How retail’s apocalypse spawned a “med-tail” renaissance

 As healthcare startup names go, Eternal is certainly not subtle. 

An athlete-focused care clinic started by a cofounder of The Athletic, Eternal raised $13 million earlier this year for high-performance healthcare, with locations in New York and San Francisco. Clients come in for proprietary testing in what’s essentially a wired gym, submitting to bloodwork, bone scans, and workout sessions measuring numerous performance metrics to arrive at an action plan that gets reevaluated after six months. Annual membership costs $4,800. 

“The idea is that we’re all aging at some point, so when you’re 70 years old, you’re probably going to look back and either thank the person that you were when you were younger, or maybe need to take better care of yourself,” Charlotte Winthrop, Eternal’s chief marketing officer, said.

Like other startups catering to high-end clientele, Eternal highlights how new demand for preventative care — as well as a boom in venture capital funding — is creating a new tier of boutique fitness and healthcare. The wellness industry’s push into brick-and-mortar spaces represents an upgrade for clients who want even more data-driven health and a “concierge-level experience,” Joe Vennare, cofounder of industry newsletter Fitt Insider, said. 

But the med office real estate boom isn’t limited to upper-crust athletes. Eternal represents just one facet of a real estate explosion focused on smaller, more dispersed medical, wellness, and healthcare offices. Real estate brokerage JLL found the medical outpatient building sector is seeing “significant growth,” with leasing for these types of tenants up 15% nationally in Q4 2024, reaching 19 million feet of new leasing activity. 

“Hospitals are trying to move as much off campus as they possibly can so they can backfill that space on campus with high-value services.”

Doctors might call this surge in leasing a case of comorbidity. The pandemic gave hospital and healthcare systems a vision of remote and virtual care and the potential of making it easier to reach patients. Diagnostic tools have also advanced and become more compact, enabling caregivers to consider smaller facilities. 

A hair follicle

Importantly, hospitals and health systems used to charge substantially more — up to 50% in some cases — to perform the same service at their central campus, until a wave of reform legislation introduced a decade ago began to level the playing field in favor of what’s called site neutrality. Healthcare systems realized it was becoming less economically viable to offer certain services with lower margins at the most expensive real estate they owned, and expanding hospitals can be expensive. That pressure has pushed medical systems to open up smaller satellite outpatient locations as a way to save money. Staffing figures support this shift; today, 6.8 million healthcare workers operate from medical outpatient buildings, versus 5.5 million in hospitals, figures that were even just 15 years ago. Another real estate brokerage, CBRE, found that 80% of medical facilities under construction today aren’t hospital-adjacent.

“Hospitals are trying to move as much off campus as they possibly can so they can backfill that space on campus with high-value services like surgeries, inpatient care, and high-acuity-level stuff,” said Matt Coursen, who leads JLL’s healthcare leasing advisory services. “The lower-acuity stuff is going out into the community more than ever before.”

It also doesn’t help that hospital systems are experiencing significant financial distress postpandemic, said Katie Reilley, senior director of healthcare strategy for Ankura, a national consultancy with a healthcare focus. Shifting care to a leased office means less capital spending on facilities.

There aren’t many segments of the retail world that are growing, so what Coursen calls the “med-tail” world, like high-end dental and primary care facilities, is finding a new home in retail centers built near residential areas and potential patients. Some private primary care chains have been expanding, too, like Amazon One Medical, which is continuing to add new locations this year even after competitors Walgreens and Walmart expressed frustration finding profitable ways to grow.

Various human bones

Technology coupled with demographic changes — namely the so-called “silver tsunami” of an increasing older adult population — will boost demand for healthcare services, exciting many investors about the opportunities this space presents. CBRE’s analysts forecast increased activity this year, with spillover leasing into underutilized office space to meet growing demand. Boston, Houston, Dallas, and Orlando are all expected to have more than half a million square feet of leasing this year each.

Treatments and care that used to require a visit for a hospital can now be done in a small office adjacent to a grocery store. Outpatient volumes are expected to grow 10% in the next five years, leading existing medical providers to expand into suburban and Sunbelt markets to reach patients. 

