, schooling and health opportunities for themselves and their children. On a wider level, fewer children in a society meant that more resources were available to every individual child, he said.

    Family planning means more resources available for the kids the women do have. That’s not really controversial.

  64. 64
    Aimai says:

    @Emma: to me betsy’s argument is analagous to the “rape victims brought it on themselves” style arguments that (sometimes well meaning) parents and administrators make. Of course its true that an individual woman can lower her personal risk of being raped by never going to parties, drinking, going out of the house, having any male relatives or friends who are rapists….etc..etc…etc… But aside from the absurdity of arguing that women should live tbeir entire lives fending off rape risk when one woman does so it is not a solution for the entire society. In fact one woman–or many women–withdrawing themselves from the pyblic sphere actually increases the risk to other women since it cedes the pyblic realm to men and the subset who are rapists. Similarly the “advice” to unnamed and imagined “bad parents” to “hold off” on having kids until the economy can support a midde class two parent educated family model is good, and well meaning, when aimed at a specific person but does nothing to enable people from structurally and institutionally disadvantaged communities from attaining the desired status and stability. And some of the people you are so cavalierly lecturing will end up pregnant, or with a special needs child, or fostering or adopting someone else’s child at personal expense, so that through no choice of their own they are no longer free to pursue an ayn randian/ libertarian vision of perfect individualism and middle class success.

  65. 65
    Betsy says:

    @Aimai: come on, aimai. I read your comments first of anyone’s on this site. That hurts.

    You are a superb reasoner. But work with me here. I’m trying to explore a problem, not judge, shame, slut-tsk or whatever.

    I have a fair amount of hands-on experience with this, too — I can assure you I’m not looking at the problem from inside a gated community and I am trying to help by directly mentoring of poor children. No, I do not shame their parents. Just come off the reaction PLEASE because I respect what you have to say.

    It’s OK to say “should”. Some choices are better than others!

    How can we promote better choices? Within the context of liberal values and social and economic justice, and above all, women’s rights.

  66. 66
    maurinsky says:

    I think the family planning that other countries engage in is laudable, and I would love it if no one in this country had a baby without planning for him or her.

    This is not possible in our nation, and in fact it is getting more difficult for people to plan their families.

    So I think the short answer is that while it would be ideal for people to wait until they are educated, have a job and money in the bank, it is a pipe dream in the current United States.

  67. 67
    Betsy says:

    @Aimai: I agree with all of that, except the idea that I am lecturing, and all of the stuff you attribute to me that was not in my original observation.

    Can what you say in your last comment be valid, and yet — still, some people greatly hurt themselves and their children’s futures by acting terribly, terribly irresponsibly?

    How can we help these people make better choices, AND preserve their autonomy and equality? You say the answers I tend to agree with.

  68. 68
    Aimai says:

    @Cervantes: i think that judging other people is americas favorite sport but its not a useful act of social engineering or social justice. If you want people to have fewer children and also fewer costly sick or special needs children lecturing them, shaming them, calling them failures or selfis or stupid is literally the most counterproductive thing you can do–saying “im a liberal” while dojng it doesnt make it effective. We know what lowers out of control population increases: female education, expansion of opportunity, free contraception, free prenatal care, extensive free child and parenthealth care so that families can maintain work while caring for children and elderly.

    If tou had all that stuff in place the number of the fantasy enemy “poor women chhoosing to have too many children” would vanish as a priblem. The truth is that the numbers betsey is pretending to have on her sude dont exist. Poor women are not having four annd five kids. They are having one or two at different and earlier times than upper class women. They are time shifting their childbearing years because they have to (accident) or because it makes sense for them to do so. Change the overall picture in terms of resources and life chances and teen pregnancy will drop–in fact it has droppped significantly in the last few years. Betsey is just peddling an old moral panic that has no relation to the real causes of poverty in this country.

