Latest / Trumponomics / How Falling Fertility Threatens the Global Economy

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How Falling Fertility Threatens the Global Economy · Trumponomics

• 0:02
  Speaker 1: Fifty years ago, the average woman gave birth to five
• 0:06
  Speaker 1: children during her lifetime. Today that's down to about two
• 0:09
  Speaker 1: and a half kids. At the same time, in many countries,
• 0:13
  Speaker 1: people are dying at a faster rate than they're being born.
• 0:17
  Speaker 1: This presents nations with an ultimately grim result. Without an
• 0:21
  Speaker 1: influx of immigrants, their populations will decline. On the first
• 0:25
  Speaker 1: of a special two part episode of Benchmark, we explore
• 0:29
  Speaker 1: why fertility rates are down around the world, what this
• 0:32
  Speaker 1: means for the global economy, and what countries like the
• 0:35
  Speaker 1: United States can do to reverse this trend. Welcome to Benchmark.
• 0:49
  Speaker 1: I'm Scott Landman, an economics editor with Bloomberg News in Washington.
• 0:53
  Speaker 1: We're talking about fertility because it is an underlying driver
• 0:56
  Speaker 1: of a nation's economy. You need babies to keep a
• 0:59
  Speaker 1: popular relation growing over time, which in turn supports a
• 1:03
  Speaker 1: growing workforce. It also means houses and schools need to
• 1:06
  Speaker 1: be built, Goods need to be made and sold for
• 1:08
  Speaker 1: kids and babies, and so on. One reason why economic
• 1:12
  Speaker 1: growth is generally slower today than it was decades ago
• 1:15
  Speaker 1: is because there's no baby boom like there was after
• 1:18
  Speaker 1: World War Two. In this two part episode of Benchmark,
• 1:21
  Speaker 1: we're looking at this drop in fertility rates from two
• 1:23
  Speaker 1: different perspectives. Next week, we'll hear from an expert on
• 1:27
  Speaker 1: China's demographics who explores whether the nation's one child policy
• 1:31
  Speaker 1: is responsible for a very low fertility rate. But our
• 1:35
  Speaker 1: guest today isn't our typical expert on economics and demographics.
• 1:39
  Speaker 1: She has a much more personal connection to this issue
• 1:42
  Speaker 1: that led her to explore and research fertility. Her name
• 1:45
  Speaker 1: is Elizabeth Katkin. She's an attorney in Denver, Colorado, and
• 1:49
  Speaker 1: the author of the book Conceivability What I Learned Exploring
• 1:53
  Speaker 1: the Frontiers of Fertility. It was just published in June
• 1:56
  Speaker 1: by Simon and Schuster. Liz, congratulations on the book and
• 2:00
  Speaker 1: welcome to Benchmark. Thank you very much for having me.
• 2:03
  Speaker 1: It's a pleasure to be here. Liz, tell us a
• 2:06
  Speaker 1: bit first about yourself and your personal story that led
• 2:09
  Speaker 1: you to write this book. Sure you know as you
• 2:12
  Speaker 1: as you mentioned in your introduction, I have not a
• 2:14
  Speaker 1: fertility or demographic expert. By background, um far more mundane
• 2:18
  Speaker 1: than that. I was a corporate lawyer, and I was
• 2:21
  Speaker 1: living in Washington, d C. And got married at the
• 2:24
  Speaker 1: age of thirty, and shortly after that started trying to
• 2:29
  Speaker 1: have children. There was nothing really in my background or
• 2:31
  Speaker 1: my family's background that led me to believe or expect
• 2:36
  Speaker 1: that I would have any trouble. We just kind of
• 2:38
  Speaker 1: got married and I was working and my husband was working,
• 2:41
  Speaker 1: and we thought, well, you know, and that was a
• 2:42
  Speaker 1: good time to start a family. And it wasn't until
• 2:45
  Speaker 1: we started trying to have to have a baby that
• 2:49
  Speaker 1: that we realized, well, we we slowly tipped it into
• 2:52
  Speaker 1: long to the long journey ahead of us, But it
• 2:54
  Speaker 1: wasn't until we started that that we encountered some troubles
• 2:57
  Speaker 1: and what ultimately started out as a as a first
• 3:02
  Speaker 1: trip to a doctor to see what might be wrong,
• 3:04
  Speaker 1: turned into a nine year journey to have two children.