The demand has been pushing past traditional medical offices, with many clinics taking up space in unused retail locations. Coursen said that a Pier 1 imports retail site makes a good candidate for retrofitting into a specialty clinic, and a big-box retail store can be transformed into a medical clinic. Because of the ancillary benefits, landlords have been excited to lease space that they traditionally wouldn’t have given over to medical tenants, said Meghann Martindale, who leads retail intelligence for Avison Young. Repeat visits and new foot traffic benefit surrounding retail properties. Healthcare spending also represented 22% of consumer spending in 2023, per CBRE figures. 

The high-end longevity clinics and fitness sites remain a niche compared to the larger medical office, but they’re poised to flex their financial muscles in coming years. The list of new startups and franchises tapping into wellness trends has exploded: Humanaut, a longevity and health clinic, raised $8.7 million last fall and has three locations open or in the works; Sunday Health, a dementia care startup, signed a lease in January for its first brick-and-mortar facility in Alexandria, Virginia; longevity platform Biograph has two locations, in New York City and the Bay Area; and competitor Fountain Life boasts six clinics, including a new site in Miami. These facilities offer slick, streamlined, and spa-like spaces — table stakes for the high-end crowd they’re seeking to attract.

Fitt Insider’s Vennare also highlighted Neko Health, an AI-powered body scanning startup backed by Spotify founder Daniel Ek with locations in London and Stockholm, which raised $260 million for further expansion into Europe and the US. He sees the industry growing substantially in the next few years. It won’t just be one-off clinics in wealthy neighborhoods, but a “bolt-on” category, where gyms or even hotels with a wellness angle will seek to colocate with these facilities. 

“This will be an expected part of the wellness and health journey,” he said.

https://sherwood.news/business/the-strip-mall-will-see-you-now-how-retails-apocalypse-spawned-a-med-tail/

How To Overcome Negative Thoughts: 4 Secrets From Philosophy

 We’ve all got that voice in our heads. The internal heckler perched in your skull’s cheap seats, shouting things like “You’re not good enough,” or “Why are you even trying?” (My internal voice sounds like a mix between my fifth-grade gym teacher and one of those scary moms from a reality show about cheerleading.)

This voice narrates our lives like it’s Ken Burns in a documentary about self-doubt. It’s not helpful. But we listen. We always listen. So what’s to be done?

Let’s look in a less-than-expected place: philosophy of language.

Enter Ludwig Wittgenstein. This guy changed the face of philosophy twice. In his first book he proposed that philosophy was a problem, not a solution. That the reason philosophers keep getting stuck in the same debates is because they’re asking questions that are just grammatically broken. He felt asking “What is the meaning of life?” is like asking “What flavor is Thursday?”

And his second book, Philosophical Investigations, spends 300 pages systematically tearing his previous ideas to shreds. (Imagine if Darwin published “The Origin of Species” and then came back ten years later with a treatise titled, “Actually Never Mind.”) In it, Wittgenstein introduces the idea of “language games”: the concept that the meaning of a word is based entirely on how it’s used.

So what’s that have to do with our internal narrator, that Terry Gross of your inner despair? Surprisingly, a lot.

Sometimes self-improvement isn’t about changing who you are. Sometimes it’s just about changing your wording. And when you clean up the language, you clean up the mess. You stop assuming that your brain is a lighthouse of universal truth and start treating it like a confused foreign exchange student.

Please note: I’m using Wittgenstein’s ideas as a springboard here. These are my interpretations. Wittgenstein would probably look at this post the way Da Vinci might glare at the Mona Lisa coasters on sale at the Louvre.

That said, let’s get to it…

Those Awful Words In Your Head

Wittgenstein said, “The limits of my language mean the limits of my world.” What he’s saying, in essence, is that the way we talk shapes what’s possible in our lives.

So if the default phrase in your vocabulary is “I’m falling apart,” then congratulations, you’ve successfully trained your brain to treat a mild inconvenience like the apocalypse. Hope you like cortisol.

This aligns eerily well with the mechanisms of Cognitive Behavioral Therapy, though Wittgenstein predated it. CBT teaches us that our thoughts shape our emotions, and our emotions influence our behavior.