  69. 69
    Betsy says:

    @Original Lee: well, then I guess I am a victim of financial Darwinism.

    At least now you can’t accuse me of not knowing how it feels.

  70. 70
    Cervantes says:

    @Violet:

    I don’t think what Betsy is saying is all that controversial.

    Well, clearly, it is, here, at the moment. But I agree: it should not be.

    @Betsy:

    How can we promote better choices? Does anyone want to talk about that?

    Obvious answer: Educate our girls; work to give them access to tools they can use.

    Presumably there are better answers not immediately obvious to me.

  71. 71
    PJ says:

    @Betsy: You talk about having children as if it were the same thing as buying a pet. You can work for minimum wage at two jobs all of your life and still be financially unstable in this country. Your advice boils down to “poor people should not reproduce.”

    In any event, these same medical financial issues can afflict anyone without children, as well. All too often, what would have been minor medical issues become major ones because people have no insurance or have to weigh whether they can afford co-pays and deductibles.

  72. 72
    Betsy says:

    @Aimai: thanks for all the straw men, and for the personal attacks. Good Lord. Your material is usually so eloquent and irresistibly logical, and I have greatly admired what you write. So your attacks, they really hurt and suck, and boy am I sorry you found that necessary.

  73. 73
    Diana says:

    @Betsy: this is a most ancient debate. I’m with Betsy, but only because this planet is at 7 billion people and counting. What with global warming and all, we could wind up with a population crash.

    Should today’s poor not have children because previous generations had too many? A lot of people here will say no. People have a right to have a family, and it’s victim-blaming to say otherwise.

    But look at this debate in terms of global warming: by carbon loading our atmosphere, we have irrevocably f*cked future generations. So if you think past f*ck-ups shouldn’t be visited upon the children, you had better be a most rigorous climate hawk. Because otherwise you’ve agreed with Betsy, whether you are honest about it to yourself or not.

  74. 74
    Violet says:

    @Betsy:

    some people greatly hurt themselves and their children’s futures by acting terribly, terribly irresponsibly?

    They sure do. When people drink and drive, if they get caught we say they were stupid, made bad choices, have a problem, are irresponsible.

    @Aimai:

    i think that judging other people is americas favorite sport

    It’s the world’s favorite “sport.” People judge other people. That’s the human condition.

  75. 75
    Cervantes says:

    @Aimai:

    OK, if my question to you was not helpful, we can ignore it.

    Moving on …

    The truth is that the numbers betsey is pretending to have on her sude dont exist

    I rarely know what anyone is “pretending” so I’ll leave that aside — and I did not read Betsy negatively at all — but I agree that one should have reliable numbers before urging this or that course of action, hence my earlier caveat.

  76. 76
    Mnemosyne says:

    @Betsy:

    can’t provide them with food, can’t give them toothpaste or toothbrushes, can’t provide sleeping quarters, can’t provide anyplace to do schoolwork, has no working vehicle, lives 10 people to a three-bedroom house,

    Frankly, though, a lot of the time there are major underlying problems going on in a family like that. My nephew’s father grew up in that kind of chaotic family situation, and it turned out that there’s severe ADHD and bipolar disorder running through the family (both of which have a strong genetic component), but he didn’t get diagnosed until he was in his mid-30s and had already been to prison multiple times. When you have family members with mental illness, or addictions, or physical illness that affects their thinking (like epilepsy), that’s going to affect decision-making in a really major way.

    So it’s easy to say, They shouldn’t have children until they’re ready, but a lot of the time, they are medically incapable of making a rational decision like that without serious support, but because they went to crappy schools and lived in crappy neighborhoods, they were never diagnosed or treated, so they just continue the chaos through to the next generation and beyond.

  77. 77
    Roger Moore says:

    @Betsy:

    You are a superb reasoner. But work with me here. I’m trying to explore a problem, not judge, shame, slut-tsk or whatever.

