Editor’s note, October 4, 8 am ET: We’re bringing you some of our best-loved Your Mileage May Vary columns while Sigal Samuel is on parental leave. The one below was originally published last year.

This unconventional advice column offers you a unique framework for thinking through moral dilemmas. It’s based on value pluralism: the idea that each of us has multiple values that are equally valid but that often conflict with each other. Submit your own question here.

---

My partner and I did IVF recently and luckily we ended up with several embryos. One of those will be implanted in me so I hopefully get pregnant. But which one?

My fertility clinic is encouraging me to do PGT-A testing, which would screen for things like Down syndrome and would also let me see the sex of each embryo so I could potentially choose whichever I want. (And to be honest, I really want a girl!) I’m also hearing about these new companies that can test embryos for all kinds of things — like how smart the kid might be, how tall they’ll get, and whether they’ll have a lower chance of getting breast cancer, diabetes, mental illness, stuff like that.

I don’t know how to feel about any of this. On the one hand, it feels weirdly eugenics-y to do so much tinkering with embryos, and I can’t help feeling a little pressured into overmedicalizing everything with these expensive tests. But then again, if I could do something to make my baby healthier and happier, don’t I kind of have to do everything in my power? What does a parent owe their child?

Dear Expecting,

This is such an exciting — and also confusing — time. You’re about to have your first kid, and that comes with all sorts of fears and insecurities and hopes and dreams. You want to do the right thing — no, the best thing! — for your child. It’s a beautiful impulse. Unfortunately, it makes it easy for companies to prey on you.

So let me walk you through what these companies can and can’t really provide. After we talk about the science, we can talk about the ethics. 

The simpler test you mentioned, PGT-A, has been around since the 1990s. It can indeed screen for conditions like Down syndrome and let you see the sex of each embryo. Mind you, that doesn’t predict what gender your child will ultimately end up identifying with — more on that soon.

The newer testing you mentioned is called polygenic testing. The conditions it screens for are complex ones, influenced by thousands of genes. We’re talking about everything from breast cancer to depression. Some companies even offer screenings not for disease prevention, but for genetic enhancement — so you can select for a taller kid or a kid with higher IQ.

Polygenic testing companies claim to predict each embryo’s risk for each condition, and the potential reduction of risk you’ll get if you choose one embryo over another. As the statistical geneticist Sasha Gusev explains, it’s very, very easy to be misled by this claim. If the company claims to lower absolute risk of Type 2 diabetes by 12 percent, you might think this means, “The chance of my kid ever developing diabetes just went down by 12 percent — great!” But really what it means is that, all else equal, a kid who would’ve developed diabetes is likely now at the high end of pre-diabetes instead, or just develops diabetes a few years later. The same holds true for other conditions, like breast cancer. Sure, if your kid is going to develop diabetes or breast cancer, you’d rather they develop it later — but it’s not the bill of perfect health customers might imagine.  

“Typical risk reduction estimates tend to exploit statistical assumptions to overstate their benefits and lead to confusion,” Gusev writes.

It’s also important to note that there’s a difference between a physical disease like cancer, which is straightforwardly and universally negative, and a complex mental health condition like depression. For one thing, polygenic scores don’t perform as well in psychiatry, as the psychologist Eric Turkheimer notes. Plus, most mental health conditions come in mild to moderate to severe forms, and it’s not clear that we should want to get rid of mild or moderate manifestations. 

“Sure, it would be nice if no one ever got depressed, but what would that actually mean?” Turkheimer writes. “People are going to be sad, and the most modern models of psychiatric disorders view most of them as extremes on continuous dimensions of normal behavior. I don’t think we want some kind of genetic version of Soma.”

To give a personal example: I have generalized anxiety with some obsessive tendencies. Is that a major pain in the butt sometimes? You bet. But if I could wave a magic wand and get rid of it, would I? No. In my experience, this trait is linked to another trait I deeply value: my creativity. The same thing that propels me down rabbit holes of worry also propels me down rabbit holes of getting super curious about some topic, researching it into the wee hours of the morning, and then writing a novel or children’s book about it.

That brings me to one other scientific issue: pleiotropy. It’s a fancy term for a simple truth, which is that genes can have an effect on more than one trait. When it comes to behavioral polygenic testing, we actually know very little about which genes cause what — a gene that’s correlated with depression or anxiety may also be correlated with a bunch of other things. So, if everyone were to start selecting embryos to try to protect their kids from depression or anxiety, what would happen? We don’t know! 

Pleiotropy is a scientific issue, but it’s also a moral issue, because in trying to protect your kid from a negative outcome, you could also be accidentally barring them from a positive one.

And that’s just the tip of the moral iceberg.

Another issue is the potential psychological harm that can result from commodifying our kids — treating them like consumer objects with selectable parts. Let’s say you use polygenic testing to try to select for high IQ. Even if the company’s predictor is right 80 percent of the time, that means it’s wrong 20 percent of the time. What happens if it’s wrong about your kid, and they end up with a low IQ instead of a high one? How will your kid feel? Unless you hide the truth from them, they’ll know that they are not what you wanted, that they failed to live up to the vision you went out of your way to chase.

The same goes for sex selection via good old PGT-A. I know you really want a girl. But what would happen if you select for a girl, and then your child grows up and turns out to be trans? They may feel an extra sense that they’re letting you down by not conforming to the gender expectations you had for them.

Then there are the ethical questions around unequal access. Polygenic testing isn’t cheap. (One company, Orchid, charges $2,500 per screened embryo. Test 10 embryos and that’ll cost you $25,000.) So, at least in the short term, that raises the specter of entrenching a caste system, where the gap between rich and poor expands dramatically as the rich get smarter and stronger.

Technologies tend to get cheaper over time, so maybe everyone will ultimately be able to afford polygenic testing. But that raises another problem: implicit coercion. If more and more of us make ourselves smarter and stronger, we may create a society in which everyone feels pressure to alter their child’s biology — even if they don’t want to. To refuse embryo selection would mean to put a child at a huge professional disadvantage, or to face moral condemnation for making “suboptimal” kids when optimization is possible. Society may no longer offer health insurance benefits or accommodations for kids with disabilities (or even non-enhanced IQ), reasoning that “it was the parents’ choice.” 

Some philosophers, like Julian Savalescu, already argue that parents have a “moral obligation to create children with the best chance of the best life.” Polygenic testing companies love that argument; Orchid founder Noor Siddiqui tells parents that “the responsible decision” is to “protect their children” from disease, using language like, “What if you could have stopped it…but chose not to?” And we generally live in a culture that’s obsessed with optimization. 

So it’s no wonder that you find yourself asking, “If I could do something to make my baby healthier and happier, don’t I kind of have to do everything in my power?” 

It’s a view that will be very appealing to utilitarians, who believe the right action is the action that maximizes well-being or happiness. But maximizing principles can be dangerous. If we’re laser-focused on maximizing one value, however noble it may be, that can lead us to overlook a host of other important values. Think about diversity, for example; polygenic testing could lead to a less diverse world. 

And it’s not even clear how to maximize well-being given that each embryo will have some downsides: How would you choose between one embryo with a slightly elevated risk for schizophrenia, another with a moderately elevated risk for cancer, and a third with a high risk for Alzheimer’s? You’d have to decide how to rank the importance of each condition, which would require a dizzying bit of moral math: How much weight do you put on the longevity associated with each condition, how much on patient-reported quality of life for each condition, and how much on your own ability to cope with each — and society’s ability (which will change over the years)? Plus, even if the screening does end up optimizing life for your individual child, it could have negative effects on the population level, for the reasons we covered above.

As the Nobel laureate Herbert Simon pointed out, many problems contain way more variables and way too much uncertainty for maximizing along a single axis to be feasible or even desirable. So it often makes sense to just go with an option that’s “good enough.” He coined the term “satisficing” — a portmanteau of “satisfying” and “sufficing” — to describe opting for this good enough choice.

What would satisficing look like in the context of embryos? If there’s a very serious condition that runs in your family — like Tay-Sachs or the BRCA mutation that markedly increases cancer risk — then I do think there’s a strong case for screening for that. These conditions are debilitating and can lead to early death. Nobody wants them. Genetic testing that lets us prevent them is an awesome gift. 

Then there are conditions that can include suffering, like autism, but can also be very compatible with a happy life. Mental health conditions in particular are heavily socially constructed — a lot of the associated suffering comes about because society constructs a certain biological reality as a problem and doesn’t support the people who have it. In these cases, if you want to give your child a “good enough” or even “optimized” life, remember that you don’t have to achieve that by biological means; working to change the social environment can be just as important, and it doesn’t carry the societal risks associated with polygenic testing. 

Ultimately, when considering what counts as a “good enough” life, each parent will draw the line in a slightly different place. And there’s a part of that that can’t be boiled down to objective facts about disease, because this is also about how well-resourced the parent feels — emotionally, socially, and financially — to deal with a certain condition. What feels manageable to one parent may feel crushingly hard to another. 

So, I can’t tell you exactly which screenings to do and which to forgo. What I do want to tell you is to resist being bullied or shamed by others, especially those with a profit incentive to push you in a certain direction.

As the epidemiologist Abby Lippman has noted, genetic testing is supposed to offer parents more choice, but it too often has the opposite effect. When someone like Orchid’s Siddiqui says about a disease, “What if you could have stopped it…but chose not to?” — well, that language preys on parents’ worst fears and insecurities. It holds parents hostage while pretending to be giving them more autonomy. 

You are nobody’s hostage. You are a moral agent free to look at the many different relevant factors, weigh them all in the balance, and then make the choice that works well enough for your family.   

Bonus: What I’m reading

• Silicon Valley is obsessed with IQ, so it’s no surprise that tech execs there are using polygenic testing in hopes of creating supersmart babies. This article shows the kind of mental pretzels customers get into when trying to figure out whether to select the embryo with the highest predicted IQ or that with the lowest risk of disorders. One couple asks: “How much additional risk of ADHD cancels out against 10 extra IQ points?”

• Rereading “The Last Children of Down Syndrome,” Sarah Zhang’s 2020 Atlantic feature on prenatal testing, it struck me that when people think “prenatal testing,” Down syndrome is often the first condition that comes to mind, even though it’s not the most severe or straightforwardly negative (it’s compatible with a happy life). It’s just that Down syndrome was easy to test for, so we started testing for it early. I wonder if that built up the condition as a bogeyman in the expectant parent’s imagination — if the fact that we could screen for it shaped the public’s perception of Down syndrome as something that should be screened for and potentially screened out.