So, if you reframe the way you describe your experience, the experience itself begins to shift. CBT asks you to interrogate your thoughts like a suspicious customs agent. “Did you pack this thought yourself? Is it based in reality or are you just hungry and irritated because someone didn’t like your Instagram post?”

Which brings us back to the Wittgenstein quote. Because this is exactly what he meant (at least, that’s what I’m saying, and he’s dead so he can’t correct me). Sometimes feeling better is just a matter of proofreading your internal narrator.

Take one negative phrase you say to yourself regularly. “I’m a failure.” Okay. Cross-examine. Did you fail at everything? Did you forget to call your grandmother or did you set fire to an orphanage? Why are you calling it failure and not disappointment or learning or simply not ideal? Look at the words you’re using and ask, “Is this accurate?”

For instance, stop saying “Everything sucks.” Unless you’ve personally verified the entire known universe and confirmed it is irredeemable, just say “I am mildly inconvenienced by the long line at Chipotle.” One of those you can deal with. The other requires a bunker and canned goods.

Be more accurate, neutral and constructive: “I’m freaking out” becomes “I feel unprepared.”

Stop labeling your identity. Describe your state. “I’m lazy” becomes “I’m avoiding it because the task feels scary.”

You know what happens when you change “No one likes me” to “I feel disconnected from people right now”? You start to look for connection instead of confirmation that you’re unlovable.

You think you need therapy, but maybe what you need is a thesaurus.

But what if it does go deeper? What if it’s a negative pattern you’ve had for decades?

Those Awful Patterns In Your Brain

You might notice that the voice doesn’t even try new material. It’s like around puberty, someone handed us a psychological screenplay full of bad dialogue, tired plot twists, and an obsessive emphasis on how everything is our fault. And instead of rewriting it, we just keep doing table reads.

Enter Wittgenstein, stage left, muttering about language games. If the story I tell myself when I receive a curt email is “I’ve disappointed someone again,” that’s not an objective truth. It’s a game I’m playing. A narrative I’ve defaulted to.

So the next time you find yourself mid-rumination, ask: “What role am I playing right now? And is this really the game I want to keep playing?” The trick is to start treating your inner dialogue like malfunctioning software. If your GPS got you lost five times in a row, would you continue taking its advice? No. You’d throw it out the window and go back to printing out MapQuest directions like it’s 2004. Same principle applies to your brain.

Let’s bring in our modern psychological accomplice: Schema Theory argues that our minds operate through interpretive templates formed in early life, like masochistic Mad Libs.

Insert disappointing behavior here → apply abandonment schema → cue existential tailspin.

You think your inner monologue is you? It’s not. It’s a propaganda machine run by a committee of childhood wounds and cultural expectations. And that voice keeps chattering away with all the fervor of a conspiracy theorist at a municipal zoning meeting. But the truth? You can change the game. You can choose a different role in the story.

So, here’s the exercise — call it Wittgenstein’s Role Roulette. When you’re mid-sulk, ask: “What would a different version of me say right now?”

You get a text message: “Hey. Can we talk?” Now, your default schema flips the panic switch. “This is bad. I’m about to be shamed, fired, or dumped.” But this time imagine you’re a different you:

• The Dispassionate Scientist: “Interesting. My heart is racing. Let’s observe that.”
• The Calm Executive: “They probably want clarification. Let’s see what it is.”
• The Chronically Unbothered Dad: (Shrugs. Continues grilling sausages.)

Yes, it feels ridiculous. It should. You’re detoxing from a lifetime of believing your internal narrator was you. It’s not you. It’s just the tired, neurotic screenwriter in your head who keeps recycling old plotlines.

Now some people are going to say no matter what they do, the voice pushes back. Okay, then we need to dismiss it altogether…

Turning The Voice Off

What fascinates me is how little scrutiny we apply to this inner voice. We challenge our news sources, roll our eyes at politicians, but when the voice in our head says, “You’re a loser,” we assume it must be reporting based on verifiable data from the Department of Existential Appraisal.