• 3:07
  Speaker 1: So um, over the course of nine years, I had
• 3:10
  Speaker 1: seven miscarriages, ten IVF cycles, and saw doctors in six countries,
• 3:16
  Speaker 1: and eventually I had a healthy boy and a girl.
• 3:20
  Speaker 1: It really is an incredible story that you write about
• 3:23
  Speaker 1: in your book, and just to take a step back
• 3:26
  Speaker 1: for a moment, I know you don't really go in
• 3:29
  Speaker 1: depth into why fertility rates are lower today or why
• 3:33
  Speaker 1: there's such a burgeoning industry and fertility treatments. I think
• 3:37
  Speaker 1: you do mention some factors. But I'm wondering, are are
• 3:41
  Speaker 1: the struggles of people to bear children? Are those kinds
• 3:44
  Speaker 1: of struggles more common today than they were forty or
• 3:47
  Speaker 1: fifty years ago, or has it just become less of
• 3:50
  Speaker 1: a taboo to talk about this kind of thing, you know,
• 3:53
  Speaker 1: I think it's actually both. I think it certainly is
• 3:55
  Speaker 1: less of a taboo to talk about it. But to
• 3:58
  Speaker 1: the extent I did delve into some of the statistics,
• 4:01
  Speaker 1: I mean, fertilities at at an all time low in
• 4:03
  Speaker 1: the US, and approximately one in six couples are confronting
• 4:09
  Speaker 1: and fertility now, which is really an amazingly high number
• 4:13
  Speaker 1: if you think about that one in six couples, so
• 4:16
  Speaker 1: that seven million women a year are seeking help for fertility.
• 4:20
  Speaker 1: And so I think it's it's certainly the case that
• 4:22
  Speaker 1: people are talking about it more, but there are a
• 4:24
  Speaker 1: lot more people having trouble. And as you mentioned, you know,
• 4:27
  Speaker 1: our birth rate is as much lower than it was
• 4:30
  Speaker 1: fifty years ago, and I think that is, you know,
• 4:32
  Speaker 1: partly by choice, women focusing more on their careers. But
• 4:35
  Speaker 1: I think a lot of it is also, you know,
• 4:38
  Speaker 1: not by choice, and I think it's probably you know,
• 4:41
  Speaker 1: I don't have the exact data on this, but more
• 4:44
  Speaker 1: economically skewed now as well. I mean, the reality in
• 4:47
  Speaker 1: this country is that if you're confronting infertility, your odds
• 4:51
  Speaker 1: of having a baby you're significantly higher if you have
• 4:54
  Speaker 1: the funds to make it through a few rounds of treatment,
• 4:57
  Speaker 1: and the prices are so astronomical that a lot of
• 5:00
  Speaker 1: the population can afford that. And you did end up
• 5:04
  Speaker 1: going outside the US for a good portion of your
• 5:08
  Speaker 1: treatment of your journey, So you have a pretty broad
• 5:11
  Speaker 1: perspective on this issue. How do you think the healthcare
• 5:16
  Speaker 1: and fertility industry in the United States helps or may
• 5:20
  Speaker 1: even harm people who are having these kinds of fertility problems. Yeah,
• 5:26
  Speaker 1: I mean that that's a that's a fantastic question. That
• 5:29
  Speaker 1: is the crux of the problem. I mean, I think
• 5:31
  Speaker 1: the fertility care, like like a lot of healthcare in
• 5:35
  Speaker 1: the United States, it's really a double edged sword. I mean,
• 5:37
  Speaker 1: I think it really helps some people, um, and it
• 5:40
  Speaker 1: really doesn't serve many other people. That's for a couple
• 5:45
  Speaker 1: of reasons that I that I conclude that, I mean
• 5:46
  Speaker 1: one one as purely as I mentioned the economics of it, So,
• 5:50
  Speaker 1: you know, compared to other countries, women and couples facing
• 5:54
  Speaker 1: in fertility start out at a pretty steep disadvantage in
• 5:59
  Speaker 1: the US. In most of the developed world, there are
• 6:03
  Speaker 1: medical systems in place, whether it's national national health services
• 6:07
  Speaker 1: or mandatory insurance that cover fertility services. So fertility is
• 6:12
  Speaker 1: really clearly treated as a medical problem in most of
• 6:17
  Speaker 1: the developed world, and people are able to get help
• 6:20
  Speaker 1: for that. You know, in the United States, of course,
• 6:23
  Speaker 1: we have no national health service, and as far as
• 6:25
  Speaker 1: insurance coverage goes, only fifteen states require any form of insurance.
