Good morning. Today, we have the latest on the assassination attempt and presidential campaign — as well as my colleague Sarah Kliff's explanation of why childbirth has gotten so expensive. —David Leonhardt
On to MilwaukeeThe dizzying swirl of the 2024 presidential campaign will continue this week. Just two days after the attempted assassination of Donald Trump, the Republican National Convention begins today in Milwaukee. In Washington, meanwhile, Democrats seem set to spend another week agonizing over whether President Biden is too old and politically damaged to be their party's nominee. Here is the latest Times coverage:
For the latest on the assassination investigation and the campaign, follow live Times coverage today.
Baby profits
Americans spend more on childbirth than nearly anything else that happens at the hospital. The average delivery is $13,000. Even after insurance pays, patients who have babies still end up on the hook for nearly $3,000. I've spent 15 years covering the high costs of American health care, an industry in which patients routinely encounter $600 Band-Aids and $3,000 Covid tests. Recently, I've been amazed at how much hospitals, doctors and medical device companies are charging families for newborn care. They are eking out more money from each step of having a baby. They often tap into the anxiety that so many parents feel as they form new families. "People are willing to do anything to ensure the well-being of their kids even before they meet them," said Neel Shah, chief medical officer at Maven, a women's health clinic. MoneymakersHealth care companies have several chances to make their pitch between a positive pregnancy test and the birth of a child. In the first trimester, genetic companies sell tests that claim to detect serious and rare problems from a few vials of the mother's blood. But these tests, which can cost thousands of dollars, are usually wrong when they make grave predictions about an infant's health. The inaccurate results can lead parents to spend thousands on more tests and even to consider abortion. The second trimester often brings a pitch for umbilical-cord blood banking. Brochures in obstetricians' offices describe how paying to freeze and store a newborn's stem cells may be vital if the child becomes ill later in life. But the few parents who try to use their samples often find that they are unusable, either because they have too few stem cells or because they are contaminated. Azeen Ghorayshi and I investigated these companies in a story The Times published today. Most spending on childbirth goes toward delivery and newborn care. Cesarean section delivery remains the most common surgery in American hospitals, despite years of advocacy to lessen its use. About 30 percent of kids are born this way, more than twice the World Health Organization's recommendation. One reason is that we have bizarre incentives. Hospitals earn 50 percent more for C-sections than for vaginal deliveries, even though recent research shows they cost less than vaginal deliveries. When cheaper medical care earns more money, that warps behavior. Neonatal intensive care is also proving to be very profitable. Nearly 40 percent more babies went to these units, supposedly reserved for the sickest kids, from 2008 to 2018. But the infants weren't sicker. Some doctors worry that hospitals may send healthy babies to the NICU because it pays better. Investors, seeing the opportunity, have been buying up neonatology practices. Capitalizing on fearThe experts I talked to have a few explanations for why these efforts work. To start, there are millions of births every year. Hospitals know that childbirth will always make up a large share of their revenue. Another reason is that the most successful messages — the case for banking cord blood, buying advanced genetic tests or spending a few extra nights in the NICU — are selling safety for your child. Lastly, these pitches tend to come from a trusted source: our doctors. They distribute brochures that overstate the benefits of cord blood banking or genetic testing. Cord blood banks even pay obstetricians to collect the stem cells. When your doctor endorses a new and promising technology, it is awfully hard to say no.
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Opinions Programs to prevent beach erosion cannot keep up with the demands of beach towns. We should let beaches shrink and expand naturally instead, Sarah Stodola writes. Democrats are trapped in the fantasy of America presented in "The West Wing." In reality, our politics are more like "Veep," Elizabeth Spiers argues. Four Times Opinion writers discuss what to expect from the Republican convention.
Retirement: A pioneering New York rabbi said goodbye to her L.G.B.T.Q. congregation. Ask Vanessa: What does it mean to dress like a zillennial? No contact: Many Americans, encouraged by social media, are estranging themselves from their families. Dementia: For older adults, too much or too little sleep has been linked to cognitive issues. Metropolitan Diary: Trapped on the terrace. Lives Lived: The photographer Thomas Hoepker captured five people lounging on a Brooklyn waterfront as the World Trade Center burned in the background, an indelible image of 9/11. Hoepker died at 88.
Copa América: Argentina won the title, beating Colombia 1-0 (see the winning goal). The match was delayed for over an hour because of dangerous chaos outside the stadium. Euro 2024: Spain won the final 2-1, keeping alive England's nearly six-decade streak without a title. Spain's teenage star Lamine Yamal was the breakout player of the tournament. Tennis: Carlos Alcaraz dominated Novak Djokovic in the Wimbledon men's final to win his second straight Grand Slam. M.L.B. Draft: The Cleveland Guardians used their No. 1 pick to select Travis Bazzana of Oregon State, an Australian second baseman. Learn more about his journey to the pros.
The threats of climate change and artificial intelligence have some Americans fearing the end of the world. Drew Miller, a retired Air Force colonel, has an answer to those anxieties: Fortitude Ranch, a collection of survivalist compounds across the U.S. He and other so-called "preppers" are betting that doomsday can be good for business. More on culture
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