What Wittgenstein’s work on language games said is that language is a very poor substitute for reality. And what we call “thoughts” are often just language in drag, pretending to be truth.

Simply put: don’t believe everything you think. This is the same voice that told you bell bottoms would be a good idea. It cannot be trusted. You are not your thoughts. You are the person having them. And until you stop confusing the two, you’ll keep calling this prison home.

So how does this relate to modern psychology? Acceptance and Commitment Therapy talks about how we emotionally “fuse” with thoughts that pop up. You don’t challenge the premise; you accept it as context. Then you act in accordance with the tone it sets. You’re no longer trying to solve a problem; you’re playing a game your thought just started.

And cognitive de-fusion is when we choose to step out of the game entirely.

When a thought is distressing or emotionally sticky, don’t engage with the content. Instead, name the pattern. Label it. Abstract it. Metaphor the hell out of it. Describe it in a way so comically mundane that you break the trance:

• “Oh, the ‘Imposter Syndrome Monologue’ again. Seen it, heard it, not buying merch.”
• “That’s an AM radio station that only plays guilt rock.”
• “My brain has scheduled another showing of Shame: The Unauthorized Musical.”

Once labeled, the thought is moved from the Limbic Fire Pit of Panic to the more manageable Linguistic Holding Cell of Detached Observation.

It loses the hypnotic power of being The Truth™. You turn it from a predator into a punchline. It’s like when someone insults you and rather than wrestling with their statement, you just say, “Oh, that’s my brother being a jerk again.”

Time to up the ante. What about when you’re full-on spiraling and cannot get a grip?

How To Stop Spiraling

One irritating comment from the voice and now your central nervous system is reenacting The Battle of Dunkirk. It’s like being caught in a mental centrifuge that starts with a mundane annoyance and ends with the irrevocable conclusion that you are fundamentally unlovable.

Cognitive Load Theory says the human brain can only process a limited amount of information at once. You know how your browser crashes when you have 47 tabs open, half of them YouTube videos and the other half articles you’re pretending you’ll read later? That’s your mind.

You might think you’re spiraling because you haven’t found the “answer” to your issue yet. The reality is you’re spiraling because you haven’t asked a question precise enough to be answerable.

This is where Wittgenstein, who never used the word “vibes” even once, steps in. He famously said: “Philosophical confusion arises when language goes on holiday.” Which is a gentle way of saying: Your mind isn’t broken; it’s just clogged with poorly defined words.

Words with just enough emotional seasoning to feel profound, but not enough precision to be useful. Again: a language game. You’re speaking in phrases that look like sentences, but when examined closely, they collapse into slogans. They’re not wrong. They’re just hollow.

You need to ask: What am I actually saying to myself? “Healing,” “growing,” “evolving.” These aren’t destinations. They’re generic menu items at the spiritual Cheesecake Factory. These phrases are not insight. They’re camouflage. They give the illusion of depth while actively preventing it. They allow you to avoid eye contact with your feelings.

Instead of saying “I’m paralyzed by indecision about my life,” say: “I haven’t defined what I want.” That’s it. That’s the whole monster. Say it right, and the monster shrinks from a Lovecraftian beast into an irritating but manageable rodent.

Ask yourself: “What’s the simplest way I can say what’s wrong?” And not in florid poetry:

• “I feel like a failure.” — Too dramatic. Try again.
• “I don’t feel successful.” — Still vague. Try again.
• “I haven’t defined what success means.” — Ding ding ding!

Congratulations. You’ve just been yanked into the realm of solvable problems.

You do not require a breakthrough. You need clarity. Say your problem in one sentence without using the word “journey.” A sentence that feels like a slap instead of a poem. If it sounds like a quote on a candle, try again. It’s probably about fear. Or shame. Or recognition. Or control. The thing underneath the thing which you can actually do something about.

You can solve “I haven’t defined what progress looks like.” You cannot solve “Am I a cosmic disappointment?” unless you’re planning to email God and request KPIs.