    Maybe that isn’t your intent, but it has been your effect. Giving advice is all well and good when you’re giving it to a specific set of people who are still in position to avoid the problem you’re trying to save them from, but it goes off the rails when you turn it into a general pronouncement. In that case, you’re inevitably going to be including people who have already suffered from whatever you’re trying to steer them clear of, and you’re implicitly blaming them for their own problems even if that wasn’t your goal.

  78. 78
    Barbara says:

    @Betsy: Sorry. I have extended family members and who say things very similar to your original post — that poor people should stop doing things that make them poor. As if anyone outside of a few romantic young people dreaming of being starving artists, plans and works hard to ensure their poverty, and as if our system isn’t set up to actually require that there be a certain level of poverty.

    And most of these relatives are quite concerned that I no longer work for money. I am always being asked when I am going back to work. If my immediate family is unfortunate enough to land in dire straits, I will be lectured by them about how I could have prevented our troubles, after all they repeatedly told me I needed to go back to paid work.

    What you said reminded me of them, and also brought to mind that there are many other people who share these general view. I don’t know what to call them: I shouldn’t have called them Betsy-types but I don’t think I’d call them libertarians, either. What would you call the people who hold your world-view (besides right? ; )).

    I’ll say it all again: what looks like a bad choice to you might be a reasonable choice for someone in different circumstances; sometimes there are no good choices; some people are simply not capable, for whatever reasons, of making and carrying through good choices — we are not all equally functional.

    And now I have to leave, I’ll check back in later this afternoon.

  79. 79
    Betsy says:

    @Mnemosyne: word, yeah. We’re working on that. Hoping to break that cycle.

    It is passed on. Some patterns suck. It’s OK to judge those patterns and try to replace them with better ones.

  80. 80
    FlyingToaster says:

    @Elmo: That’s really creepy and irresponsible of the school.

    I remember being in second grade and being exempted from the running parts of the President’s physical fitness thang (early Nixon), specifically because of asthma.

    I remember being in Junior High and given a different time to complete the “24 laps around the gym” number because of asthma (slow jog/fast walk, I still beat out all the girls taking speed).

    This really, really sucks. And the school should have been covering the medical bills since it was their negligence. GRRRRRR.

    @Orphos: This.

  81. 81
    Mnemosyne says:

    @Betsy:

    Some patterns suck. It’s OK to judge those patterns and try to replace them with better ones. See? I went there. “SHOULD”. Gasp!

    Right, but we’re not talking about a “pattern.” We’re talking about illnesses that need to be treated, preferably from a young age. You can’t voluntarily decide to stop having bipolar or ADHD or epilepsy, and if you don’t have access to doctors (or the right kind of doctors), you are probably not going to be able to break that pattern on your own any more than someone born with half a leg is going to be able to walk on his/her own.

  82. 82
    Aimai says:

    The system ate my very long, thoughtful, never before made in such detail post to betsey and cervantes. Here is a shorter:

    Despite the moral panic style arguments being advanced here population growth in the US is not happenning because lots of poor people (poor black people or poor white people) are having “four five and ten kids.” Absent immigration we will have a falling population. A few local cases or infamous cases do not make a real social crisis.

    There is a movement in this country that promotes birth, early marriage, and ignorance but its not found among the imaginary black community but among white evangelicals in the Natalist or Quiverfull movement.

    The argument that poor white and black women are carelessly, stupidly, mindlessly, outbreeding their resource base/husbands earning power/society’s needs is really old. It goes back, in this country, to white nativist, anglo saxon, protestant, revulsion for catholic (and mormon) hordes.

    If you want to revive these arguments now “for the sake of the children” or qua do gooder you are going to receive some pushback on behalf of the poor communities who have always been subjected to lectures, social engineering, and outright attack and child theft for the crime of trying to have families while poor.

