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Home Publications Blogs Beat the Press The Prospects for Children in Single-Parent Family

The Prospects for Children in Single-Parent Family

Friday, 10 January 2014 06:27

Michael Gerson tells readers:

"The tie between single-parent households and poverty is an economic, not a moral, assertion. Poor single parents naturally find it harder to hold full-time jobs and invest in the welfare of their children."

While this is true, it does not follow that the answer is to somehow force couples to stay together in bad and possibly abusive relationships, as Gerson seems to imply. The difficulty faced by children in single-parent families can be seen as a problem of adequate supports in the form of affordable child care or guarantees of paid time off for sick days and family leave. In other countries where such support does exist, children in single-parent families do not face nearly the same handicap as they do in the United States. (See Shawn Fremstad's discussion here and here.)

The other key pillars in Gerson's argument about poverty also don't stand up well to the facts.

"This is a type of poverty that Johnson could not foresee: a decline in blue-collar jobs, rooted in global trends, requiring workers to gain skills that schools could not reliably impart, leaving whole communities economically depressed and isolated, while many children were deprived of economically stable and supportive two-parent families, leading to dangerously stalled social mobility and creating divisions of class that are inconsistent with the American ideal."

Globalization did not just happen. There was a conscious decision to put manufacturing workers in direct competition with low-paid workers in the developing world, while largely protecting highly paid professionals like doctors and lawyers. This had the predicted effect of redistributing income upward. There also is little evidence that technology has had more impact in displacing less educated workers in the last three decades than in prior decades. 

Comments (41)Add Comment
When Will They Ever Learn?
written by Last Mover, January 10, 2014 6:44

Poor babies they are, stupid liberals sitting around like that waiting on a public education to bulk them up with sufficient skills to survive the gale winds of global competition.

Of course that's what happens when such matters are left up to public schools. It's pretty clear isn't it, that other developed and developing nations went to home schooling long ago to acquire cutting edge skills that whipped America into second and third global place from long term stagnation driven by structural unemployment.

But that wasn't enough for stupid liberals was it. After shunning home schooling, they shunned two-parent families as well, encouraged by big government welfare programs that actually paid them to have more children by ... well, you know, just about anybody ... eventually culminating in the ultimate incarnation of structural unemployment - same sex marriage which obviously fails miserably to produce productive children at all.

How could it, when two people of the same sex can't possibly specialize between themselves enough to keep a job and raise children at the same time?
overpaid doctors
written by parent, January 10, 2014 9:01

You seem fixated on overpaid doctors. My son is currently contemplating applying to medical school. He is an excellent student at a top university; he will likely be accepted to several schools. I am advising him to seriously contemplate the financial choice he is making by choosing to become a doctor.

Four years at a private medical school will equal $350,000 dollars of debt by the end of residency. Medical school also implies four years of lost wages and benefits- equivalent for someone of his background of at least another $300,000. Residency also involves another 3 years of working at around $10/hr and implies another $200,000 of lost wages. So, when he starts work at age 30 he is already $850,000 down. If he goes into primary care as he plans his starting salary will be around $160,000- a high wage for sure, but drastically reduced with loan payments that will eat up 40% his after tax income for his first ten years of practice.

His lifetime total income (including all benefits) per hour worked would be much higher as a LA County fireman and would only be slightly lower if he chose to become an elementary teacher in the LAUSD. And someone of my son's background and motivation would likely lead him to become a battalion chief or school principal- and there the financial deficit of choosing medicine would be even more marked.

Yes, there are extremely high earning physicians in plastic surgery, radiology, and orthopedics. But, for the bulk of graduating medical students who enter primary care it is a very poor financial decision.