Okay, we’ve covered a lot. Let’s round it up and see what Wittgenstein had to say about dealing with good feelings…

Sum Up

Here’s how to overcome negative thoughts…

• Those Awful Words In Your Head: You’re not broken; you’re linguistically self-harming. You’re not failing at life. You’re failing at semantics.
• Those Awful Patterns In Your Brain: Next time your brain decides to spin up another melodramatic, self-defeating narrative, pause. Don’t respond yet. Take a breath. Ask: “What game am I playing here?” And pick a new role.
• Turning The Voice Off: When that internal narrator starts criticizing, don’t debate it. Just nod and go, “Ah. That rant again. Haven’t heard that one in a while.”
• How To Stop Spiraling: If you insist on narrating your life like a Shakespearean tragedy, remember: most of those end with everyone dead because somebody misheard a message. Don’t let bad phrasing be your tragic flaw. Start speaking about your emotions with the boring specificity of a DMV form.

Okay, you’re feeling good. Sun’s shining. Coffee’s perfect. No one’s talking to you about crypto. What does that voice in your head all too often do?

Starts dissecting the feeling like it’s the Zapruder film:

“Why am I happy?”
“Do I deserve this?”
“Is this joy even legal in my income bracket?”

Can you imagine applying this same logic to sex? “Hang on, I need to understand why this feels good before I continue.” Congratulations, you’ve just killed the mood and the species.

In psychology there’s the concept of “labeling”: putting feelings into words makes them manageable. Works for anxiety, guilt, shame. If you label them, they lose their grip. And this is where our friend Ludwig lurches into frame with his most famous quote: “Whereof one cannot speak, thereof one must be silent.”

It’s not advice. It’s not a koan. It’s not some cryptic Austrian burn. It’s a warning. It means: language has limits. Experience is bigger. Not everything survives translation.

Like joy, for instance.

Wittgenstein understood that language has boundaries. That experience, real capital-F Feeling, exists outside the reach of words.

When you’re depressed, anxious, spiraling — language is your weapon. You name it; you tame it. It works because naming a thing gives you distance. But with happiness we don’t want distance. So what if we took Wittgenstein’s advice and just shut up when the moment demands it?

The next time you feel good, resist the urge to interrogate it. Don’t ask it for ID or proof of residence. Let it breathe. Let the sun hit your face. Let the cat stay asleep on your chest. Let the world be briefly kind.

In these moments, we should remember that Wittgenstein taught us that language is imperfect.

So let the world, as it is, be enough.

https://bakadesuyo.com/2025/06/negative-thoughts-2/

Senate Republicans Revise Trump Tax Bill To Win Over Holdouts, Eye July 4 Passage

 Senate Republicans unveiled a revised version of President Trump’s $4.2 trillion tax package early Saturday morning, making targeted concessions on state tax deductions, Medicaid policy, and renewable energy provisions in an effort to unite their caucus ahead of a July 4 deadline set by the White House.

Senate Majority Leader John Thune (AP)

The updated draft reflects compromises among Senate GOP factions that have sparred for weeks over how aggressively to cut social safety net programs and whether to roll back clean energy incentives enacted under the Biden administration. The legislation, if passed, would serve as the centerpiece of Mr. Trump’s second-term economic agenda.

Senate Majority Leader John Thune announced that voting on the bill would begin Saturday afternoon, with a final vote potentially coming as soon as Sunday. If it does pass the Senate, Republican leaders have indicated they will call House members back to Washington early next week in hopes of sending the legislation to the president’s desk before Independence Day.

However, it remains uncertain whether all 50 Republican senators are prepared to back the measure. Senator Ron Johnson of Wisconsin said Saturday on Fox News that he would oppose beginning debate on the bill immediately, citing the need for more time. “This is an important bill,” Johnson said. “There’s no need to rush it.”

A Revised SALT Cap

To address concerns from House Republicans representing high-tax states, the new draft raises the cap on the state and local tax (SALT) deduction from $10,000 to $40,000 for five years. The cap would snap back to its original level thereafter, with a modest 1% annual increase during the interim period. The deduction would begin phasing out for taxpayers earning more than $500,000 annually.

A House provision aimed at curbing SALT workarounds used by pass-through businesses was stripped from the text. While fiscal conservatives have criticized the SALT compromise as overly generous, the deal is expected to secure the support of swing-district Republicans and has been endorsed by the White House.