  83. 83
    Mnemosyne says:

    Also, this whole story reminds me of the horrifying story of Debra Reid, whose son with asthma and diabetes was taken from her because she was too demanding with doctors and ER staff about her son’s care. Six weeks after he went into foster care, he died of a severe asthma attack. So, basically, her son died and she was accused of Munchausen by Proxy because, as a poor person, she was too insistent that her son get the best possible medical care.

  84. 84
    PJ says:

    @Aimai: Someone poor is clearly irresponsible, and thus incapable of raising children well, while someone wealthy is clearly responsible, and is thus certain to raise children well.

  85. 85
    Aimai says:

    @Mnemosyne: yup one reason im taking betsey yo so sharply is that poor families often live in environmentally damaged areas with little to no health care or educational support. During the medicaid expansion fiasco i read a story about a poor white southern woman who had three special needs kids and no husband. The kids had autism and other mental/medical issues. Sure–you could argue that working class mommy shouldnt have had the second kid at all or maybe she didnt know the first was autistic when she got pregnant. Maybe her husband shouldnt have gotten her pregnant twice and then abandoned the family or come back for one more reunion in a state where she couldnt get an abortion. Or maybe she thought the second and third children would be healthy and grow up to help care for the oldest child.

    Maybe she didnt know that toxic waste from the local mines increased her risk of having all three children’s special needs exceed her salary as a waitresss.

    But what good does lecturing her or holding people like this up for contempt and criticism do to prevent the next such woman from making the same reproductive choices?

  86. 86
    john b says:

    @Betsy:
    not going to get into all the details, but my wife and I decided to have kids literally weeks before I found out I’d likely be losing my job at the end of the year. It has worked out (more or less). but a move across the country and making about 70% of what we did BEFORE we had a kid

  87. 87
    Cervantes says:

    @Aimai:

    Not to worry, your “shorter” is definitely long enough — but it seems unrelated to anything I said. Perhaps it would saved you time to just have answered my simple-enough questions after all!

  88. 88
    Betsy says:

    @Aimai: You show me where the contempt and criticism is. Also, the lecturing. (PJ, that goes for you too. You have enlarged my original comment and conflated it with someone else’s view.

    I feel for that parent you name, Aimai, and her kids. Our system should never have left her in the dirt like that. It’s ridiculous.

    Other than that I’m done with both of you today. Go aim your indignance on some right-wing slut-shaming prick who deserves it.

    I will put my feminist bona fides, and my direct personal help to poor people who are up against incredible odds, up to anyone’s straw men.

  89. 89
    Cervantes says:

    @PJ:

    Someone poor is clearly irresponsible, and thus incapable of raising children well, while someone wealthy is clearly responsible, and is thus certain to raise children well.

    I count four assertions that no one else here has made.

    You must be bored.

  90. 90
    Omnes Omnibus (the first of his name) says:

    @Betsy: The last sentence in your original post made it pretty clear that you expected your suggestion to generate some controversy. It has done so. It isn’t always easy to read tone in written comments, but it is fairly obvious that your comment struck people as classist. It may not have been your intent, but it pretty clearly had that effect. BTW, I would also say that once you introduce the word should into a discussion, you are no longer having an empirical discussion.

  91. 91
    jl says:

    Thanks for an interesting and sobering post.

    ” A high first dollar health plan (which is where the entire US system is going) ”

    I did not realize that RM’s diagnosis of the overall direction of the US healthcare system was so grim.
    Why, oh why, does the US insist on continuing this 30+ year failed experiment? It has been 30 years since Mark Pauly basically drew an X on a piece of paper and asserted that all markets were the same and like minded economists acted like, and even asserted explicitly that the market for health care was the same as the market for ice cream, and if you interfere with perfectly informed consumer decisions, its just a subsidy that will result in people consuming too much care, just as they would eat too much ice cream if the price were kept artificially low. Well, the US population does probably consume ‘too much’ care, that costs too much, but as illustrated by the Mayhew family experience last night, it is not for any reasons related to drawing an X on a piece of paper and asserting that the market for healthcare is just like the market for ice cream.