• One trait that many people assume we should select for is a great memory. But I highly recommend the short story “Funes the Memorious” by Jorge Luis Borges. It’s a reminder that having too good a memory is not always a benefit.  

Vox Members got to read this story first. Support independent journalism and get exclusive access to stories like this by becoming a Vox Member today.

This story was originally published in The Highlight. To get access to member-exclusive stories like this every month, become a Vox Member today.

In the moody alcoves of a lobby bar in Chicago in 2021 over French 75s, Dr. Louise King, a gynecologic surgeon, and Katie L. Watson, a bioethics professor, found themselves in conversation about a topic that had long frustrated them both: Female surgeons are consistently underpaid compared to male surgeons, even after accounting for specialty, rank, age, and other factors. 

What troubled them even more was how the pay gap compounded in King’s own field. Surgeons who perform procedures that are specifically for women, like gynecological surgeries, are paid less for their services than surgeons who perform comparable surgeries for the male anatomy. Gynecologic surgeons are also predominantly women. Over the course of the conversation, Watson termed this situation “double discrimination,” a phrase that captures the overlapping dilemma of lower pay for surgeries in a specialty that is overwhelmingly female and also serves a primarily female patient population.

That term, which has since entered the medical literature, stuck because the problem it describes has been well documented for decades. In 1997, a group of gynecologic surgeons published a paper in the journal Gynecologic Oncology with a title that gets straight to it — “Is Adam worth more than Eve?” Dr. Barbara A. Goff, now chair of Obstetrics and Gynecology at University of Washington Medicine, and colleagues found that doctors are paid around 44 percent more for performing male-specific procedures than analogous female-specific ones. 

In the three decades since, the problem hasn’t been fixed. To the contrary, it has been effectively institutionalized, built into the systems and codes that determine how surgeons bill for procedures of all kinds. Today, gynecologic or female-specific procedures are in large part still reimbursed at lower rates than male-specific procedures even when they take similar time and skill.

Those disparities have consequences that extend beyond the compensation of individual doctors. When gynecological procedures don’t bring in as much money to hospitals, those same hospitals are disincentivised to offer women’s health services. That can lead to worse care for women and, crucially, fewer training opportunities for the surgeons who do that work. 

But this historically persistent inequality is not a foregone conclusion.

How healthcare services are billed changes all the time as procedures get reevaluated, new ones get added, and medical societies and experts push for revisions. In fact, one of the biggest changes in how maternity care is billed and reimbursed is set to take effect early next year, splitting up services for prenatal care, delivery, postpartum care, and more. While this is a long-overdue fix for obstetrics, gynecologic surgery — which covers most of a woman’s life outside of childbearing years — continues to be left out of the conversation. 

And although real change will require concerted efforts, King and Watson — and other advocates who have spent years documenting this disparity — have a fairly clear sense of how to start fixing it.  

How surgical procedures are valued

The work of deciding how much a medical procedure is worth starts well above the head of any given doctor, medical practice, or hospital. In the United States, the Centers for Medicare and Medicaid Services, a federal agency that administers healthcare and health insurance policies, sets rates for different procedures based on a metric called relative value units (RVUs). An RVU is supposed to take into account how long a procedure takes, the skill it requires, and the intensity of work it demands. Both Medicare and private insurers consider these figures when they’re settling on reimbursement levels. If a procedure has a higher RVU, it is valued more highly, and makes more money.

In a recent study, cheekily titled “Price and Prejudice,” researchers from the Mount Sinai Health System found that out of 55 pairs of sex-specific procedures that they evaluated in 2023, 75 percent had lower RVUs for procedures on female patients. On average, RVUs for male-specific procedures were 30 percent higher, and when those procedures were performed in a hospital or surgical center, surgeons were paid around 26 percent more.

For example, doctors will often perform biopsies — taking a small sample of tissues, cells, or fluids — on both male and female genitalia to diagnose problems. In 2023, researchers found that Medicare’s standard national rate for reimbursing surgeons was $121.32 for a penile biopsy but only $65.74 for a vaginal biopsy. 