Senate Republicans also removed a controversial Section 899 “revenge tax” on foreign companies and investors following concerns from Wall Street and a request from Treasury Secretary Scott Bessent.

Tax Relief and Medicaid Tweaks

The legislation makes permanent the individual and corporate tax cuts first enacted in 2017 and introduces new temporary breaks for tipped workers, seniors, and car buyers. In a nod to moderate Republicans, the revised bill creates a $25 billion rural hospital fund intended to mitigate the effects of Medicaid spending reductions that critics warn could threaten services in underserved areas.

Senator Susan Collins of Maine had pressed for a $100 billion allocation but has not yet commented on whether the smaller fund will earn her support.

The new version delays the full impact of a 3.5% cap on state Medicaid provider taxes from 2031 to 2032. The cap, which would begin phasing in by 2028, applies only to states that expanded Medicaid under the Affordable Care Act. Additionally, the bill imposes new work requirements for Medicaid recipients and would require ACA-expansion beneficiaries to contribute to their care through co-pays or deductibles.

Renewable Energy Rollbacks and New Land Sales

Republicans accelerated the phaseout of tax credits for wind and solar energy projects, now requiring such projects to be fully operational by the end of 2027 to qualify. That change, reportedly supported by Mr. Trump, could impact companies like NextEra Energy, the nation’s largest renewable developer.

Senate Democratic Leader Chuck Schumer criticized the change, warning on social media that the rollback would “jack up your electric bills and jeopardize hundreds of thousands of jobs.”

The bill also ends the $7,500 electric vehicle tax credit sooner than earlier versions proposed, cutting it off after September 30, 2025, including for used and commercial EVs.

A separate provision reinstated in the draft would authorize the sale of up to 1.2 million acres of federal land across 11 western states for housing and community development, a measure pushed by Senator Mike Lee of Utah. The plan could raise up to $6 billion but faces resistance from GOP senators in affected states.

Tax credits for hydrogen production, originally slated to end this year, would now continue through 2028 for projects started by then.

Broader Cuts and Debt Ceiling Increase

The legislation includes steep cuts to funding for the Consumer Financial Protection Bureau and federal food assistance programs, while increasing allocations for the U.S.-Mexico border wall. It preserves $15 million in funding for a task force to study alternatives to the IRS Direct File program, though it drops language that would have terminated the free filing service entirely — a defeat for tax software providers like Intuit.

A proposed tax on money transfers by non-citizens was scaled back from 3.5% to 1%, a win for companies like Western Union and MoneyGram.

Finally, the bill would raise the debt ceiling by $5 trillion, a move intended to avert a potential federal default projected for as early as August.

With internal GOP divisions still simmering, the path to final passage remains uncertain. Yet with Independence Day looming, Senate Republicans are betting that the new concessions will be enough to unify their ranks — and deliver a long-sought legislative victory for the president.

https://www.zerohedge.com/political/senate-republicans-revise-trump-tax-bill-win-over-holdouts-eye-july-4-passage

Bowman: ''The N Word' Causes Cancer, Diabetes, Heart Disease In Black People'

 by Steve Watson via Modernity.news,

Former New York City Democratic Rep. Jamaal Bowman claimed during a CNN appearance that racism against black people causes them to contract serious illnesses.

Bowman suggested that hearing racist slurs is a direct cause of cancer, diabetes and heart disease among black Americans.

“The problem is we’re not dealing with America’s original sin,” Bowman blathered, adding “this disease of hate and racism towards black and brown people and sexism towards women and anti-LGBTQ sentiment, we are not dealing with that.”

Addressing the token Republican on the panel, Bowman stated “Your colleagues in the Republican Party do not hold each other accountable when it comes to the racism that comes from the party on a consistent basis.”

“Where you are calm about this,” Bowman contiuned to rant, “I’m a black man in America. The reason why heart disease—listen to what I’m saying—the reason why heart disease and cancer and obesity and diabetes are bigger in the black community is because of the stress we carry from having to deal with being called the n-word directly or indirectly every day.”