    The warnings of thoughtful economists like Kenneth Arrow, who knew a whole lot more economics than the applied policy people who pushed the failed policy were ignored, for all practical purposes.

    BTW, even Pauly has admitted that his X on paper + bald assertion analysis was inadequate as the mess of the US healthcare unfolded, but who cares, the fat cats who control things got what they wanted, and they can hire plenty of ‘economists’ to repeat the line that lines their pockets.

  92. 92
    PJ says:

    @Cervantes: Aimai made reference to the do-gooder mentality in the history of this country which attributes poverty to irresponsibility and which Betsy, liberal bona fides and all, appears to embrace (“people should hold off having even one child until they have completed their education or job training, have a stable job, and some emergency money in the bank. . .maybe we would have a nation of activists and union members, if instead of popping out kids they have no hope of supporting, people would use their time and energy to militate for better conditions for workers and families”). In other words, poor people are irresponsible for having children instead of being liberal activists.

  93. 93
    aimai says:

    @Cervantes: Its a long thread, Cervantes–I’m sorry I wasn’t able to directly answer your question to your satisfaction. My answer would be–if it is still relevant to you–that in fact very few people “continue to have four, five, six, ten” kids when they can’t afford them. Very few people in the grand scheme of things, that is, i a population of 300 million. Sure: people you see on TV or troublesome people you may know (or who are salient to you because you hear about them locally) may fall into this category but in reality very few people statisically fall into this category. If you have data showing this is a real problem then by all means offer it. But in reality US birthrates are relatively low and are affected by overall economic trends rather rapidly. Teen birthrates and accidental birthrates are falling wherever contraception is available and in accordance with the (new theory) decline of lead in the environment. I don’t think people respond well to censorious lectures by their social betters–I think its pretty clear that people respond to other incentives and thoughtful social change and institutional support. So while I certainly can think of some lousy parents who chose to have lots of kids, and some unfortunate people who had children who were more expensive than they thought they would be, or whose circumstances changed between having the child and the lengthy period during which they needed to support the child, I just don’t see your basic question “when do I think other people are having too many children’ is really relevant to the discussion. What I think and when I, personally, think people should “take responsibility” to stop having children isn’t important since it doesn’t affect real people’s life choices at all. But if you are asking I, personally, think people like Bob Duggar should be sterilized at birth.

  94. 94
    aimai says:

    @Betsy: Look, Betsy, you are suffering from a sense of injury because people in your community are, as you see it, taking you up too sharply on what you said. I’m sorry if you feel bad about it. You made a fairly standard argument and I responded to it taking into account where that argument comes from historically, and where it usually goes socially and politically. I get that this surprises you because you think that “when a good person makes a bad argument” everyone should take it for granted that the goodness of the intentions overwhelms the suckiness of the argument. But the argument is the argument. It also happens to be the case that there are real world people right now, in this community, who fall under the hypothetical category of “people who made a mistake, or a retrospective mistake” in the timing of their sex, reproduction, marriage, or job choices such that they end up with “more children” than they can take care of. I try to put myself in the position of the imaginary “people who don’t take responsibility” for the children they are “popping out” and I think man, those men and women must feel like shit when they read comments like Betsy’s–and people on this board have told you that they feel they fall into the category you are excoriating as problematic. So let’s admit that we both are saying things that someone on this board may feel cut a little too close to the bone.

    I am sure you didn’t mean to imply that lots of people in this country are irresponsible, stupid, mean, thoughtless or whatever else when you said upfront that there is (some signficant number) of people who thoughtlessly and to their own despite have more children than they can afford. In fact I know you didn’t because every time someone has come up with a real world example of a person who made a choice to have a kid which was doubtful, dangerous, sad, or problematic you have generously said “those aren’t the people I mean.” And I’m sure that’s true. You don’t mean most of the people who are suffering right now under our crappy economy. You mean the very small segment of the population which is truly awful, or truly stupid, or truly mean. But they aren’t statistically significant and/or most social outreach won’t reach them.