.ag-root{--ag-m: #3b3fb6;--ag-f: #e2552c;--ag-m-ink: #3b3fb6;--ag-f-ink: #c74d2a;--ag-bg: transparent;--ag-knock: #ffffff;--ag-card: #f5f4f1;--ag-ink: #16161d;--ag-ink-2: #4a4a55;--ag-ink-3: #686872;--ag-rule: #16161d;--ag-grid: #e4e3df;--ag-track: #ebeae6;--ag-focus: #1a73e8;--ag-head: var(--ag-host,Georgia,"Times New Roman",serif);--ag-ui: -apple-system,BlinkMacSystemFont,"Segoe UI","Helvetica Neue",Helvetica,Arial,sans-serif;--ag-head-weight: 700;--ag-head-track: -0.01em;--ag-ease: cubic-bezier(.2,.8,.2,1);container-type: inline-size;container-name: ag;display: block;position: relative;width: 100%;max-width: 760px;margin: 2.25em auto;padding: 14px 0 10px;border-top: 3px solid var(--ag-rule);background: var(--ag-bg);color: var(--ag-ink);font-family: var(--ag-ui);font-size: 16px;line-height: 1.4;text-align: left;-webkit-font-smoothing: antialiased;-webkit-text-size-adjust: 100%;box-sizing: border-box}.ag-root.ag-root{font-family: var(--ag-ui);font-size: 16px;line-height: 1.4;font-style: normal;font-weight: 400;letter-spacing: normal;word-spacing: normal;text-transform: none;text-indent: 0;text-align: left;color: var(--ag-ink)}.ag-root.ag-root i,.ag-root.ag-root em{font-style: normal}.ag-root.ag-root .ag-ft em{font-style: italic}.ag-root.ag-root *,.ag-root.ag-root *::before,.ag-root.ag-root *::after{box-sizing: border-box;letter-spacing: inherit;font-family: inherit;text-transform: inherit}.ag-root[data-ag-palette="teal"]{--ag-m: #00829b;--ag-f: #d4661a;--ag-m-ink: #007a91;--ag-f-ink: #b85a1a}.ag-root[data-ag-palette="violet"]{--ag-m: #5b3fb0;--ag-f: #c4661c;--ag-m-ink: #5b3fb0;--ag-f-ink: #b35e1c}.ag-root[data-ag-style="feature"]{--ag-head: "Bricolage Grotesque","Helvetica Neue",Arial,sans-serif;--ag-ui: "Instrument Sans","Helvetica Neue",Arial,sans-serif;--ag-head-weight: 800;--ag-head-track: -0.025em}.ag-root[data-ag-style="minimal"]{--ag-head: var(--ag-ui);--ag-head-weight: 650;--ag-head-track: -0.015em}.ag-root[data-ag-mode="dark"]{--ag-bg: #141417;--ag-knock: #141417;--ag-card: #1f1f24;--ag-ink: #ededf2;--ag-ink-2: #b9b9c4;--ag-ink-3: #8b8b97;--ag-rule: #ededf2;--ag-grid: #2c2c33;--ag-track: #26262c;--ag-focus: #8ab4f8;--ag-m: #6f73e8;--ag-f: #e5603a;--ag-m-ink: var(--ag-m);--ag-f-ink: var(--ag-f);color-scheme: dark}.ag-root[data-ag-mode="dark"][data-ag-palette="teal"]{--ag-m: #1e9db3;--ag-f: #dd7430;--ag-m-ink: #1e9db3;--ag-f-ink: #dd7430}.ag-root[data-ag-mode="dark"][data-ag-palette="violet"]{--ag-m: #8a6ee6;--ag-f: #cf7f22;--ag-m-ink: #8a6ee6;--ag-f-ink: #cf7f22}@media (prefers-color-scheme: dark){.ag-root[data-ag-mode="auto"]{--ag-bg: #141417;--ag-knock: #141417;--ag-card: #1f1f24;--ag-ink: #ededf2;--ag-ink-2: #b9b9c4;--ag-ink-3: #8b8b97;--ag-rule: #ededf2;--ag-grid: #2c2c33;--ag-track: #26262c;--ag-focus: #8ab4f8;--ag-m: #6f73e8;--ag-f: #e5603a;--ag-m-ink: var(--ag-m);--ag-f-ink: var(--ag-f);color-scheme: dark}.ag-root[data-ag-mode="auto"][data-ag-palette="teal"]{--ag-m: #1e9db3;--ag-f: #dd7430;--ag-m-ink: #1e9db3;--ag-f-ink: #dd7430}.ag-root[data-ag-mode="auto"][data-ag-palette="violet"]{--ag-m: #8a6ee6;--ag-f: #cf7f22;--ag-m-ink: #8a6ee6;--ag-f-ink: #cf7f22}}.ag-root[data-ag-mode="dark"]{padding-left: 16px;padding-right: 16px}@media (prefers-color-scheme: dark){.ag-root[data-ag-mode="auto"]{padding-left: 16px;padding-right: 16px}}.ag-root.ag-root .ag-x,.ag-root.ag-root p,.ag-root.ag-root h2,.ag-root.ag-root h3,.ag-root.ag-root button,.ag-root.ag-root select,.ag-root.ag-root input,.ag-root.ag-root ul,.ag-root.ag-root li,.ag-root.ag-root label,.ag-root.ag-root table{margin: 0;padding: 0;border: 0;background: none;box-shadow: none;font: inherit;color: inherit;letter-spacing: normal;text-transform: none;text-decoration: none;line-height: inherit;min-height: 0;width: auto;max-width: none;float: none}.ag-root.ag-root svg,.ag-root.ag-root .ag-pt-svgwrap svg{display: block;max-width: none;height: auto;overflow: visible}.ag-root.ag-root button{cursor: pointer;-webkit-appearance: none;appearance: none;border-radius: 0}.ag-root.ag-root :focus{outline: none}.ag-root.ag-root :focus-visible{outline: 2px solid var(--ag-focus);outline-offset: 2px;border-radius: 4px}.ag-root.ag-root .ag-sr{position: absolute !important;width: 1px !important;height: 1px !important;padding: 0 !important;margin: -1px !important;overflow: hidden !important;clip: rect(0 0 0 0) !important;white-space: nowrap !important;border: 0 !important}.ag-root.ag-root [hidden]{display: none !important}.ag-root.ag-root .ag-hed{font-family: var(--ag-head);font-size: 23px;line-height: 1.12;font-weight: var(--ag-head-weight);letter-spacing: var(--ag-head-track);color: var(--ag-ink);text-wrap: balance}.ag-root.ag-root .ag-dek{font-size: 15px;line-height: 1.4;color: var(--ag-ink-2);margin-top: 6px;text-wrap: pretty}@container ag (max-width: 480px){.ag-root.ag-root .ag-hed{font-size: 22px}.ag-root.ag-root .ag-dek{font-size: 14px}}.ag-root.ag-root .ag-ft{margin-top: 14px;padding-top: 12px;border-top: 1px solid var(--ag-grid);font-size: 12px;line-height: 1.45;color: var(--ag-ink-3)}.ag-root.ag-root .ag-method{margin-bottom: 8px;font-size: 12.5px;line-height: 1.5;color: var(--ag-ink-2);text-wrap: pretty}.ag-root.ag-root .ag-method b{font-weight: 600;color: var(--ag-ink)}.ag-root.ag-root .ag-ft-row{display: flex;flex-wrap: wrap;align-items: baseline;gap: 2px 14px}.ag-root.ag-root .ag-ft em{font-style: italic}.ag-root.ag-root .ag-credit{color: var(--ag-ink-3);white-space: nowrap}.ag-root.ag-root .ag-about-btn{margin-left: auto;padding: 4px 0;font-size: 12px;font-weight: 500;color: var(--ag-ink-2);display: inline-flex;align-items: center;gap: 6px;white-space: nowrap}.ag-root.ag-root .ag-about-btn::after{content: "";width: 5px;height: 5px;margin-top: -3px;border-right: 1.5px solid currentColor;border-bottom: 1.5px solid currentColor;transform: rotate(45deg)}.ag-root.ag-root .ag-about-btn:hover{color: var(--ag-ink)}.ag-root.ag-root .ag-ft-end{margin-left: auto;display: flex;align-items: center;gap: 14px}.ag-root.ag-root .ag-logo{flex: none;align-self: center;width: 31px;height: 15px;background-color: var(--ag-ink);-webkit-mask: url("data:image/png;base64,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") center / contain no-repeat;mask: url("data:image/png;base64,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") center / contain no-repeat}.ag-root.ag-root .ag-about{margin-top: 8px;padding-left: 10px;border-left: 2px solid var(--ag-grid);display: grid;gap: 6px;font-size: 12.5px;line-height: 1.5;color: var(--ag-ink-2)}.ag-root.ag-root .ag-about a{color: inherit;text-decoration: underline;text-decoration-color: var(--ag-ink-3);text-underline-offset: 2px}.ag-root.ag-root .ag-about a:hover{text-decoration-color: currentColor}.ag-root.ag-root .ag-sw{display: inline-block;width: 10px;height: 10px;border-radius: 50%;flex: none;vertical-align: baseline}.ag-root.ag-root .ag-sw-m{background: var(--ag-m)}.ag-root.ag-root .ag-sw-f{background: var(--ag-f)}.ag-root.ag-root .ag-num{font-variant-numeric: tabular-nums}.ag-root.ag-root .ag-btn{display: inline-flex;align-items: center;justify-content: center;gap: 8px;min-height: 44px;padding: 10px 18px;border-radius: 999px;background: var(--ag-ink);color: var(--ag-knock);font-size: 15px;font-weight: 650;line-height: 1;transition: transform .15s var(--ag-ease),opacity .15s}.ag-root.ag-root .ag-btn:hover{opacity: .88}.ag-root.ag-root .ag-btn:active{transform: scale(.97)}.ag-root.ag-root .ag-btn[disabled]{opacity: .35;cursor: default}.ag-root.ag-root .ag-btn-ghost{background: transparent;color: var(--ag-ink);box-shadow: inset 0 0 0 1.5px var(--ag-grid)}.ag-root.ag-root .ag-btn-ghost:hover{box-shadow: inset 0 0 0 1.5px var(--ag-ink-3);opacity: 1}.ag-root.ag-root .ag-icon-btn{display: inline-flex;align-items: center;justify-content: center;width: 44px;height: 44px;flex: none;border-radius: 50%;color: var(--ag-ink);box-shadow: inset 0 0 0 1.5px var(--ag-grid);transition: box-shadow .15s}.ag-root.ag-root .ag-icon-btn:hover{box-shadow: inset 0 0 0 1.5px var(--ag-ink-3)}.ag-root.ag-root .ag-icon-btn svg{width: 18px;height: 18px}.ag-root.ag-root .ag-axis-cap{display: flex;justify-content: space-between;gap: 12px;font-size: 12px;color: var(--ag-ink-3)}.ag-root.ag-root .ag-bar-track{position: relative;height: 16px}.ag-root.ag-root .ag-bar{position: absolute;left: 0;top: 0;bottom: 0;width: 0;border-radius: 0 4px 4px 0;transition: width .9s var(--ag-ease)}.ag-root.ag-root .ag-bar-m{background: var(--ag-m)}.ag-root.ag-root .ag-bar-f{background: var(--ag-f)}.ag-root.ag-root .ag-bar-guess{background: repeating-linear-gradient(135deg,color-mix(in srgb,var(--ag-f) 55%,transparent) 0 2px,transparent 2px 7px);box-shadow: inset 0 0 0 1.5px var(--ag-f);transition: none}.ag-root.ag-root .ag-q-stage{margin-top: 12px}.ag-root.ag-root .ag-q-prog{display: flex;align-items: center;gap: 6px;margin-bottom: 8px;font-size: 12px;color: var(--ag-ink-3);font-weight: 600}.ag-root.ag-root .ag-q-prog span{margin-left: 6px}.ag-root.ag-root .ag-ink-m{color: var(--ag-m-ink)}.ag-root.ag-root .ag-ink-f{color: var(--ag-f-ink)}.ag-root.ag-root .ag-q-chart{margin-top: 10px;display: grid;gap: 8px}.ag-root.ag-root .ag-q-row{display: grid;grid-template-columns: 1fr;gap: 5px}.ag-root.ag-root .ag-q-row-hd{display: flex;justify-content: space-between;align-items: baseline;gap: 10px;font-size: 13px;color: var(--ag-ink-2)}.ag-root.ag-root .ag-q-row-hd b{font-weight: 650;color: var(--ag-ink);font-size: 15px;font-variant-numeric: tabular-nums}.ag-root.ag-root .ag-q-lab{display: inline-flex;align-items: center;gap: 6px;font-weight: 600}.ag-root.ag-root .ag-q-guess-tick{position: absolute;top: -5px;bottom: -5px;width: 2px;margin-left: -1px;background: var(--ag-ink);opacity: 0;transition: opacity .3s .6s}.ag-root.ag-root .ag-q-guess-tick.is-on{opacity: 1}.ag-root.ag-root .ag-q-guess-lab{position: absolute;top: 100%;margin-top: 7px;transform: translateX(-50%);white-space: nowrap;font-size: 12px;font-weight: 600;color: var(--ag-ink-2);opacity: 0;transition: opacity .3s .7s}.ag-root.ag-root .ag-q-guess-lab.is-on{opacity: 1}.ag-root.ag-root .ag-q-guess-lab.is-end{transform: translateX(-100%)}.ag-root.ag-root .ag-q-guess-lab.is-start{transform: none}.ag-root.ag-root .ag-range{display: block;width: 100%;height: 40px;margin-top: 2px;background: transparent;-webkit-appearance: none;appearance: none;cursor: grab;touch-action: pan-y}.ag-root.ag-root .ag-range:active{cursor: grabbing}.ag-root.ag-root .ag-range::-webkit-slider-runnable-track{height: 4px;border-radius: 2px;background: var(--ag-grid)}.ag-root.ag-root .ag-range::-moz-range-track{height: 4px;border-radius: 2px;background: var(--ag-grid)}.ag-root.ag-root .ag-range::-webkit-slider-thumb{-webkit-appearance: none;width: 28px;height: 28px;margin-top: -12px;border-radius: 50%;background: var(--ag-knock);border: 2px solid var(--ag-f);box-shadow: 0 1px 4px rgba(0,0,0,.18)}.ag-root.ag-root .ag-range::-moz-range-thumb{width: 24px;height: 24px;border-radius: 50%;background: var(--ag-knock);border: 2px solid var(--ag-f);box-shadow: 0 1px 4px rgba(0,0,0,.18)}.ag-root.ag-root .ag-range:focus-visible{outline: none}.ag-root.ag-root .ag-range:focus-visible::-webkit-slider-thumb{outline: 2px solid var(--ag-focus);outline-offset: 2px}.ag-root.ag-root .ag-q-hint{font-size: 12px;color: var(--ag-ink-3)}.ag-root.ag-root .ag-fade-in{animation: ag-in .5s var(--ag-ease) both}@keyframes ag-in{from{opacity: 0;transform: translateY(8px)}to{opacity: 1;transform: none}}.ag-root.ag-root .ag-q-end{text-align: left}.ag-root.ag-root .ag-q-recap{margin: 12px 0 4px;display: grid;gap: 6px}.ag-root.ag-root .ag-q-recap-row{display: grid;grid-template-columns: minmax(0,1fr) auto;gap: 2px 12px;font-size: 13px;color: var(--ag-ink-2);align-items: center}.ag-root.ag-root .ag-q-recap-row .ag-num{color: var(--ag-ink);font-weight: 600}.ag-root.ag-root .ag-q-mini{grid-column: 1 / -1;position: relative;height: 8px;border-radius: 4px;background: var(--ag-track)}.ag-root.ag-root .ag-q-mini i{position: absolute;top: -2px;width: 12px;height: 12px;margin-left: -6px;border-radius: 50%;border: 2px solid var(--ag-knock)}.ag-root.ag-root .ag-q-mini i.ag-g{background: var(--ag-knock);border: 2px solid var(--ag-ink-2);width: 12px;height: 12px}.ag-root.ag-root .ag-q-cta{display: flex;flex-wrap: wrap;gap: 10px;margin-top: 12px}.ag-root.ag-root a.ag-btn{text-decoration: none;color: var(--ag-knock)}.ag-root.ag-root .ag-pt-svgwrap{position: relative;margin-top: 8px;touch-action: manipulation}.ag-root.ag-root .ag-pt-svgwrap svg:focus-visible{outline: 2px solid var(--ag-focus);outline-offset: 4px}.ag-root.ag-root .ag-pt-dot{transition: transform .9s var(--ag-ease),opacity .5s,r .15s;cursor: pointer}.ag-root.ag-root .ag-pt-dot.is-m{fill: var(--ag-m)}.ag-root.ag-root .ag-pt-dot.is-f{fill: var(--ag-f)}.ag-root.ag-root .ag-pt-dot{stroke: var(--ag-knock);stroke-width: 2px}.ag-root.ag-root .ag-pt-dot.is-on{stroke: var(--ag-ink);stroke-width: 2.5px}.ag-root.ag-root .ag-pt-dim .ag-pt-dot:not(.is-on):not(.is-hit){opacity: .45}.ag-root.ag-root .ag-pt-grid{stroke: var(--ag-grid);stroke-width: 1px}.ag-root.ag-root .ag-pt-zero{stroke: var(--ag-ink);stroke-width: 1.5px}.ag-root.ag-root .ag-pt-tick{fill: var(--ag-ink-3);font-size: 11px;font-family: var(--ag-ui);font-variant-numeric: tabular-nums}.ag-root.ag-root .ag-pt-card{margin-top: 14px;min-height: 88px;padding-top: 14px;border-top: 1px solid var(--ag-grid);display: grid;gap: 8px}.ag-root.ag-root .ag-pt-empty{font-size: 14px;color: var(--ag-ink-3);align-self: center;justify-self: center;text-align: center}.ag-root.ag-root .ag-ex-ctl{display: grid;gap: 10px;margin-top: 16px}.ag-root.ag-root .ag-ex-head{display: grid;grid-template-columns: minmax(0,40%) minmax(0,1fr) 66px;gap: 14px;align-items: end;margin-top: 18px;padding-bottom: 6px;border-bottom: 1px solid var(--ag-grid)}.ag-root.ag-root .ag-ex-legend{display: flex;flex-wrap: wrap;gap: 4px 12px;font-size: 12px;color: var(--ag-ink-2)}.ag-root.ag-root .ag-ex-legend span{display: inline-flex;align-items: center;gap: 5px}.ag-root.ag-root .ag-ex-axis{position: relative;height: 16px;font-size: 11px;color: var(--ag-ink-3);font-variant-numeric: tabular-nums}.ag-root.ag-root .ag-ex-axis span{position: absolute;bottom: 0;transform: translateX(-50%);white-space: nowrap}.ag-root.ag-root .ag-ex-axis span:first-child{transform: none}.ag-root.ag-root .ag-ex-axis span:last-child{transform: translateX(-100%)}.ag-root.ag-root .ag-ex-pcth{font-size: 11px;color: var(--ag-ink-3);text-align: right;line-height: 1.2}.ag-root.ag-root .ag-ex-list{list-style: none}.ag-root.ag-root .ag-ex-row{border-bottom: 1px solid var(--ag-grid)}.ag-root.ag-root .ag-ex-btn{display: grid;grid-template-columns: minmax(0,40%) minmax(0,1fr) 66px;gap: 14px;align-items: center;width: 100%;padding: 7px 0;text-align: left;transition: background .15s}.ag-root.ag-root .ag-ex-btn:hover{background: color-mix(in srgb,var(--ag-card) 70%,transparent)}.ag-root.ag-root .ag-ex-names{display: grid;gap: 1px;font-size: 13px;line-height: 1.3;min-width: 0}.ag-root.ag-root .ag-ex-names span{display: flex;gap: 6px;align-items: baseline;min-width: 0}.ag-root.ag-root .ag-ex-names span>i{overflow: hidden;text-overflow: ellipsis;white-space: nowrap;font-style: normal}.ag-root.ag-root .ag-ex-names .ag-sw{width: 8px;height: 8px;transform: translateY(-1px)}.ag-root.ag-root .ag-ex-names .is-f{color: var(--ag-ink-2)}.ag-root.ag-root .ag-ex-track{position: relative;height: 22px}.ag-root.ag-root .ag-ex-track::before{content: "";position: absolute;left: 0;right: 0;top: 50%;height: 1px;background: var(--ag-track)}.ag-root.ag-root .ag-ex-gl{position: absolute;top: 0;bottom: 0;width: 1px;background: var(--ag-track)}.ag-root.ag-root .ag-ex-bar{position: absolute;top: 50%;height: 3px;margin-top: -1.5px;border-radius: 2px;opacity: .45;transition: left .7s var(--ag-ease),width .7s var(--ag-ease)}.ag-root.ag-root .ag-ex-bar.is-m{background: var(--ag-m)}.ag-root.ag-root .ag-ex-bar.is-f{background: var(--ag-f)}.ag-root.ag-root .ag-ex-dot{position: absolute;top: 50%;width: 13px;height: 13px;margin: -6.5px 0 0 -6.5px;border-radius: 50%;box-shadow: 0 0 0 2px var(--ag-knock);transition: left .7s var(--ag-ease)}.ag-root.ag-root .ag-ex-dot.is-m{background: var(--ag-m)}.ag-root.ag-root .ag-ex-dot.is-f{background: var(--ag-f)}.ag-root.ag-root .ag-ex-pct{text-align: right;font-size: 14px;font-weight: 650;font-variant-numeric: tabular-nums;display: flex;justify-content: flex-end;align-items: center;gap: 5px}.ag-root.ag-root .ag-ex-pct .ag-sw{width: 7px;height: 7px}.ag-root.ag-root .ag-ex-detail{padding: 4px 0 14px;display: grid;gap: 8px;animation: ag-in .35s var(--ag-ease) both}.ag-root.ag-root .ag-cpt{color: var(--ag-ink-3);font-size: 12px;font-weight: 400;margin-left: 6px;white-space: nowrap;font-variant-numeric: tabular-nums}.ag-root.ag-root .ag-flag{font-size: 12px;color: var(--ag-ink-2);border-left: 2px solid var(--ag-grid);padding: 2px 0 2px 10px}.ag-root.ag-root .ag-ex-none{padding: 24px 0;text-align: center;color: var(--ag-ink-3);font-size: 14px}.ag-root.ag-root .ag-ex-row.is-enter{animation: ag-in .45s var(--ag-ease) both}@container ag (max-width: 540px){.ag-root.ag-root .ag-ex-head{grid-template-columns: minmax(0,1fr) 60px}.ag-root.ag-root .ag-ex-head .ag-ex-legend{grid-column: 1 / -1}.ag-root.ag-root .ag-ex-btn{grid-template-columns: minmax(0,1fr) 60px;gap: 4px 12px;padding: 10px 0}.ag-root.ag-root .ag-ex-names{grid-column: 1 / -1}}.ag-root.ag-root .ag-cpt{color: var(--ag-ink-3);font-size: 