I am surprised you focus so much on the nominal income of physicians. As an economist you should know better. What really matters is after tax income adjusted for hours work and opportunity costs related to the large outlay of physician education and training.
medical education
written by Paul, January 10, 2014 9:19
Parent raises some interesting issues but I wonder how generally well known it is that medical education (undergrad plus med school) is at least 2 years longer than most other medical education systems and even the US medical establishment admits that it is a redundant and inefficient system, so much so that there are alternative 6 year BA/MD programs in the US (2 I know of). The transformation of medical education into graduate education was really a process that had as much to do with status and power as it had to do with better training. 8 years in school, you should really have and MD/Phd and be doing research and most doctors and especially primary care physicians should be not wasting the time and money. (Remember the US medical outcomes are significantly better than the rest of the OECD countries and some ways worse).
No Protectionism for Doctors
written by Dean, January 10, 2014 9:35

the fact is that equally qualified doctors work for much less money elsewhere in the world. We don't protect our autoworkers or textile workers from foreign competition, I see no need to protect our doctors. If that means that people in the United States don't want to train to become doctors is there a reason we should care? They don't want to become farm workers either.
written by skeptonomist, January 10, 2014 10:16
Dean is certainly right that doctors in other countries earn much less than in the US, but is this because there is more international competition in those countries? About a quarter of US physicians are foreign - what is the percentage in European countries, for example (where crossing borders should be much easier)? There are good reasons why cross-border movement of this type of "labor" is not easy (you don't have to be fluent in English to work in the fields). Plenty of people want to be doctors in those other countries, probably in part because there is more government support for their education.
written by PeonInChief, January 10, 2014 11:24
I remember many years ago, when the Reagan Administration first got into the "they wouldn't be poor if they were married" thing, watching interviews with some of the young men that they were suggesting should marry the mothers of their children. and thinking, no, no, please god, don't marry this guy. He didn't finish high school, doesn't have a job or any prospect of same, and has never even taken his now two-year-old child to the park. Many young women make the very sensible decision that the guy is more trouble than he's worth.

And we do this because we don't want to spend the money on affordable housing and childcare, which would, in fact, make the lives of single mothers easier. And all women should be really insulted by this argument.
written by Alex Bollinger, January 10, 2014 11:27
@parent: your son might graduate with that much debt, but the median graduate will have $170,000 in debt at the end of med school.

As for pay, I don't know where you're getting your numbers. Average pay for a primary care physician is $221K (no, not starting salary, but primary care medicine isn't the only field where people earn more later in their careers than earlier). Average pay for an elementary school teacher is $52K.

Unless you're using hourly data that doesn't take into account all the extra hours teachers put into their jobs: an hour or two a day emailing and talking with with parents, a couple hours a day correcting, weekends preparing lessons, summers engaging in professional development.... Contrary to popular belief among 8-year-olds, teachers don't just disappear when school's over.

Last, none of this is even the point of Prof. Baker's argument. If primary care physicians aren't that well paid in the US, then they won't attract international competition. If it really just is certain specialties that are way overpaid, then those are the specialties that'll attract foreign practicioners who'll drive down wages.

Really, there is nothing to fear from competition, other than losing unearned privilege (um, ok, so there is a lot to fear for some people). Free markets just move resources around more efficiently. If doctors didn't earn so much after graduating, med schools couldn't get away with charging so much.
written by Alex Bollinger, January 10, 2014 11:33
@skeptonomist: It might also be because they allow more people to become doctors. The biggest bottleneck in our medical system is the residency program, which hasn't expanded to keep up with population growth since the mid 1990's.

Also, at least in Europe, doctors aren't required to get an undergraduate degree; they go straight to med school after high school, just as lawyers here go straight to law school.

If the US doesn't want to train enough doctors to meet demand, then importing more doctors is the way to go. Sometime in this system needs to give, and currently it's patients being thrown into huge debt and avoiding doctors entirely who are forced to pay the price.
written by Alex Bollinger, January 10, 2014 11:40
@Last mover: Hate to rain on your parade, but most developed countries have, rightly, banned home schooling. "Home school," for many American parents who claim to do it, is an excuse to not send their kid to school at all, and state laws are often too weak to force compliance with any educational standards at all. There are some good homeschooling parents, but those are usually the ones who have no problem with standardized testing and other means of making sure they're doing the job they claim they're doing.

Seriously, for someone as into home schooling as you seem to be, I'm surprised you haven't seen any of the "X country oppresses home schoolers!!!!!" headlines that litter wingnut publications.
written by Alex Bollinger, January 10, 2014 11:45
@Paul: too true. Same with law school. In France, it requires 3 years of education to get your foot in the door, and 5 years to become a full lawyer, vs. 7 years in the US. Law prof. Paul Campos argues that law school is 1 year too long anyway; he says the last year isn't important to practicing law but it gets the law school another $60,000.
written by Alex Bollinger, January 10, 2014 12:00
Also, "encouraging marriage" is a euphemism for policies that would take money away from single parents and give more benefits to married couples in the hopes that single adults will get married. The US does this more than any other developed nation, even tying health care to marital status.