    If you are concerned about teen pregnancy or the crushing burden of children on poor families there’s a shitload more stuff to be done than just wondering whether there is “some point at which” people “should” do something about it.

  95. 95
    Amy says:

    @David in NY: Parenting is a 24/7 job and you are going to make mistakes. Don’t beat yourself up over it.

  96. 96
    Gindy51 says:

    The quickest road to poverty is to be female, single and have kids. I leave you with the numbers:
    http://www.dailykos.com/story/.....ng-more-so

  97. 97
    grrljock says:

    Finally, the pharmacist realized the one way valve chamber was on a different page of the electronic prescription screen

    Glad to hear your child is doing well now. Your story, with a thankfully good outcome, provides such a good illustration of systemic gaps in US healthcare. I appreciate how you put the description above, of how important electronic system displays can be, along with the bigger and more obvious factors of co-pay, miscommunication, and resources. Keep up your great posts.

  98. 98
    JaneE says:

    Miscommunication happens. IMHO, the physician should have told your wife everything to expect, including a special valve because of your child’s age. Not hitting page down to see end of list is a common human failing. Not having the computer count the items on the list of prescriptions (including the special valve) to verify the completeness of the order could be a system flaw. All of these things can be fixed, probably without a great deal of effort or money.

    The money problem – that is society’s failure. Not everyone has $50 in their pocket, or a credit card to use in an emergency. Delaying treatment almost always means higher cost when treatment is done. Sometimes the cost is a life, or a limb in addition to money. We have to make the country realize that medical care, health care, should be for everyone – not just the rich or fortunate. That is a lot harder to change.

  99. 99
    pseudonymous in nc says:

    @Patricia Kayden:

    My sister has two children with disabilities and lives in Canada. No financial crisis due to their illnesses. That’s how civilized countries should operate.

    Ill health is stress enough.

    But America is great at turning “why don’t we all have…” questions into “why should they have…” ones.

  100. 100
    Nicole says:

    Following up on Betsy’s initial comment- thing is, on a large level, when people have more money, they choose to have fewer children. It really doesn’t work the other way around. So if the ultimate goal is to reduce the number of kids born to people who can’t financially afford them, frankly, the way to do it is to increase the amount of money people have to where they could probably afford them, but would choose not to.

    That said, universal contraception and comprehensive sex education are good things for everyone and would certainly help.

    And, having kids young is not necessarily a bad thing. As someone upthread pointed out, delaying childbearing brings health risks. I didn’t have my son until my late 30s and ended up having to be induced early because I was at danger of stroke. A friend of mine, 40 when she delivered, did have a stroke, four days after giving birth. Another, 44, died on the operating table delivering twins. Ancedotes, yes, but out of the women I know who have had kids after 35, more of them have had problems than have not. And that doesn’t touch the number of couples who wait until their late 30s or 40s and then can’t conceive.

    So my perfect solution would be more money for people who don’t got it. That would help a lot things, actually.

  101. 101
    Matt says:

    A high first dollar health plan (which is where the entire US system is going) for parents’ who lack one of the above conditions would have made a scary but very fixable situation into a significant crisis on the medical and financial side.

    More importantly, when that system turned a minor medical emergency into a total financial clusterfuck, IT WOULD BE WORKING AS INTENDED BY THE PEOPLE WHO BUILT IT. That’s the fundamental problem – the system isn’t fucked because it’s poorly-implemented, it’s fucked because the overarching design goal is to punish poor people for being poor. Until we accept this fact, trying to fix the injustices by tweaking around the edges is always going to turn out poorly.