• 6:31
  Speaker 1: You know, four of those states only require insurance for
• 6:33
  Speaker 1: married couples, and there's only about a half a dozen
• 6:36
  Speaker 1: states that have enough insurance to really help a woman
• 6:40
  Speaker 1: or a couple have a baby. And so in most
• 6:44
  Speaker 1: of America, patients confronting and fertility are really on their
• 6:47
  Speaker 1: own financially. That makes it a very difficult climate. Do
• 6:51
  Speaker 1: you think that if the insurance coverage were much more
• 6:54
  Speaker 1: extensive for fertility treatments in the United States that that
• 6:58
  Speaker 1: would increase birth rates? I mean, has been shown to
• 7:01
  Speaker 1: have some sort of link in the countries that that
• 7:04
  Speaker 1: you know that do provide that kind of coverage. It's
• 7:07
  Speaker 1: a great question. I don't know that I have the
• 7:10
  Speaker 1: data to give you to give you a firm answer
• 7:13
  Speaker 1: on that, because I haven't looked at the data so
• 7:15
  Speaker 1: much on the on the national insurance and how it
• 7:17
  Speaker 1: affects birth rates. But I do know you know from
• 7:21
  Speaker 1: my research here that there are a great number of
• 7:24
  Speaker 1: people that just don't pursue IVF simply because they can't
• 7:28
  Speaker 1: afford it, or that the insurance coverage, you know, is
• 7:33
  Speaker 1: limited to certain treatments and not others, So the insurance
• 7:36
  Speaker 1: is actually shaping the treatments in ways that are probably
• 7:40
  Speaker 1: not beneficial to having a baby. So you know, I'm
• 7:43
  Speaker 1: sorry I can't give you a give you the hard
• 7:45
  Speaker 1: numbers on that, but I think it's something well worth
• 7:48
  Speaker 1: worth looking into. But I think it does really disservice
• 7:53
  Speaker 1: a lot of people that they can't they can't afford
• 7:55
  Speaker 1: the care, or that the insurance is really you know,
• 7:58
  Speaker 1: dictating their care. That's that's another problem I encountered in
• 8:02
  Speaker 1: a number of the people I interviewed for the book,
• 8:04
  Speaker 1: or people feeling like they didn't have choices or didn't
• 8:09
  Speaker 1: make the healthiest choices because of the limitations of their insurance.
• 8:15
  Speaker 1: Now it's not just insurance coverage for fertility treatments that
• 8:20
  Speaker 1: helps people have children. But you also spend a lot
• 8:23
  Speaker 1: of your book covering the issue of of using a
• 8:27
  Speaker 1: surrogate carrier to to have a child. And it's really
• 8:31
  Speaker 1: interesting to read about how there's just such vastly different
• 8:35
  Speaker 1: laws and regulations, not just from country to country, but
• 8:39
  Speaker 1: in the US, you know, practically every state has some
• 8:42
  Speaker 1: different law on this issue. How do you think, you know,
• 8:45
  Speaker 1: having more uniform regulations or laws on surrogate mothers would
• 8:51
  Speaker 1: potentially affect people's ability to have more children. Well, I
• 8:56
  Speaker 1: think having having uniform laws, you know, across the US
• 9:00
  Speaker 1: would certainly make things easier for a lot of people,
• 9:04
  Speaker 1: because right now what you have is sort of among
• 9:07
  Speaker 1: people that have already gotten to the stage that they've
• 9:09
  Speaker 1: figured out they need a surrogate. And there, you know,
• 9:12
  Speaker 1: you've got to be pretty far in the process and
• 9:14
  Speaker 1: have reasonably deep pockets to get to the point of
• 9:17
  Speaker 1: doing I v F with surrogacy. You then have to
• 9:19
  Speaker 1: plunge into a new realm of do we need to
• 9:21
  Speaker 1: travel and go somewhere else or do we have to
• 9:24
  Speaker 1: pick a surrogate that lives somewhere else. And it's it's
• 9:26
  Speaker 1: kind of like complex pieces of a puzzle to find
• 9:30
  Speaker 1: a state with the right clinic that you want and
• 9:33
  Speaker 1: the right doctor that you want, and the surrogacy surrogacy
• 9:36
  Speaker 1: favorable laws that you want. And I think, you know,
• 9:40
  Speaker 1: having more clarity of that would make it a lot
• 9:42
  Speaker 1: easier for patients and would make it a lot a
• 9:44
  Speaker 1: lot more equitable for people throughout the country. Is there
• 9:48
  Speaker 1: any sort of main database that tells people our websites.