How many people think twice about leaving their spouses when they no longer want to be in a relationship because they're afraid they'll lose access to needed medical care? If the answer is "0," then the GOP has no case that tax benefits, etc., will "encourage marriage." If it's 1 or more, then it's already far too many.

Because it's not even a skip and a hop away from prostitution: people are encouraged to enter into conjugal relationships in order to get money and resources. The relationship is always abusive if the government punishes you for not being in it because people's sexual and emotional autonomy is not being respected.

I'm still surprised how few people even give lip service to the concept of "consent."
Low Wage Jobs and Globalization
written by PJR, January 10, 2014 12:21
Gerson, and many others, don't seem to grasp that low wage jobs are jobs that pay low wages. Had the minimum wage continued to grow with productivity--a policy decision--people in these jobs would be far better-off today, and the same could be said of the many people who are paid a bit more than the minimum. Additionally, unions once turned low wage jobs into better jobs, before policy turned against unions.
written by watermelonpunch, January 10, 2014 4:24

Don't a rather large percentage of marriages break up primarily or partly because of economic issues?
Seems to me if someone wants couples not to split, they should make it so that they don't have to cope with relationship straining economic hardships like dealing with high unemployment, difficulty in the labor market, and low wages.
written by djb, January 10, 2014 8:19


Yea i dont know why he is fixated on doctors..... training is brutal.....education debt in this country is double canadas for doctors.....by the time out of training and out of debt half your working years are up.....needs to focus on people who make money without working....not docs
written by Simon, January 10, 2014 8:28
Parent is right and Dean is being myopic here. Doctors are paid less in other countries because the government supports their investment. The adjusted income of primaryc care docs is similar to school teachers. The math is here: http://benbrownmd.wordpress.co...edconsent/ Instead of poaching medical professionals other countries invested in we should socialize the cost of training our doctors and then pay them less, as well as adjust the ratio of specialists to generalists.
Doctors are largely in the one percent, almost all are in the two percent
written by Dean, January 10, 2014 10:25
Doctors are the most highly paid profession -- and the government protects them. That is a good argument to fixate on doctors. If you want them to be rich, start a charity for them. Otherwise let them compete in the market like ordinary workers.
The opportunity cost of training for a profession does not determine future salaries
written by John Wright, January 11, 2014 12:14
@parent wrote:

"I am surprised you focus so much on the nominal income of physicians. As an economist you should know better. What really matters is after tax income adjusted for hours work and opportunity costs related to the large outlay of physician education and training."

I have no issue with someone spending great amounts of money and time pursuing their passion. This might be music, sports, art, rare baseball cards, literature or even medicine.

However, the amount of personal investment, in most of these pursuits, is disconnected from any expectation of a future income stream.

One could even argue that the cost/time expenditure of becoming a new doctor is a way of restricting entry to the profession and further justifying high pay for existing doctors.

And I my limited viewpoint from the electronic measurements industry, I believe continued improvements in diagnostic equipment should make medical diagnosis more accurate and less dependent on the education of a trained physician.

The same could be said for surgical robots and surgeons.

Furthermore, I suspect high leverage medical breakthroughs that benefit large numbers of people are largely dependent on much lower paid, but educated at high opportunity cost, biochemists, chemists, mathematicians, research scientists and engineers.

As can be observed with many recent college graduates, the opportunity cost incurred in spending a great sum of money and four years pursuing a degree does not always lead to a high paying occupation.

Perhaps the cost of medical training would fall if the future perceived income stream to physicians was lowered?

written by Last Mover, January 11, 2014 12:32

Some seriously ignorant arguments are made above about doctors. Since when does a profession have a guarantee to recover its educational investment in future income while others with similar investment, albeit usually at a lower level, can't even get a job at all?

All licensed medical doctors have a guaranteed job as long as they want it. Why is the bloated, wasteful, investment to become a doctor in America supposed to guarantee recovery of the same?

What does an expensive education, grueling training, sincerity, hard work, and benefits provided to patients have to do with not enough doctors caused by an intended shortage designed to drive up doctor pay?