Providing no evidence whatsoever, Bowman added, “If your colleagues would listen and try to learn and engage and grow and stop being so hateful, we could have a better country, but unfortunately we’re still here.” 

When a white panelist stated “I feel your passion, and I understand where you’re coming from, I really really do—” Bowman yelled, “we have cops beat black people to death and they’re acquitted.”

Absolutely unhinged.

*  *  *

https://www.zerohedge.com/political/radical-democrat-claims-n-word-causes-cancer-diabetes-heart-disease-black-people

Can a baby bonus really make Americans have more kids? What big families say

 Raising seven children in Jacksonville, Fla., requires Tanya Hardaker and her husband to stretch their dollars, especially as basic costs like food and transportation keep soaring. While he earns more than $200,000 annually, which she knows "is a lot," they must be "extremely thrifty" to stay financially secure as a family of nine on a single income.

Their seven children, four of whom were adopted and are on Medicaid, are now ages 9 to 18. The kids eat free breakfast and lunch at school, keeping the weekly grocery bill to about $250 during the school year. (It doubles during the summer when all seven kids are home.) The family upcycles and trades clothes with other families at their church. Their house is less than 2,000 square feet, even after making an addition. For vacations, they go camping or sometimes rent a beach house in Jacksonville.

People have a vision of what success in America looks like - a big house, new cars - but "we've done what's best for us," Hardaker told MarketWatch. As her kids start going to college, the former accountant plans to return to work to offset new costs.

"I'm not a tradwife. I never meant to stay home," Hardaker said. "But God really has blessed us, and I've used my time, talent and treasure to run this big old household."

Families as large as Hardaker's are rare in the U.S. The typical American family with kids today has two or fewer children, and only 20% of families with children under age 18 had three or more kids in 2023, according to calculations based on Census Bureau data.

The country's fertility rate is hovering near record lows and remains below the so-called replacement rate of 2.1 children per woman needed to maintain the size of the population. An increasing share of Americans say they are unlikely to have children at all. The reasons behind this phenomenon are a source of intense debate.

Americans of reproductive age themselves point to shifting personal priorities, as well as affordability and societal issues like climate concerns. The intensity of modern parenting, which research indicates is a response to rising inequality, may also be fueling ambivalence about having kids.

Left-leaning advocates focus on family policy, and highlight things like the lack of child care and paid family leave as signs that the U.S. government and society aren't pro-family. They also emphasize federal programs, like Medicaid and Head Start, as important supports for Americans who have more children.

On the right, where concerns about declining fertility have caught the attention of prominent figures like Vice President J.D. Vance and billionaire Elon Musk, policymakers are entertaining a slew of ideas to encourage families to have more children. Conservative pronatalist groups, which support increasing the fertility rate, have been sharing ideas with the White House, including a $5,000 baby bonus and more education for women about their ovulation cycles. Lawmakers are also exploring expanding the child tax credit and providing families with government-funded "Trump accounts" that would give every newborn $1,000 in an investment account, which could be used when they turn 18 for funding education, buying a home or starting a business.

While family-friendly policies can ease the serious economic challenges weighing down many American parents today, they are unlikely to set off the "baby boom" President Donald Trump hopes to ignite.

Hardaker, the mother in Jacksonville, said she has heard many politicians talk about the importance of families, but said there is no serious support for working and low-income parents in America. She pointed to the lack of high-quality and affordable child care, sufficient parental leave and paid time off at corporations, and affordable housing near public schools and public libraries.

Politically as well as culturally, "we have not valued families. We have not valued mothers. And ultimately, we really don't value children," Hardaker said.

MarketWatch spoke with parents across the U.S. with four or more children about their decision to have larger-than-average families and the financial demands of supporting them. All of the parents who agreed to be interviewed were married, and most were religious. Many said they simply wanted to have a lot of kids. They generally had high household incomes for their areas and for families their size - more than $200,000 - and noted that supporting their family was still financially difficult and required lifestyle compromises and careful management of their money and time. Some of the families had two earners; others had one. Many of the working parents had flexibility in their work schedules and the ability to work from home - benefits they described as critical for allowing them to be available for their children.

