Are birth rate declines really bad problems?

For economic systems that depend on indefinite growth to remain solvent it is an existential crisis over the long run and not just for capitalism. Social security has to have more working age adults paying in than seniors withdrawing as does government in general. Local governments will collapse when there are fewer families to purchase houses and pay property taxes. It is also a disaster for national governments who will have a shortage of new recruits for their military and working age adults to pay for its public services. Unlike Japan, which has been shrinking for almost 2 decades and South Korea which is also currently shrinking in population, the U.S. isn’t projected to start shrinking for another 60 years, which is another lifetime for most people reading this. Declining fertility rates would be tenable if it wasn’t compacted with the problems of rising rates of chronic diseases and cancers that will also hamper economic productivity of a shrinking working age adult population. The U.S. spent over $4 trillion on healthcare in 2022 with over $250 billion of that going to pay for cardiovascular disease and stroke, the leading cause of death. That >$4 trillion in total healthcare spending and >$250 billion on cardiovascular disease and stroke are maintenance costs, not new wealth, especially the latter as the costs of productivity loss from cardiovascular disease and stroke in persons under 65 years of age exceeded the spending on those diseases for them. Healthcare spending, which is not in fact additional wealth but additional maintenance costs burdening the real economy, will only grow to consume a larger share of GDP not only as the U.S. becomes older but also as the proportion of adults plagued by chronic diseases continues to grow larger. The American Heart Association presidential advisory projects, based on demographic shifts and an assumed inflation rate of 1.9% annually for medical care, that by 2050 the cost of treating hypertension will increase 220% from $160 billion to $513 billion in 2022 adjusted dollars. The cost of treating stroke is projected to increase 535% from $67 billion in 2020 to $423 billion in 2022 adjusted dollars. The cost of treating coronary heart disease is projected to rise 124% from $260 billion in 2020 to $584 billion in 2022 adjusted dollars. The cost of treating diabetes is projected to rise 311% from $186 billion to $765 billion in 2022 adjusted dollars. The cost of treating all cardiovascular risk factors is projected to triple from $400 billion to $1.3 trillion in 2022 adjusted dollars by 2050. The cost of treating all cardiovascular disease and stroke conditions is projected to triple by 2050 as well from $627 billion in 2020 to $1.85 trillion by 2050 in 2022 dollars consuming 4.6% of GDP by itself; it currently consumes less than 3% of GDP. Productivity losses due to morbidity and mortality are expected to cost 54% more in 2050 rising from $234 billion in 2020 to $361 billion in 2022 adjusted dollars. These are conservative estimates that assumes a lower rate of inflation in medical costs than what we’ve experienced over the past four years.