• 9:52
  Speaker 1: I'm sure that there's got to be some some sources
• 9:54
  Speaker 1: of information, but it does even with that, it probably
• 9:57
  Speaker 1: is pretty bewildering to most people. Yeah, and most people
• 10:01
  Speaker 1: end up hiring an agency and or a lawyer to
• 10:04
  Speaker 1: handle it for them, which adds again substantially to the cost.
• 10:07
  Speaker 1: We never went that route. We didn't use a US surrogate,
• 10:10
  Speaker 1: but we also didn't use a US you know, agency
• 10:13
  Speaker 1: or a lawyer. Partly I had the advantage of being
• 10:16
  Speaker 1: a lawyer, but I was able to research it on
• 10:19
  Speaker 1: available resources. But it is it is like a massive
• 10:22
  Speaker 1: my friend called it a secret second job. It's a
• 10:25
  Speaker 1: massive research project and it's a lot of information to
• 10:30
  Speaker 1: handle on your on and I think you know, hand
• 10:33
  Speaker 1: in hand, it's it's a little a little different from
• 10:36
  Speaker 1: your question, but hand in hand with the regulation of
• 10:38
  Speaker 1: surrogacy is the regulation of the egg and sperm donors.
• 10:41
  Speaker 1: And I think that, you know, that's really a minefield
• 10:44
  Speaker 1: in this country, where it's not only different state by state,
• 10:49
  Speaker 1: but has much longer term implications for the children who
• 10:54
  Speaker 1: are actually born born of a donor egg or donor
• 10:57
  Speaker 1: sperm or the parents. And there's there's not only any
• 11:00
  Speaker 1: regulation of it, there's also no tracking of it, which
• 11:04
  Speaker 1: makes us an outlier, you know, an outlier in the
• 11:06
  Speaker 1: developed world where other countries are paying careful attention. I mean,
• 11:10
  Speaker 1: between all these barriers to infertility treatments, of financial barriers,
• 11:15
  Speaker 1: figuring out the surrogacy laws and regulations, I mean, how
• 11:19
  Speaker 1: much does this discourage people who don't have kind of
• 11:22
  Speaker 1: the you know, the fierce will, plus the financial resources
• 11:27
  Speaker 1: to figure out how to solve their own fertility issues. Yeah,
• 11:32
  Speaker 1: I think it discourages people a lot. I mean, I
• 11:34
  Speaker 1: think there are a lot of people who feel like
• 11:37
  Speaker 1: they hit a brick wall because they know they want
• 11:40
  Speaker 1: to have a child and they're not quite sure how
• 11:42
  Speaker 1: to get there. Then I think there are those that
• 11:44
  Speaker 1: figure out how to get there, but realize they need
• 11:46
  Speaker 1: a hundred thousand dollars to get there, and they don't
• 11:48
  Speaker 1: have it, and then they're the intrepid few, you know
• 11:51
  Speaker 1: that go overseas. I I myself went overseas, and I
• 11:54
  Speaker 1: interviewed quite a few others, but I spoke with a
• 11:57
  Speaker 1: woman I profiled her and her husband in the book,
• 11:59
  Speaker 1: who had done all the research on their own and
• 12:02
  Speaker 1: really just couldn't. They had gone through a few cycles
• 12:05
  Speaker 1: in the US without an egg donor, had spent pretty
• 12:09
  Speaker 1: much all the money they had allotted for IVF, then
• 12:12
  Speaker 1: found out they needed an egg donor, and we're looking
• 12:15
  Speaker 1: at cost estimates of about fifty dollars for that cycle,
• 12:19
  Speaker 1: and they went to Spain and for all in cost
• 12:23
  Speaker 1: of ten thousand euros, including the full I VF, the
• 12:27
  Speaker 1: medication for the mother, the medication for the donor, the
• 12:30
  Speaker 1: travel um, their whole total cost was ten thousand euros. So,
• 12:35
  Speaker 1: you know, some people are able to get around that
• 12:38
  Speaker 1: by leaving the country. Not everybody really has the knowledge
• 12:42
  Speaker 1: and resource base to figure to figure that out yet,
• 12:45
  Speaker 1: but it's starting to grow quite significantly. But ten thou euros,
• 12:49
  Speaker 1: you know, it's it's kind of low for uh, these
• 12:52
  Speaker 1: kinds of treatments or journeys. And yet it's still a
• 12:56
  Speaker 1: lot for you know, the average American who may not
• 12:59
  Speaker 1: make much money. And you know, we write a lot