The artificial shortage created by the medical profession is what guarantees those jobs. Glorifying that shortage by praising what doctors go through to become doctors is like praising Bernie Madoff for making a lot of money for his clients despite what they ended up paying for it.
written by djb, January 11, 2014 5:17

Dear Dean

Not only do doctors have their working years cut way down because they are training so long....reqiring them to make more to catch up.... but even what t hey make does not put them in the top 1%..
.I. ... look it up.....
written by djb, January 11, 2014 5:42

In fact dean

If you look up the salary of primary care docs the median salary is about 190 to 200 k

The top 5% starts at 188 k

The top 1% starts at about 390 k

But this misleading.....they average doc owes 200 k in student loans. ... with interest the pay 30 or 40 k to pay it back and they can't deduct it.....they "make too much" to deduct the interest.....

And the real wealth of 1% isn't in their annual income....its in their assets.....somee of it hidden off shore
written by djbo, January 11, 2014 5:51
I don't know why Dean baker has a bug up his butt for doctors.....but I guarantee you the millionaires and billionaires love having him have the doctors run interference for them.... hiding the actual villains

......... also stealing doctors from other countries where they arr desperately needed to lower the salaries of doctors in us isn't right

Doctors in India get their training for next to nothing....on merit.... and when they don't they mostly come from rich families so have no debt

So yea they can come here work for less..... unfair to american born and traibed doca who have that 200000 dollar debt
djb, don't ignore Dean Baker's comments here and other posts on this subject
written by jaaaaayceeeee, January 11, 2014 6:48
For example, we can prevent brain drain from other countries, and 1/3 of our doctors ARE in the 1% (with the overwheming majority in the top 3%).

written by djb, January 11, 2014 7:28

Let's ignore amount of debt

Let's ignore shortened work years due to length of training

Both of which greatly decrease lifetime earnings

Lets ignore that it's assets not just income that counts..... then Let's pick on the docs

If he was talking about cardiologists or surgeons making 500 k to a million... I am with him.... but the primary care docs making 180 k with with 200k in debt and shortened work years....
. Sorry cant go along
$180k gets you in top 2 percent of wage earners
written by Dean, January 11, 2014 7:32

I believe you are looking at family income data. If you look at wage data $180k is the cutoff for the top 2.0 percent, $250k for the top 1 percent http://www.ssa.gov/cgi-bin/netcomp.cgi?year=2012 You will find the overwhelming majority of doctors, including primary care physicians, in this hod.
written by djb, January 11, 2014 7:57
most docs I know aren't in it for the money

so lets make higher education free for those who qualify and then our docs can compete with doc imports from india, for example, ie then they can make less

I am sure that most wouldn't have a problem with this

and this would weed out those docs who are in it for the money

a good thing

written by djb, January 11, 2014 8:03
but my bigger point is this

its not the the top 5 percent or even the top 2 percent or even the top 1 percent of the earners

its really the top 0.01 percent causing all the trouble

and with the gains in productivity there should be no question that we should have full exployment and living wages for everyone

with lower weekly hours, more vacation, earlier retirement

we produce more goods and services with less labor than ever before in history

the problem is the top 0.01 percent and the incredibly unequal distribution of the money supply to them

and they love having people not in the same category as them being viewed as equal to them

anyway thanks for answering and thanks for you contributions
written by djb, January 11, 2014 9:45
But that table shows the income subject to federal tax based on w2 data

And assuming the person making 180 k maxes out their 401 k,

Then the 180 probably is really around 195 k to 200 k

Wheres the person really making 180 would probably show as making 165 k

This gives a take home of around 112 k

For a 200 k educational loan to pay back that’s about 19 k a year for 15 years at least

Then you got licensing fees, professional society dues and , continuing education expenses

Lets say this is around 4 k a year

That’s 23 k off the take home since none of it is deductable since the doc makes too much

So that’s a take home of around 89 and that’s more like making 133k

And lets shorten the lifetime working years by 20 % due to 8 years training post college