But when asked whether they felt government policy could encourage people to have more children, these parents said the costs of raising a family are so large that a one-time baby bonus or even an annual tax break, while helpful, would not likely be enough to financially move the needle for those on the fence, especially as Americans face a broader affordability crisis that is forcing them to focus on other needs. They felt the decline in the fertility rate was the result of society at large, including lawmakers not prioritizing families - let alone large families - in the face of such challenges.

Having a larger family is a decision made for spiritual, not material, gain, they noted - but the overall high cost of living today means most Americans feel they must concentrate their energy on work instead.

These days, "everybody needs to go to college, everybody needs to have a career," Hardaker said, and such expectations leave "less time and money for children." In an age when many people are worried about the economy and their own financial security, raising a family - especially a large one - can "just feel like one more thing to worry about," she added.

"It is an expensive world," Rep. Blake Moore, a Utah Republican who has four children, told MarketWatch. "You're going to want your child to have a better future and more upward mobility than you have," and there are "some really difficult economic factors that exist in our country today" for people considering having children, he said.

While Moore himself introduced a bill to enhance the child tax credit so that "families are supported," he added: "I don't think you can offer a dollar amount of economic bonus to encourage a couple to have a child."

Having more children ultimately "has to be an emotional decision," said Rebecca Hedaya-Heller, an estate attorney who has four children in Long Island, N.Y. Lawmakers could relieve some of the financial pressures parents face, and "I would like the money, but it's not enough," she said. "It's not a math thing. ... You're giving years of your life" to raise a child.

Large families are the norm for Hedaya-Heller, who grew up in an Orthodox Jewish community as one of six children. When she unexpectedly became pregnant with her fourth child a few years ago, she felt like it was "another jewel in my crown." She lives in a four-bedroom house with her husband and kids, now ages 11, 9, 5 and 2, and works from home.

"Everyone has different lifestyles," she said. For a family of six on Long Island, even a simple lifestyle still requires generous financial resources, Hedaya-Heller acknowledged. She and her husband, who works as an engineer, have a household income in the top 20% for their area. Yet having a big family means no big vacations - summers are often as simple as getting a local beach pass - or, at most, going to Florida to visit the grandparents.

"These days, families have very adventurous, exotic life experiences that we are foregoing," she said.

In aspirational TikTok videos about big-family life, the kids are often well behaved and well dressed, standing in height order, dancing for the camera. Their homes are spacious and clutter-free. The parents' financial resources seem as abundant as their patience.

"Are you going to stop now that you got a boy?" read the caption in one family's video as five daughters in matching floral dresses walk past their father, one by one, in age order, followed by their baby brother, the sixth child. The answer is apparent when their mother, who is pregnant, appears onscreen at the end, glowing.

As with most content on social media, these are idealized portrayals. "It doesn't align with my life," said Rachel Greszler, a research fellow at the Heritage Foundation, the conservative think tank.

Greszler, an economist, has six children between the ages of 7 and 16, and works full time with "a lot of flexibility" in her hours and her ability to work remotely. "I love having a big family," she told MarketWatch. "But no, it's not tied up with a pretty pink bow."

Greszler normally wakes up at 4:45 a.m., has a coffee, reads her Bible and goes out for a run before her children leave for school. Her four oldest kids can walk or bike to school on their own. She or her husband then takes their two youngest to school, which starts at 9:25 a.m., and commutes to work. One of them usually returns home by 3:45 p.m. to walk the youngest children home and then continues working remotely from soccer practice and other activities.

"It's messy. It's loud. But it's fun, and it's great, and I wouldn't trade it for anything," Greszler said.

Like some parents interviewed for this piece, she declined to share her household income, but said they are in the top 20% of earners in their area. Greszler and her husband expanded their house to have seven bedrooms, with the six kids sharing four of them. The home has five bathrooms. They drive a Mercedes-Benz Sprinter van that can accommodate 12 passengers and "looks like an Amazon delivery truck," she said. For vacations, they often drive to see grandparents in western New York.

https://www.morningstar.com/news/marketwatch/20250628166/can-a-baby-bonus-really-make-americans-have-more-kids-heres-what-big-families-say