12px;font-weight: 400;font-style: normal;margin-left: 6px;white-space: nowrap;font-variant-numeric: tabular-nums;letter-spacing: 0}.ag-root.ag-root .ag-cpt-wrap{position: relative;display: inline-block}.ag-root.ag-root .ag-cpt-btn{padding: 2px 0;margin-left: 6px;line-height: 1.2;cursor: help;text-decoration: underline dotted;text-decoration-color: var(--ag-ink-3);text-underline-offset: 3px}.ag-root.ag-root .ag-cpt-btn:hover,.ag-root.ag-root .ag-cpt-wrap.is-open .ag-cpt-btn{color: var(--ag-ink);text-decoration-color: currentColor}.ag-root.ag-root .ag-tip{position: absolute;left: 0;bottom: calc(100% + 6px);z-index: 5;width: max-content;max-width: min(260px,72vw);padding: 8px 10px;border-radius: 6px;background: var(--ag-ink);color: var(--ag-knock);font-size: 13px;font-weight: 500;line-height: 1.35;white-space: normal;text-align: left;box-shadow: 0 4px 14px color-mix(in srgb,var(--ag-ink) 18%,transparent);display: none;pointer-events: none}.ag-root.ag-root .ag-cpt-wrap.is-open .ag-tip{display: block;animation: ag-fade .15s linear both}@keyframes ag-fade{from{opacity: 0}to{opacity: 1}}.ag-root.ag-root .ag-tip-k{display: block;margin-bottom: 2px;font-size: 11px;font-weight: 500;opacity: .7}.ag-root.ag-root .ag-pair{display: grid;gap: 4px}.ag-root.ag-root .ag-pair-row{display: flex;justify-content: space-between;align-items: baseline;gap: 12px}.ag-root.ag-root .ag-pair-name{font-size: 15px;font-weight: 500;line-height: 1.3;min-width: 0}.ag-root.ag-root .ag-pair-val{font-size: 15px;font-weight: 600;white-space: nowrap}.ag-root.ag-root .ag-find{position: relative}.ag-root.ag-root .ag-find svg{position: absolute;left: 0;top: 50%;width: 15px;height: 15px;margin-top: -7.5px;color: var(--ag-ink-3);pointer-events: none}.ag-root.ag-root .ag-find input{display: block;width: 100%;min-height: 40px;padding: 8px 0 8px 24px;border-radius: 0;background: transparent;border-bottom: 1px solid var(--ag-grid);font-size: 16px;color: var(--ag-ink);-webkit-appearance: none;appearance: none;transition: border-color .2s}.ag-root.ag-root .ag-find input:hover{border-bottom-color: var(--ag-ink-3)}.ag-root.ag-root .ag-find input:focus-visible{outline: none;border-bottom-color: var(--ag-ink)}.ag-root.ag-root .ag-find input::placeholder{color: var(--ag-ink-3);opacity: 1}.ag-root.ag-root .ag-find input::-webkit-search-cancel-button{-webkit-appearance: none}.ag-root.ag-root.ag-root .ag-q-btn{min-height: 42px;padding: 10px 20px;border-radius: var(--ag-r);background: transparent;color: var(--ag-ink);box-shadow: inset 0 0 0 1px var(--ag-ink);font-size: 15px;font-weight: 500;transition: background-color .2s,color .2s,transform .15s}.ag-root.ag-root.ag-root .ag-q-btn:hover{background: var(--ag-ink);color: var(--ag-knock)}.ag-root.ag-root .ag-pt-find{margin-top: 10px;max-width: 340px}.ag-root.ag-root .ag-pt-hits{list-style: none;margin-top: 6px;display: grid;gap: 0}.ag-root.ag-root .ag-pt-hits:empty{display: none}.ag-root.ag-root .ag-pt-hit{display: block;width: 100%;padding: 6px 0;text-align: left;font-size: 14px;font-weight: 500;line-height: 1.3}.ag-root.ag-root .ag-pt-hit:hover{text-decoration: underline;text-underline-offset: 3px;text-decoration-color: var(--ag-grid)}.ag-root.ag-root .ag-pt-none{padding: 6px 0;font-size: 13px;color: var(--ag-ink-3)}.ag-root.ag-root .ag-pt-finding .ag-pt-dot:not(.is-hit):not(.is-on){opacity: .15}.ag-root.ag-root .ag-pt-dot.is-hit{stroke: var(--ag-ink);stroke-width: 2px}.ag-root.ag-root .ag-pt-cap{margin-top: 6px}.ag-root.ag-root .ag-pt-cap>span{display: inline-flex;align-items: baseline;gap: 5px;font-weight: 500;white-space: nowrap}@container ag (max-width: 340px){.ag-root.ag-root .ag-pt-cap{font-size: 11px;gap: 6px}.ag-root.ag-root .ag-pt-cap>span{gap: 3px}}.ag-root.ag-root .ag-arrow{font-weight: 400;color: var(--ag-ink-3)}.ag-root.ag-root .ag-pt-card{margin-top: 12px;min-height: 0;padding-top: 12px;border-top: 1px solid var(--ag-grid);display: grid;gap: 8px}.ag-root.ag-root .ag-pt-empty{font-size: 14px;color: var(--ag-ink-3)}.ag-root.ag-root .ag-ex-ctl{display: flex;flex-wrap: wrap;gap: 12px 32px;align-items: end;margin-top: 16px}.ag-root.ag-root .ag-ex-ctl .ag-find{flex: 1 1 220px}.ag-root.ag-root .ag-ex-sels{display: flex;gap: 20px;flex-wrap: wrap}.ag-root.ag-root .ag-mini{display: grid;gap: 2px}.ag-root.ag-root .ag-mini-k{font-size: 12px;color: var(--ag-ink-3)}.ag-root.ag-root .ag-mini-v{position: relative;display: block}.ag-root.ag-root .ag-mini-v::after{content: "";position: absolute;right: 2px;top: 50%;width: 6px;height: 6px;margin-top: -5px;border-right: 1.5px solid var(--ag-ink-2);border-bottom: 1.5px solid var(--ag-ink-2);transform: rotate(45deg);pointer-events: none}.ag-root.ag-root .ag-mini-sel{display: block;min-height: 40px;padding: 8px 20px 8px 0;background: transparent;border-bottom: 1px solid var(--ag-grid);font-size: 15px;font-weight: 500;color: var(--ag-ink);-webkit-appearance: none;appearance: none;cursor: pointer;border-radius: 0}.ag-root.ag-root .ag-mini-sel:hover{border-bottom-color: var(--ag-ink-3)}.ag-root.ag-root .ag-mini-sel:focus-visible{outline: none;border-bottom-color: var(--ag-ink)}.ag-root.ag-root .ag-ex-head{margin-top: 24px}.ag-root.ag-root .ag-ex-names .ag-ex-n{overflow: hidden;text-overflow: ellipsis;white-space: nowrap;font-style: normal;min-width: 0}.ag-root.ag-root .ag-ex-names .ag-cpt{margin-left: 0;flex: none;font-size: 11px}.ag-root.ag-root .ag-ex-names .is-f{color: inherit}.ag-root.ag-root .ag-ex-pct{font-weight: 600}.ag-root.ag-root .ag-ex-detail{padding: 4px 0 12px;gap: 8px}.ag-root.ag-root .ag-ex-detail .ag-pair-name,.ag-root.ag-root .ag-ex-detail .ag-pair-val{font-size: 15px}.ag-root.ag-root .ag-ex-pager{display: flex;justify-content: space-between;align-items: center;gap: 12px;margin-top: 8px}.ag-root.ag-root .ag-ex-count{font-size: 13px;color: var(--ag-ink-3);font-variant-numeric: tabular-nums}.ag-root.ag-root .ag-ex-pbtns{display: flex;gap: 8px}.ag-root.ag-root .ag-icon-btn[disabled]{opacity: .3;cursor: default}@container ag (max-width: 480px){.ag-root.ag-root .ag-ex-sels{width: 100%}.ag-root.ag-root .ag-ex-sels .ag-mini{flex: 1 1 0;min-width: 0}.ag-root.ag-root .ag-mini-sel{width: 100%}}.ag-root.ag-root .ag-stat{display: block;text-wrap: pretty}.ag-root.ag-root .ag-stat-num{font-family: var(--ag-head);font-weight: 600;font-size: 30px;line-height: 1.05;letter-spacing: -0.025em;font-variant-numeric: tabular-nums;color: var(--ag-ink);margin-right: 8px}.ag-root.ag-root .ag-stat-cap{font-size: 15px;font-weight: 500;line-height: 1.35;color: var(--ag-ink-2)}.ag-root.ag-root .ag-stat-cap span{white-space: nowrap}.ag-root.ag-root .ag-stat-num.ag-ink-m{color: var(--ag-m-ink)}.ag-root.ag-root .ag-stat-num.ag-ink-f{color: var(--ag-f-ink)}.ag-root.ag-root .ag-stat.is-small .ag-stat-num{font-size: 24px}.ag-root.ag-root .ag-stat.is-small .ag-stat-cap{font-size: 14px}.ag-root.ag-root .ag-mu-ctl{display: flex;gap: 6px;align-items: stretch;margin-top: 14px}.ag-root.ag-root .ag-select-wrap{position: relative;flex: 1 1 auto;min-width: 0}.ag-root.ag-root .ag-select{display: block;-webkit-appearance: none;appearance: none;cursor: pointer;font-size: 16px}.ag-root.ag-root .ag-select-wrap .ag-select{position: absolute;inset: 0;width: 100%;height: 100%;opacity: 0;min-height: 0}.ag-root.ag-root .ag-select-face{display: flex;align-items: center;min-height: 40px;height: 100%;padding: 6px 34px 6px 12px;border-radius: var(--ag-r);background: transparent;box-shadow: inset 0 0 0 1px var(--ag-grid);transition: box-shadow .2s;font-size: 15px;font-weight: 500;line-height: 1.3}.ag-root.ag-root .ag-select-wrap:hover .ag-select-face{box-shadow: inset 0 0 0 1px var(--ag-ink-3)}.ag-root.ag-root .ag-select-wrap:has(.ag-select:focus-visible) .ag-select-face{outline: 2px solid var(--ag-focus);outline-offset: 2px}.ag-root.ag-root .ag-select-wrap::after{content: "";position: absolute;right: 14px;top: 50%;width: 6px;height: 6px;margin-top: -5px;border-right: 1.5px solid var(--ag-ink-2);border-bottom: 1.5px solid var(--ag-ink-2);transform: rotate(45deg);pointer-events: none}.ag-root.ag-root .ag-mu-ctl .ag-icon-btn{width: 40px;height: auto;min-height: 40px}.ag-root.ag-root .ag-mu-ctl .ag-icon-btn svg{width: 14px;height: 14px}.ag-root.ag-root .ag-mu-sum{margin-top: 14px}@container ag (max-width: 480px){.ag-root.ag-root .ag-mu-ctl{gap: 4px}.ag-root.ag-root .ag-mu-ctl .ag-icon-btn{width: 32px}.ag-root.ag-root .ag-select-face{font-size: 14px;padding-left: 10px;padding-right: 28px}.ag-root.ag-root .ag-select-wrap::after{right: 11px}}.ag-root.ag-root .ag-mu-strip-wrap{margin-top: 12px}.ag-root.ag-root .ag-mu-strip-lab{font-size: 13px;color: var(--ag-ink-3)}.ag-root.ag-root .ag-mu-strip{position: relative;height: 48px;margin-top: 2px}.ag-root.ag-root .ag-mu-strip::before{content: "";position: absolute;left: 0;right: 0;top: 31px;height: 1px;background: var(--ag-grid)}.ag-root.ag-root .ag-mu-zero{position: absolute;top: 15px;bottom: 0;width: 0;border-left: 1.5px dashed var(--ag-ink-2);margin-left: -0.75px}.ag-root.ag-root .ag-mu-zero-lab{position: absolute;top: 0;transform: translateX(-50%);font-size: 11px;font-weight: 500;line-height: 1;color: var(--ag-ink-2);white-space: nowrap}.ag-root.ag-root .ag-mu-tick{position: absolute;top: 23px;width: 2px;height: 16px;margin-left: -1px;padding: 0;border-radius: 1px;opacity: .45;transition: height .25s var(--ag-ease),top .25s var(--ag-ease),width .25s var(--ag-ease),opacity .2s}.ag-root.ag-root .ag-mu-tick.is-m{background: var(--ag-m)}.ag-root.ag-root .ag-mu-tick.is-f{background: var(--ag-f)}.ag-root.ag-root .ag-mu-tick::after{content: "";position: absolute;inset: -8px -3px}.ag-root.ag-root .ag-mu-tick:hover{opacity: .9}.ag-root.ag-root .ag-mu-tick.is-on{opacity: 1;top: 16px;height: 30px;width: 4px;margin-left: -2px;box-shadow: 0 0 0 2px var(--ag-knock);z-index: 2}.ag-root.ag-root .ag-mu-pair{margin-top: 14px;padding-top: 12px;border-top: 1px solid var(--ag-grid);display: grid;gap: 10px}.ag-root.ag-root .ag-mu-side{display: grid;gap: 4px}.ag-root.ag-root .ag-mu-line{display: flex;justify-content: space-between;align-items: baseline;gap: 12px}.ag-root.ag-root .ag-mu-name{font-size: 15px;font-weight: 500;line-height: 1.3;min-width: 0}.ag-root.ag-root .ag-mu-val{font-size: 15px;font-weight: 600;white-space: nowrap}.ag-root.ag-root .ag-mu-pair .ag-bar-track{height: 12px}.ag-root.ag-root .ag-q-prog{display: block;margin: 0 0 8px;font-size: 12px;font-weight: 500;color: var(--ag-ink-3)}.ag-root.ag-root .ag-q-lab{display: inline-flex;align-items: baseline;flex-wrap: wrap;font-size: 15px;font-weight: 500;line-height: 1.3}.ag-root.ag-root .ag-q-row-hd b{font-weight: 600}.ag-root.ag-root .ag-q-foot{display: flex;flex-wrap: wrap;align-items: center;justify-content: space-between;gap: 10px 16px;margin-top: 6px}.ag-root.ag-root .ag-q-foot.is-result{margin-top: 26px}.ag-root.ag-root .ag-q-endline{font-size: 17px;font-weight: 500;line-height: 1.35;color: var(--ag-ink);text-wrap: pretty}.ag-root.ag-root .ag-q-endnum{font-family: var(--ag-head);font-weight: 600;font-size: 30px;letter-spacing: -0.025em}.ag-root.ag-root .ag-q-hint{display: flex;flex-wrap: wrap;align-items: center;gap: 4px;font-size: 12px;color: var(--ag-ink-3)}.ag-root.ag-root .ag-q-ring{display: inline-block;width: 10px;height: 10px;border-radius: 50%;box-shadow: inset 0 0 0 2px var(--ag-ink-2)}.ag-root.ag-root .ag-q-cta{display: flex;flex-wrap: wrap;align-items: center;gap: 10px 18px;margin-top: 12px}.ag-root.ag-root .ag-q-link{font-size: 15px;font-weight: 500;color: var(--ag-ink);text-decoration: underline;text-decoration-color: var(--ag-grid);text-underline-offset: 4px}.ag-root.ag-root .ag-q-link:hover{text-decoration-color: currentColor}.ag-root.ag-root{--ag-ui: "Geist","Helvetica Neue",Arial,sans-serif;--ag-head-weight: 600;--ag-head-track: -0.02em;--ag-r: 8px}.ag-root.ag-root[data-ag-mode="light"]{--ag-card: #f3f3f6;--ag-grid: #e2e2e8;--ag-track: #ececf1}@media (prefers-color-scheme: light){.ag-root.ag-root[data-ag-mode="auto"]{--ag-card: #f3f3f6;--ag-grid: #e2e2e8;--ag-track: #ececf1}}.ag-root.ag-root[data-ag-style="editorial"]{--ag-head-weight: 700}.ag-root.ag-root[data-ag-style="feature"]{--ag-head-weight: 700}.ag-root.ag-root.ag-root{font-family: var(--ag-ui)}.ag-root.ag-root.ag-root .ag-hed{letter-spacing: var(--ag-head-track)}.ag-root.ag-root.ag-root .ag-mu-name{font-weight: 500}.ag-root.ag-root.ag-root .ag-q-row-hd b,.ag-root.ag-root.ag-root .ag-mu-val,.ag-root.ag-root.ag-root .ag-pair-val,.ag-root.ag-root.ag-root .ag-ex-pct{font-weight: 600}.ag-root.ag-root.ag-root .ag-dek{text-wrap: pretty}.ag-root.ag-root.ag-root .ag-btn,.ag-root.ag-root.ag-root .ag-icon-btn,.ag-root.ag-root.ag-root .ag-select-face{border-radius: var(--ag-r)}.ag-root.ag-root.ag-root .ag-bar{border-radius: 0 2px 2px 0}.ag-root.ag-root.ag-root .ag-btn{font-weight: 600}.ag-root.ag-root.ag-root .ag-btn{transition: transform .15s var(--ag-ease),background-color .2s}.ag-root.ag-root.ag-root .ag-btn:hover{opacity: 1;background: color-mix(in srgb,var(--ag-ink) 82%,var(--ag-knock))}.ag-root.ag-root.ag-root .ag-btn:active,.ag-root.ag-root.ag-root .ag-icon-btn:active{transform: translateY(1px)}.ag-root.ag-root.ag-root .ag-icon-btn{transition: box-shadow .2s,background-color .2s,transform .15s}.ag-root.ag-root.ag-root .ag-icon-btn:hover{background: var(--ag-card)}.ag-root.ag-root.ag-root .ag-btn-ghost{background: none;box-shadow: none;padding-left: 4px;padding-right: 4px;font-weight: 500;text-decoration: underline;text-decoration-color: var(--ag-grid);text-underline-offset: 4px}.ag-root.ag-root.ag-root .ag-btn-ghost:hover{background: none;text-decoration-color: currentColor}.ag-root.ag-root.ag-root .ag-q-prog span{margin-left: 0;font-weight: 500}.ag-root.ag-root.ag-root .ag-q-mini{background: none;height: 12px}.ag-root.ag-root.ag-root .ag-q-mini::before{content: "";position: absolute;left: 0;right: 0;top: 50%;height: 1px;background: var(--ag-grid)}.ag-root.ag-root.ag-root .ag-q-mini i{top: 0}.ag-root.ag-root.ag-root .ag-range::-webkit-slider-thumb{box-shadow: 0 1px 3px color-mix(in srgb,var(--ag-ink) 22%,transparent)}.ag-root.ag-root.ag-root .ag-range::-moz-range-thumb{box-shadow: 0 1px 3px color-mix(in srgb,var(--ag-ink) 22%,transparent)}@media (prefers-reduced-motion: reduce){.ag-root.ag-root *,.ag-root.ag-root *::before,.ag-root.ag-root *::after{transition: none !important;animation: none !important}} (window.AG = window.AG || {}).data = [{"id":1,"cat":"Biopsies & lesions","mName":"Biopsy penis","mCpt":"54100","m":121.32,"fName":"Biopsy vagina","fCpt":"57100","f":65.74,"pct":59.42},{"id":2,"cat":"Biopsies & lesions","mName":"Remove penis lesion","mCpt":"54110","m":624.88,"fName":"Remove vaginal lesion","fCpt":"57135","f":191.8,"pct":106.06},{"id":3,"cat":"Biopsies & lesions","mName":"Biopsy scrotum","mCpt":"55120","m":356.83,"fName":"Biopsy vulva","fCpt":"56605","f":59.98,"pct":142.44},{"id":4,"cat":"Biopsies & lesions","mName":"Biopsy prostate","mCpt":"55705","m":265.34,"fName":"Biopsy endometrium","fCpt":"58110","f":40.33,"pct":147.22},{"id":5,"cat":"Biopsies & lesions","mName":"Removal of scrotal lesion","mCpt":"55120","m":356.83,"fName":"Removal of vulvar lesion","fCpt":"56440","f":184.01,"pct":63.91},{"id":6,"cat":"Biopsies & lesions","mName":"Excision penile lesion","mCpt":"54115","m":428.0,"fName":"Excision vaginal lesion","fCpt":"57100","f":65.74,"pct":146.74},{"id":7,"cat":"Biopsies & lesions","mName":"Laser penis","mCpt":"54057","m":98.95,"fName":"Laser vulva","fCpt":"56501","f":136.57,"pct":-31.95},{"id":8,"cat":"Genitals & other","mName":"Distal hypospadias repair","mCpt":"54328","m":934.61,"fName":"Revision of cervix","fCpt":"57700","f":365.3,"pct":87.59},{"id":9,"cat":"Biopsies & lesions","mName":"Destruction penile lesions simple","mCpt":"54050","m":108.1,"fName":"Destruction vulvar lesions simple","fCpt":"56501","f":136.57,"pct":-23.27},{"id":10,"cat":"Genitals & other","mName":"Resection of scrotum","mCpt":"55150","m":496.11,"fName":"Simple complete vulvectomy","fCpt":"56620","f":598.11,"pct":-18.64},{"id":11,"cat":"Genitals & other","mName":"Revision of scrotum","mCpt":"55180","m":690.96,"fName":"Extensive vulva surgery (partial radical)","fCpt":"56630","f":976.63,"pct":-34.26},{"id":12,"cat":"Genitals & other","mName":"Drain prostate abscess","mCpt":"52700","m":443.92,"fName":"Drain ovarian abscess open","fCpt":"58820","f":347.01,"pct":24.51},{"id":13,"cat":"Genitals & other","mName":"Excision hydrocele","mCpt":"55040","m":339.89,"fName":"Excision Bartholins gland","fCpt":"56740","f":321.25,"pct":5.64},{"id":14,"cat":"Genitals & other","mName":"Penis/scrotoplasty","mCpt":"54360","m":721.8,"fName":"Perineoplasty","fCpt":"56810","f":276.86,"pct":89.11},{"id":15,"cat":"Genitals & other","mName":"Excision of sperm cord lesion","mCpt":"55520","m":465.95,"fName":"Excision of Bartholins","fCpt":"56740","f":321.25,"pct":36.76},{"id":16,"cat":"Prostate & uterus","mName":"Interstitial prostate","mCpt":"55875","m":780.08,"fName":"Interstitial cervix","fCpt":"55920","f":463.24,"pct":50.97},{"id":17,"cat":"Urinary tract","mName":"Insert tandem male","mCpt":"53444","m":792.62,"fName":"Insert tandem female","fCpt":"57155","f":286.01,"pct":93.94},{"id":18,"cat":"Urinary tract","mName":"Reconstruction of male urethra","mCpt":"54352","m":1408.35,"fName":"Reconstruction of female urethra","fCpt":"53430","f":975.27,"pct":36.34},{"id":19,"cat":"Urinary tract","mName":"Revise remove sling male","mCpt":"53448","m":1271.79,"fName":"Revise remove sling