So lifetime earnings are lessened

Just sayin, the primary care docs are not the problem

Even with medical costs

It’s the pharmaceutical industry, medical device makers, hospital corporations, long term care facilities, intermediate care facilities and yes some doctors who do a lot of procedures, or are invested in some of the above

but not the pediatricians, family practice, internist, psychiatrists and the like

so having docs come from other countries to drive down the pay scale, when those docs don’t have any educational debt, either because their families are rich (the case with most other countries) or their government paid for their education

would really make sure that a lot more of our american born docs had to come from wealthy families as well

this of course would further entrench our aristocratic system
that’s the way it was 100 years ago

written by AlanInAZ, January 11, 2014 10:37
Doctors in India get their training for next to nothing....on merit

Medical education in the Indian government colleges is cheap but very limited capacity. Private colleges provide additional training capacity but are expensive. Many Indians are going to China and Russia for their medical education hoping to pass the qualifying exams when they come back. There have been many pieces in the Times of India on this subject.
If doctors got the same pay as docs in other countries, they wouldn't be part of the aristocracy
written by Dean, January 11, 2014 10:45
that's a small problem with your argument djb. btw, docs do get paid for internships and residencies -- maybe not what they think they deserve, but they aren't getting zero
Overpaid doctors: classic example of waste and ... shall we say hypocrisy?
written by Rachel, January 11, 2014 11:02

The excess profits for doctors and hospitals have been a problem for a long time now. They are an important cause in the growth of inequality in the US. (This is not to underrate the role of the financial sector, of course.)

But an important factor behind this medical waste has been the failure of the media to acknowledge and repeat important facts. We do not train enough doctors. We do restrict the supply of residencies. So fewer young Americans can hope to be doctors, compared to other countries. Doctors are overpaid, compared to other countries. Americans do not get enough doctor visits, compared to other countries. Major medical procedures cost much too much, compared to other countries.

But our media has failed to bring out these points sufficiently. So people on the left, partially guided by self-interested doctors, suffer from the very unproductive notion that it's just administrative costs that make US health care more expensive. No. Doctors in France don't make so much, and they see patients more often. (And our drugs cost too much. etc.) And people on the right, who used to believe in free markets, don't know enough to see how much markets have been damaged to the advantage of doctors here.

Thus Dean Baker repeating some data on the trade barriers that keep doctors salaries too high, this is ALL to the greater welfare of the vast majority of our fellows. We need this perspective. Even if some doctors are annoyed by it.

(Incidentally, U. Reinhardt did a piece on the cost of medical education debt relative to doctor income: 7.1% for one making only 150 k, 3.6% over 20 years for one who goes on to make $300 k. High. Not prohibitive. But the overpricing of medical school, relative to other science training, was tolerated by doctors because THEY too can charge too much. But it is something else that should have been part of the discussion long ago. It's another case of excess profits. These profits need to be reduced by competition, not just shifted to the taxpayer.)
written by djb, January 11, 2014 12:38
but they aren't getting zero

not enough to even pay the interest on their loans I am afraid

so the deferred interest keeps increasing the principle that will ultimately be due

but come on, upper middle class doesn't count as aristocracy

like I said lets make college and medical school free for qualified people and then they can make it with less pay

I am assuming that you want primary care docs to make like 100 k

then after having to pay loans and license fees and and professional society fees and continuing education it would be more like making 65 k

of course not for the foreign immigrants who come here with no debt

but I am talking about mainly primary care

I agree all these specialists are paid way too much

but its easy to bash all doctors as one group since we do have specialities that are way overpaid, but these are the ones living in the giant houses with the expensive cars and vacation homes etc etc

not the primary care docs

written by AlanInAZ, January 11, 2014 12:45
These profits need to be reduced by competition, not just shifted to the taxpayer

I don't see the doctor excess profits shifted to the taxpayer. Medicare charges for doctor services are now very low. The surgeon for my recent hip replacement received about $700 for the surgery and the anesthesiologist about $175 assuming 50% of the payment goes to practice overheads. I can't understand how that is excessive.
written by Simon, January 11, 2014 12:49
Dean you didn't seem to actually respond to my comment on debt and opportunity adjusted salaries to doctors. How many finance execs in the top 5% have that much debt and foregone income.Making a pithy comment about protectionism is not a response. Writing about how the US government could use its bargaining power to change medical education would be more valuable.
Don't Protect Doctors
written by Dean, January 11, 2014 1:04
I did respond -- sorry if you didn't understand it.We don't have policy on how much shoe salespeople should make, why should we have a policy on what doctors should make. Open it up to competition. If our native born doctors decide it's not worth it and they would rather work as shoe salespeople that's fine by me.
written by Simon, January 11, 2014 1:13
We also don't have a program that supplies 80% of the cost of shoes to those over 65 and those under a certain income level, as well as third party payment for shoes for everybody else. We also don't certify shoe producers for safety through licensing.
Some good resources are Ken Arrow 1963 on why Medicine is not like any other market. Also Jack Wennberg's work on how increased supply in third party payment systmes leads to more costs not less. See here: http://theincidentaleconomist....ive-care/.