  102. 102
    Betsy says:

    @aimai: As far as there being ” a shitload more stuff to be done” — OK, YOU go mentor a precious little girl whose whole life ahead of her is at risk of the same chaos, poverty, stupidity, irresponsibility, negligence, criminality, disorganization, gun violence, animal cruelty, filth, illness, and generally abominable disorder that she was born and raised into. (Yes, I can cite abundant examples of everything in that list, in one household). While you mentor, YOU tell her it doesn’t matter if she finishes her education. YOU tell her it doesn’t matter when or if she has kids. YOU tell her it doesn’t matter if she has a toothbrush. After all, that would be a VALUE JUDGMENT, and since there is no SHOULD, it’s all the same.

    It’s not anywhere near about “my sense of injury” . I could give a shit less about my sense of injury. This child is at risk and I am trying to help her. Save her, aid her, whatever. I see that dynamic is offensive to you!

    You will probably find some fucking historical SUBTEXT implicit between my ACTUAL words that makes me an evil person and injects whatever you object to into something I have nothing to do with.

    Go guilt-trip someone else. A Koch brother, or even just a random man on the street, would be a better choice. Your verbal mess is less than worthless to me.

    While y’all wait and fervently advocate for the Swedish social safety net to arrive on our shores in a Viking longship, I will advise my small, vulnerable friend to finish her education, and know how to obtain and use birth control.

  103. 103
    jame says:

    Mr. Mayhew, your family was very lucky. You’re knowledgable enough to appreciate that. It should go without saying that we shouldn’t have to rely on luck to get adequate healthcare, but here we do. Hospitals are even worse; not a day goes by without mistakes and miscommunication that result in fatalities. Our healthcare system is snafued beyond repair. Thank goodness your child is okay. Also, thank you for posting your experience and allowing me to rant a bit.

  104. 104
    PJ says:

    @Betsy: Nobody is trying to paint you as evil, they are objecting to your argument, particularly when framed as public policy. Advising your young friend on what will lead her to a better future is a good thing, but there is a difference between doing that and saying that people who are not financially stable should not have children. In the first instance, you have the possibility of positively affecting someone’s life; in the second, all you are doing is judging people for making decisions you consider unfortunate.

  105. 105
    Cervantes says:

    @PJ:

    Advising your young friend on what will lead her to a better future is a good thing, but there is a difference between doing that and saying that people who are not financially stable should not have children. In the first instance, you have the possibility of positively affecting someone’s life; in the second, all you are doing is judging people for making decisions you consider unfortunate.

    If you say that I should not cross a busy street with my eyes closed, are you judging me?

  106. 106
    Barbara says:

    Betsy, I think I get it. You’re heart is breaking because of the miserable situation your mentoree finds herself in, and the thought of all she will have to overcome to have the life she deserves is mind-boggling. I can see why you would be angry at the adults who created the noxious environment she’s growing up in. But you know something, they probably deserve our sympathy too.

    As Mnemosyne points out, there is a good chance there are (unrecognized, untreated) mental illnesses at the root of what you are seeing. And I’d add, maybe some cognitive challenges too — after all, half of all people have below average intelligence. And the stress of poverty exacerbates it all.

    I grew up around mild to moderate levels of dysfunction so to hear stories about dysfunction doesn’t ever surprise me (though it can still sadden me). As an adult in late middle-age, I’ve come to terms with the fact that the people who surrounded me didn’t choose their limitations.

  107. 107
    Barbara says:

    Might be a little late with this, considering how old this thread is, but thinking about this some more, and I don’t know where you live Betsy, and what Children’s Protective Services is like where you are, but perhaps the authorities should be involved if the situation is really as dangerous as you describe?

    Because Protective Services is what we as a society have decided will be the way we address the issues of children being raised by, as Aimee put it, “the very small segment of the population which is truly awful, or truly stupid, or truly mean.”

    Which, to beat a dead horse, is a grouping that is much different than those who have children before they have degrees, jobs, spouses, savings accounts, etc. The overlap on that Venn Diagram isn’t all that big.

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