female","fCpt":"57287","f":754.33,"pct":51.08},{"id":20,"cat":"Urinary tract","mName":"Male sling insert uro/neck sph","mCpt":"53445","m":757.72,"fName":"Female insert mesh pelvic floor add on","fCpt":"57267","f":252.12,"pct":100.13},{"id":21,"cat":"Urinary tract","mName":"Reconstruct urethra male","mCpt":"53415","m":1126.07,"fName":"Revise urethra female","fCpt":"57220","f":353.11,"pct":104.51},{"id":22,"cat":"Urinary tract","mName":"Total urethrectomy male","mCpt":"53215","m":926.14,"fName":"Total urethrectomy female","fCpt":"53210","f":776.7,"pct":17.55},{"id":23,"cat":"Genitals & other","mName":"Partial removal of penis","mCpt":"54120","m":633.01,"fName":"Partial vaginectomy","fCpt":"57106","f":546.94,"pct":14.59},{"id":24,"cat":"Genitals & other","mName":"Removal of penis","mCpt":"54125","m":825.49,"fName":"Complete vaginectomy","fCpt":"57110","f":919.02,"pct":-10.72},{"id":25,"cat":"Genitals & other","mName":"Exploratory laparotomy male","mCpt":"49000","m":778.05,"fName":"Exploratory laparotomy female","fCpt":"58960","f":1009.84,"pct":-25.93},{"id":26,"cat":"Testes & ovaries","mName":"Excise lesion testis","mCpt":"54512","m":538.47,"fName":"Ovarian cystectomy","fCpt":"58925","f":781.44,"pct":-36.82},{"id":27,"cat":"Testes & ovaries","mName":"Removal of testis","mCpt":"54530","m":511.02,"fName":"Oophorectomy","fCpt":"58940","f":567.27,"pct":-10.43},{"id":28,"cat":"Testes & ovaries","mName":"Suspension/relocation of testes","mCpt":"54680","m":787.54,"fName":"Ovarian transposition","fCpt":"58825","f":722.81,"pct":8.57},{"id":29,"cat":"Testes & ovaries","mName":"Laparoscopic orchiectomy","mCpt":"54690","m":655.38,"fName":"Laparoscopic BSO","fCpt":"58661","f":662.83,"pct":-1.13},{"id":30,"cat":"Testes & ovaries","mName":"Laparoscopic orchiopexy","mCpt":"54692","m":755.01,"fName":"Laparoscopic ovarian transposition","fCpt":"58825","f":722.81,"pct":4.36},{"id":31,"cat":"Testes & ovaries","mName":"Removal of epididymis","mCpt":"54861","m":569.64,"fName":"Removal of fallopian tubes","fCpt":"58700","f":814.31,"pct":-35.36},{"id":32,"cat":"Testes & ovaries","mName":"Vas deferens vasectomy","mCpt":"55250","m":230.43,"fName":"Essure hysteroscopy","fCpt":"58565","f":466.97,"pct":-67.83},{"id":33,"cat":"Testes & ovaries","mName":"Orchiectomy with staging","mCpt":"54530 + 38770","m":1320.25,"fName":"Oophorectomy with staging","fCpt":"58950","f":1169.79,"pct":12.08},{"id":34,"cat":"Testes & ovaries","mName":"Extensive testis surgery","mCpt":"54535","m":744.5,"fName":"Removal of ovaries extensive","fCpt":"58943","f":1188.42,"pct":-45.93},{"id":35,"cat":"Testes & ovaries","mName":"Reduce testis torsion","mCpt":"54600","m":454.43,"fName":"Reduce ovarian torsion","fCpt":"58920","f":728.24,"pct":-46.3},{"id":36,"cat":"Genitals & other","mName":"Remove penis and LN","mCpt":"54135","m":1503.24,"fName":"Vaginectomy and LN","fCpt":"57109","f":1751.97,"pct":-15.28},{"id":37,"cat":"Testes & ovaries","mName":"Revise vas deferens/spermatic ducts","mCpt":"54901","m":1056.94,"fName":"Revise fallopian tubes","fCpt":"58740","f":917.67,"pct":14.11},{"id":38,"cat":"Prostate & uterus","mName":"TURP","mCpt":"52601","m":727.22,"fName":"Hysteroscopic myomectomy","fCpt":"58561","f":360.9,"pct":67.33},{"id":39,"cat":"Prostate & uterus","mName":"Remove prostate","mCpt":"55801","m":1093.2,"fName":"Hysterectomy","fCpt":"58150","f":1028.82,"pct":6.07},{"id":40,"cat":"Prostate & uterus","mName":"Extensive prostate surgery","mCpt":"55845","m":1355.49,"fName":"Extensive TAH","fCpt":"58285","f":1440.21,"pct":-6.06},{"id":41,"cat":"Prostate & uterus","mName":"Subtotal prostatectomy","mCpt":"55821","m":837.69,"fName":"Abdominal trachelectomy","fCpt":"57530","f":381.57,"pct":74.82},{"id":42,"cat":"Prostate & uterus","mName":"Prostatectomy","mCpt":"55840","m":1165.38,"fName":"TAH","fCpt":"58150","f":1028.82,"pct":12.45},{"id":43,"cat":"Prostate & uterus","mName":"Prostatectomy LND","mCpt":"55845","m":1355.49,"fName":"TAH BSO LND","fCpt":"58200","f":1362.6,"pct":-0.52},{"id":44,"cat":"Prostate & uterus","mName":"Perineal approach prostatectomy","mCpt":"55815","m":1751.97,"fName":"Radical vaginal hysterectomy","fCpt":"58285","f":1440.21,"pct":19.53},{"id":45,"cat":"Prostate & uterus","mName":"Radical prostatectomy perineal approach","mCpt":"55810","m":1301.27,"fName":"Radical vaginal hysterectomy","fCpt":"58285","f":1440.21,"pct":-10.14},{"id":46,"cat":"Urinary tract","mName":"Removal of bladder and LN","mCpt":"51575","m":1809.92,"fName":"Anterior exenteration (no code for anterior only)","fCpt":"58240","f":2967.84,"pct":-48.47},{"id":47,"cat":"Urinary tract","mName":"Cystectomy complete with conduit","mCpt":"51596","m":2344.32,"fName":"Pelvic exenteration","fCpt":"58240","f":2967.84,"pct":-23.48},{"id":48,"cat":"Biopsies & lesions","mName":"Biopsy penis","mCpt":"54100","m":121.32,"fName":"Biopsy vulva","fCpt":"56605","f":59.98,"pct":67.67},{"id":49,"cat":"Biopsies & lesions","mName":"Biopsy prostate","mCpt":"55700","m":129.11,"fName":"Biopsy endometrium","fCpt":"58100","f":63.71,"pct":67.84},{"id":50,"cat":"Biopsies & lesions","mName":"Destruction penile lesions extensive","mCpt":"54065","m":172.83,"fName":"Destruction vulvar lesions extensive","fCpt":"56515","f":216.88,"pct":-22.61},{"id":51,"cat":"Prostate & uterus","mName":"TURP","mCpt":"52601","m":727.22,"fName":"Hysteroscopy","fCpt":"58558","f":233.48,"pct":102.79},{"id":52,"cat":"Genitals & other","mName":"Drain prostate abscess","mCpt":"55720","m":453.07,"fName":"Drain ovarian abscess","fCpt":"58820","f":347.01,"pct":26.51},{"id":53,"cat":"Genitals & other","mName":"Excision varicocele","mCpt":"55530","m":354.12,"fName":"Excision Bartholins","fCpt":"56740","f":321.25,"pct":9.73},{"id":54,"cat":"Genitals & other","mName":"Excision hydrocele","mCpt":"55500","m":395.8,"fName":"Excision Bartholins","fCpt":"56740","f":321.25,"pct":20.79},{"id":55,"cat":"Genitals & other","mName":"Scrotoplasty","mCpt":"55175","m":367.68,"fName":"Perineoplasty","fCpt":"56810","f":276.86,"pct":28.18}]; window.AG.copy = {"shared":{"method":"Percent difference is the gap between the two payments divided by their average. Because neither the male nor female procedure serves as the baseline to compare against, the average is used, yielding a single figure for each pair. Negative values mean the procedure on women pays more.","source":"Source: Penn et al., Journal of Women\u2019s Health (2025), Table 3.","credit":"Graphic: Anusha Subramanian/Vox","logoLabel":"Vox","aboutButton":"About the data","about1":"Amounts are Medicare\u2019s 2023 national reimbursement rates when the procedure is done in a hospital or surgical center.","about2":"Researchers matched each procedure on male anatomy with a comparable one on female anatomy. Some procedures appear in more than one pair. CPT codes are the billing codes listed in the study. Look any code up in Medicare\u2019s Physician Fee Schedule tool.","difference":"pay difference","srHigherMale":"higher for the male procedure","srHigherFemale":"higher for the female procedure","paysMoreFemale":"Pays more for female","paysMoreMale":"Pays more for male","noMatches":"No matching procedures","cptPrefix":"CPT"},"pattern":{"hed":"Medicare often reimburses more for procedures on men","dek":"Percent difference in 2023 Medicare reimbursement rates among pairs of comparable male and female procedures. Each dot is one pair.","findPlaceholder":"Find a procedure or code","emptyCard":"Tap or hover over a dot to see the pair","moreHits":"and {n} more, highlighted on the chart"},"quiz":{"hed":"Can you guess what Medicare pays?","dek":"Drag the slider to estimate what Medicare pays for the second procedure.","round":"Round {i} of {n}","submit":"Submit","next":"Next pair","seeResult":"See the result","yourGuess":"Your guess {amount}","endLede":"{n} of {total}","endText":"matched pairs pay the surgeon more for the procedure on male anatomy.","legendMale":"Male","legendFemale":"Female","legendGuess":"Your guess","playAgain":"Play again with new pairs","seeAll":"See all 55 pairs"},"matchup":{"hed":"Similar procedures, different pay","dek":"What Medicare paid a surgeon for matched procedures in 2023","stripLabel":"Where this pair falls among all 55","noDifference":"No difference"},"explorer":{"hed":"Every matched pair, side by side","dek":"What Medicare paid a surgeon for each procedure in 2023","searchPlaceholder":"Search a procedure or code","legendMale":"Male procedure","legendFemale":"Female procedure","pctHeader":"% diff.","count":"{from}\u2013{to} of {n} pairs","countFiltered":"{from}\u2013{to} of {n} matching pairs","sortGap":"Sorted by largest difference","sortStudy":"Sorted in the study\u2019s order","sortPay":"Sorted by highest payment","essureFlag":"Essure was taken off the U.S. market in 2018."