If you were writing at the Cato Institute what you were saying would make sense, but when you make it your professed aim to supply healthcare to all you have to start thinking about what makes the market different. Am I wrong that this is your goal?
written by Simon, January 11, 2014 1:19
Health economist Uwe Reinhardt has thought about some of these issues:

There is nothing wrong with foreign doctors
written by Dean, January 11, 2014 4:03

you obviously have some problem with foreign doctors. I don't. therefore I see no issue whatsoever in bringing in foreign doctors at the wages they are willing to work for. If that means that no one in the U.S. wants to be a doctor (it won't), I couldn't care less.
Saying that the health care market is different is just a non sequitur in this context.
Shoes program
written by Squeezed Turnip, January 11, 2014 8:11
Frank Zappa wrote a song back in 1973 about not being able to afford shoes (in honor of the 1973 recession):

As far as doctor pay goes, just because doctors are overpaid doesn't mean they should blow their wad on med school. Downward pressure on wages is inevitable, at least in a private market that's free. Artificial shortages are due to privateers bribing the rule makers to distort the market that way, but it's not a sustainable practice.
written by Simon, January 11, 2014 8:25
I dont disagree that downward pressure on wages is inevitable and necessary as noted by Turnip, only to the proposed methods and the relative inattention Dean pays to other aspects (debt loads, specialist capture of the RUC) that account for current high pay. To continuously not mention these aspects seems to me to be lazy and counterproductive. Just because low wage workers got shafted by low wage competition doesn't mean we don't have a responsibility to think about how best to design our medical system and medical education given all the aspects that do in fact make the market different from "shoe makers". Foreign workers and other medical extenders may indeed be a part of this. I don't have "a problem" with them, although one might say other countries which invest more in their doctors human capital have a right to recoup some of it. If anything having more foreign doctors will put the onus on the CMS and Med School deans to took with how specialists are compensated relative to primary care docs and how much debt doctors graduate with. Thank you Dean and others for your time on this thread. You are a valuable voice and I appreciate the work you do.
written by Simon, January 11, 2014 9:00
And my point about not having a policy regarding how much shoe makers are paid is that we do not need one because we haven't decided to provide footwear as social insurance, whereas even if we have more foreign doctor it will still be politics rather than markets deciding doctor compensation, especially if single payer is extended.
More on the public health aspect shoes
written by Squeezed Turnip, January 11, 2014 10:54
Yes, I hadn't thought of shoes as social insurance for quite a while, but then remembered how infection by hookworm got practically eliminated from Mississippi beginning in 1910. But here is a link to a more recent study (completed in 2012) where shoes were handed out. I'm sure this was but a drop in the shoe industry's bucket, but still …

I also agree that the incentive structure within the medical field is all wrong, with all the pieces being put so that the incentive is to specialize rather than providing primary care. I do put the onus pretty squarely on the education-certification system that has been constructed. Single-payer is going to require a fix on the ballooning costs of education as well. But that's what we get for letting MBAs dictate the administrative structures at universities and hospitals. What is the current charge to cost ratio at private hospitals? 9 to 1?

In any event, medtourism seems to be doing well, so why import the foreign doctors? Soon we may even just have floating hospitals: go on a Caribbean cruise into international waters, past the shadow of the AMA, get your knee replaced by a top notch surgeon, relax on the deck and get tanned? (I'm not sure what maritime law would say about this)

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About Beat the Press

Dean Baker is co-director of the Center for Economic and Policy Research in Washington, D.C. He is the author of several books, his latest being The End of Loser Liberalism: Making Markets Progressive. Read more about Dean.