• 13:02
  Speaker 1: about people can't come up with four hundred dollars for
• 13:05
  Speaker 1: an emergency expense. You know, something like this would probably
• 13:08
  Speaker 1: bankrupt most people. It's true. I mean, there are that
• 13:11
  Speaker 1: sad reality is that about fertility costs in the US
• 13:15
  Speaker 1: are paid out of pocket. And that's that's pretty much
• 13:19
  Speaker 1: the inverse of what you'd see and in many other
• 13:22
  Speaker 1: developed countries. Now, one interesting thing you write about at
• 13:26
  Speaker 1: the end of your book, when you're talking about possible
• 13:29
  Speaker 1: solutions and advice to people facing these issues. One part
• 13:33
  Speaker 1: that I found interesting as an economics editor is, you know,
• 13:36
  Speaker 1: we spend a lot of time covering the US labor market.
• 13:39
  Speaker 1: We've done a variety of stories on low unemployment, how
• 13:42
  Speaker 1: it affects people's ability to quit their job, and you
• 13:46
  Speaker 1: write that some people are actually switching jobs to move
• 13:49
  Speaker 1: to companies that actually provide better benefits for fertility treatment.
• 13:55
  Speaker 1: I want to ask you one question past that, which
• 13:59
  Speaker 1: is has anybody you've been able to use fertility treatment
• 14:02
  Speaker 1: as bargaining power with their employer say, you know, can
• 14:06
  Speaker 1: you provide me this treatment and I'll stay with you?
• 14:09
  Speaker 1: Or you know, as as bargaining for a new job,
• 14:12
  Speaker 1: say you know, that's a great question. You may have
• 14:15
  Speaker 1: just planted an idea for quite a few people, I'd say,
• 14:18
  Speaker 1: especially in the technology sector. I have not encountered anyone
• 14:23
  Speaker 1: that actually used it as a bargaining chip. But I
• 14:25
  Speaker 1: did encounter one woman who realized afterwards that she could have.
• 14:30
  Speaker 1: She left her company to go to Apple because of
• 14:34
  Speaker 1: their coverage, and when she resigned and told them why,
• 14:37
  Speaker 1: her direct manager was shocked, and he was a man,
• 14:41
  Speaker 1: and he asked her why she didn't tell him or
• 14:43
  Speaker 1: talk to him instead of that that was that important
• 14:45
  Speaker 1: to you, we probably could have gotten that for you.
• 14:48
  Speaker 1: So I think you're you're on the right track there,
• 14:51
  Speaker 1: and there may be women starting to do that, or
• 14:55
  Speaker 1: may listen to your show today and get the idea
• 14:57
  Speaker 1: to do that. But to date, so far, what I've encountered,
• 15:01
  Speaker 1: both through my own personal interviews and from reading quite
• 15:03
  Speaker 1: a few interesting blogs about it, is people figuring out
• 15:07
  Speaker 1: where would have the best coverage and targeting jobs at
• 15:10
  Speaker 1: those companies. It's it's interesting to think about in a
• 15:14
  Speaker 1: world where we have something like Uber and lyft that's
• 15:18
  Speaker 1: filled the demand for say taxi cabs in major cities,
• 15:23
  Speaker 1: you know, or even not in major cities like suburbs
• 15:26
  Speaker 1: where it's really hard to get a cab. You know
• 15:29
  Speaker 1: that you have such demand for these kinds of services,
• 15:33
  Speaker 1: and maybe there's just a company willing to come along
• 15:36
  Speaker 1: or or some sort of medical recommendation or innovation that
• 15:40
  Speaker 1: could you know, really cut through and uh, you know,
• 15:45
  Speaker 1: solve fertility issues for the many, many people who are
• 15:48
  Speaker 1: facing this. I'm just wondering, as one last question, when
• 15:52
  Speaker 1: you think about ten years from now, twenty years from now,
• 15:56
  Speaker 1: what the future of fertility looks like, you know, where
• 16:00
  Speaker 1: do you see it going from here? Are you are
• 16:02
  Speaker 1: you optimistic or do you think there's still a long
• 16:05
  Speaker 1: ways to go before people to have ready access to
• 16:09
  Speaker 1: the kinds of treatments that will help them overcome infertility. Yeah,
• 16:14
  Speaker 1: I mean that's both. That's a cop out of an answer.
• 16:16
  Speaker 1: But I'm optimistic on the scientific side because the scientific
• 16:20
  Speaker 1: progress has been really incredible. What scientists in the labs
• 16:25
  Speaker 1: are learning about egg quality and embryo evolution. And I
• 16:29
  Speaker 1: delve into this in a book, But how quality can
• 16:32
  Speaker 1: potentially be improved and what some current researchers are looking
• 16:36
  Speaker 1: at or how to actually improve eg quality in the
• 16:39
  Speaker 1: human body before you try to get pregnant. Um. So,
• 16:42
  Speaker 1: I think on the scientific side, progress in fertility, like
• 16:47
  Speaker 1: you know many other illnesses, it's it's making leaps and bounds,
• 16:50
  Speaker 1: and our research capabilities are only improving, you know. And
• 16:54
  Speaker 1: the financial side, you know, it is a little bleaker
• 16:57
  Speaker 1: when you put it in the context of what's going
• 16:59
  Speaker 1: on with healthcare and generally in this country. And I
• 17:02
  Speaker 1: think there has to at some point be a reckoning
• 17:05
  Speaker 1: with the fact that infertility actually is a medical problem,
• 17:07
  Speaker 1: you know. In my view, now it's it's treated a
• 17:10
  Speaker 1: bit more akin to having a nose job. It's really elective,
• 17:13
  Speaker 1: like if you want to have a baby, you have
• 17:14
  Speaker 1: to go spend all this money to have one. But
• 17:16
  Speaker 1: but as you you mentioned in your opening, it's the
• 17:19
  Speaker 1: real demographic implications, and you know, we have a loop
• 17:23
  Speaker 1: low birth rate and we need a growing workforce. And
• 17:26
  Speaker 1: then the only real ways to increase the population are
• 17:30
  Speaker 1: our fertility and immigration, and there those are both facing
• 17:34
  Speaker 1: some obstacles in this country right now. So I think
• 17:37
  Speaker 1: the the political solution is a little harder to be
• 17:40
  Speaker 1: optimistic about, but the scientific solution, I'm fairly optimistic for
• 17:44
  Speaker 1: our future, so I think we've just got to get
• 17:46
  Speaker 1: the balance right, all right, Well, glad to hear there's
• 17:49
  Speaker 1: some glimmer of hope on that front. Really is an
• 17:53
  Speaker 1: issue that affects so many people personally and has implications
• 17:57
  Speaker 1: for for the national fonomy and the global economy. So
• 18:02
  Speaker 1: it's something that we all have to follow very closely.
• 18:06
  Speaker 1: Liz Catkin, author of Conceivability, really fantastic book, Thank you
• 18:10
  Speaker 1: so much for joining us on Benchmark. Thank you, Scott,
• 18:13
  Speaker 1: I've really enjoyed it. Thanks. Benchmark will be back next
• 18:19
  Speaker 1: week with part two of our episode on fertility. Until then,
• 18:22
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• 18:25
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  Speaker 1: listeners can find us. You can also check us out
• 18:38
  Speaker 1: on Twitter, follow me at Scott Landman. Our guest, Liz
• 18:42
  Speaker 1: Catkin is at Liz cat Can Underscore Books. Benchmark is
• 18:47
  Speaker 1: produced by tofor Foreheads, the head of Bloomberg podcast is
• 18:50
  Speaker 1: Francesco Levie. Thanks for listening, See you next time, Scott
• 19:02
  Speaker 1: then nger Bour