}}; (function () { var AG = (window.AG = window.AG || {}); AG.components = AG.components || {}; if (AG.__core) return; AG.__core = true; AG.CATEGORIES = ["Biopsies & lesions", "Testes & ovaries", "Prostate & uterus", "Urinary tract", "Genitals & other"]; var P = function (d) { return ''; }; AG.icons = { prev: P("M168.49,199.51a12,12,0,0,1-17,17l-80-80a12,12,0,0,1,0-17l80-80a12,12,0,0,1,17,17L97,128Z"), next: P("M184.49,136.49l-80,80a12,12,0,0,1-17-17L159,128,87.51,56.49a12,12,0,1,1,17-17l80,80A12,12,0,0,1,184.49,136.49Z"), shuffle: P("M240.49,175.51a12,12,0,0,1,0,17l-24,24a12,12,0,0,1-17-17L203,196h-2.09a76.17,76.17,0,0,1-61.85-31.83L97.38,105.78A52.1,52.1,0,0,0,55.06,84H32a12,12,0,0,1,0-24H55.06a76.17,76.17,0,0,1,61.85,31.83l41.71,58.39A52.1,52.1,0,0,0,200.94,172H203l-3.52-3.51a12,12,0,0,1,17-17Zm-95.62-72.62a12,12,0,0,0,16.93-1.13A52,52,0,0,1,200.94,84H203l-3.52,3.51a12,12,0,0,0,17,17l24-24a12,12,0,0,0,0-17l-24-24a12,12,0,0,0-17,17L203,60h-2.09a76,76,0,0,0-57.2,26A12,12,0,0,0,144.87,102.89Zm-33.74,50.22a12,12,0,0,0-16.93,1.13A52,52,0,0,1,55.06,172H32a12,12,0,0,0,0,24H55.06a76,76,0,0,0,57.2-26A12,12,0,0,0,111.13,153.11Z"), search: P("M232.49,215.51,185,168a92.12,92.12,0,1,0-17,17l47.53,47.54a12,12,0,0,0,17-17ZM44,112a68,68,0,1,1,68,68A68.07,68.07,0,0,1,44,112Z") }; AG.pairSep = " vs. "; AG.reduced = function () { return !!(window.matchMedia && window.matchMedia("(prefers-reduced-motion: reduce)").matches); }; AG.h = function (tag, attrs, kids) { var svg = /^(svg|g|circle|line|text|path|rect|tspan)$/.test(tag); var el = svg ? document.createElementNS("http://www.w3.org/2000/svg", tag) : document.createElement(tag); attrs = attrs || {}; for (var k in attrs) { var v = attrs[k]; if (v == null || v === false) continue; if (k === "text") el.textContent = v; else if (k === "html") el.innerHTML = v; else if (k.slice(0, 2) === "on") el.addEventListener(k.slice(2), v); else if (k === "class" && svg) el.setAttribute("class", v); else if (k === "class") el.className = v; else el.setAttribute(k, v === true ? "" : v); } (kids || []).forEach(function (c) { if (c == null || c === false) return; el.appendChild(typeof c === "string" ? document.createTextNode(c) : c); }); return el; }; AG.money = function (v, opts) { var round = opts && opts.round; return v.toLocaleString("en-US", { style: "currency", currency: "USD", minimumFractionDigits: round ? 0 : 2, maximumFractionDigits: round ? 0 : 2 }); }; AG.pct = function (p) { var a = Math.abs(p); return (a >= 10 ? a.toFixed(0) : a.toFixed(1)) + "%"; }; AG.pctExact = function (p) { return (p 0 ? "m" : "f"; }; AG.byId = function (id) { for (var i = 0; i 0 ? "higher for the male procedure" : "higher for the female procedure"; }; AG.t = function (key, vars) { var parts = key.split("."), v = AG.copy || {}; for (var i = 0; i < parts.length && v != null; i++) v = v[parts[i]]; if (typeof v !== "string") v = key; return v.replace(/\{(\w+)\}/g, function (m, k) { return vars && k in vars ? vars[k] : m; }); }; AG.tx = function (tag, key, attrs, vars) { var el = AG.h(tag, attrs || {}); var s = AG.t(key, vars); if (/ rr.right) dx = rr.right - tr.right; if (tr.left + dx < rr.left) dx = rr.left - tr.left; tip.style.transform = "translateX(" + Math.round(dx) + "px)"; } var openedAt = 0; function show(on) { if (on && !wrap.classList.contains("is-open")) openedAt = Date.now(); wrap.classList.toggle("is-open", on); btn.setAttribute("aria-expanded", String(on)); if (on) place(); } btn.addEventListener("mouseenter", function () { show(true); }); wrap.addEventListener("mouseleave", function () { show(false); }); btn.addEventListener("focus", function () { show(true); }); btn.addEventListener("blur", function () { show(false); }); btn.addEventListener("click", function (e) { e.stopPropagation(); var open = wrap.classList.contains("is-open"); show(!open || Date.now() - openedAt < 400); }); btn.addEventListener("keydown", function (e) { if (e.key === "Escape") show(false); }); return wrap; }; AG.pairRows = function (d) { var h = AG.h; return h("div", { class: "ag-pair" }, [["m", d.mName, d.mCpt, d.m], ["f", d.fName, d.fCpt, d.f]].map(function (x) { return h("div", { class: "ag-pair-row" }, [ h("p", { class: "ag-pair-name" }, [h("span", { class: "ag-ink-" + x[0], text: x[1] }), AG.cpt(x[2])]), h("p", { class: "ag-num ag-pair-val", text: AG.money(x[3]) }) ]); })); }; document.addEventListener("click", function () { var open = document.querySelectorAll(".ag-cpt-wrap.is-open"); for (var i = 0; i < open.length; i++) { open[i].classList.remove("is-open"); open[i].firstChild.setAttribute("aria-expanded", "false"); } }); AG.stat = function (d, opts) { var h = AG.h, s = AG.side(d); var num = opts && opts.exact ? AG.pctExact(d.pct).replace("\u2212", "") : AG.pct(d.pct); return h("p", { class: "ag-stat" + (opts && opts.small ? " is-small" : "") }, [ h("span", { class: "ag-stat-num", text: num }), AG.tx("span", "shared.difference", { class: "ag-stat-cap" }), h("span", { class: "ag-sr", text: " (" + AG.t(s === "m" ? "shared.srHigherMale" : "shared.srHigherFemale") + ")" }) ]); }; AG.onVisible = function (el, fn) { if (!("IntersectionObserver" in window)) return fn(); var io = new IntersectionObserver(function (es) { if (es.some(function (e) { return e.isIntersecting; })) { io.disconnect(); fn(); } }, { threshold: 0.2 }); io.observe(el); }; AG.axisEnds = function (extraClass) { var h = AG.h; return h("div", { class: "ag-axis-cap " + (extraClass || "") }, [ h("span", { class: "ag-ink-f" }, [h("span", { class: "ag-arrow", "aria-hidden": "true", text: "\u2190" }), AG.tx("span", "shared.paysMoreFemale")]), h("span", { class: "ag-ink-m" }, [AG.tx("span", "shared.paysMoreMale"), h("span", { class: "ag-arrow", "aria-hidden": "true", text: "\u2192" })]) ]); }; AG.header = function (o) { return AG.h("div", { class: "ag-hd" }, [ AG.tx("h2", o.hed, { class: "ag-hed" }), o.dek ? AG.tx("p", o.dek, { class: "ag-dek" }) : null ]); }; AG.footer = function () { var h = AG.h; var about = h("div", { class: "ag-about", hidden: true, id: "ag-about-" + Math.random().toString(36).slice(2, 8) }, [ AG.tx("p", "shared.about1"), AG.tx("p", "shared.about2") ]); var btn = AG.tx("button", "shared.aboutButton", { class: "ag-about-btn", type: "button", "aria-expanded": "false", "aria-controls": about.id }); btn.addEventListener("click", function () { var open = about.hidden; about.hidden = !open; btn.setAttribute("aria-expanded", String(open)); }); return h("div", { class: "ag-ft" }, [ AG.tx("p", "shared.method", { class: "ag-method" }), h("div", { class: "ag-ft-row" }, [ AG.tx("p", "shared.source", { class: "ag-source" }), AG.tx("p", "shared.credit", { class: "ag-credit" }), h("div", { class: "ag-ft-end" }, [btn, AG.ta(h("span", { class: "ag-logo", role: "img" }), "aria-label", "shared.logoLabel")]) ]), about ]); }; AG.mount = function (root) { var name = root.getAttribute("data-ag"); var fn = AG.components[name]; if (!fn || !AG.data) return; root.setAttribute("data-ag-mounted", ""); if (root.parentElement) root.style.setProperty("--ag-host", getComputedStyle(root.parentElement).fontFamily); root.innerHTML = ""; fn(root); if (typeof CustomEvent === "function") root.dispatchEvent(new CustomEvent("ag:mounted", { bubbles: true })); }; AG.mountAll = function () { var run = function () { var roots = document.querySelectorAll(".ag-root[data-ag]:not([data-ag-mounted])"); for (var i = 0; i 0; }).length; var sorted = AG.data.slice().sort(function (a, b) { return a.pct - b.pct; }); var sel = null, entered = false, landed = false, pos = {}; root.appendChild(AG.header({ hed: "pattern.hed", dek: "pattern.dek" })); var findIn = AG.ta(h("input", { type: "search", "aria-label": "Find a procedure on the chart", autocomplete: "off" }), "placeholder", "pattern.findPlaceholder"); var hits = h("ul", { class: "ag-pt-hits", "aria-label": "Matching pairs" }); root.appendChild(h("div", { class: "ag-pt-find" }, [h("div", { class: "ag-find", html: AG.icons.search }, [findIn]), hits])); var wrap = h("div", { class: "ag-pt-svgwrap" }); var svg = h("svg", { role: "img", tabindex: "0", "aria-label": "Beeswarm chart. " + nM + " of 55 pairs pay more for the male procedure. Use arrow keys to step through pairs." }); wrap.appendChild(svg); root.appendChild(wrap); root.appendChild(AG.axisEnds("ag-pt-cap")); var card = h("div", { class: "ag-pt-card", "aria-live": "polite" }); root.appendChild(card); root.appendChild(h("div", { class: "ag-sr" }, [h("table", {}, [ h("caption", { text: "Table 3, facility payments, 2023" }), h("tr", {}, ["Male procedure", "Payment", "Female procedure", "Payment", "Percent difference"].map(function (t) { return h("th", { text: t }); })) ].concat(AG.data.map(function (d) { return h("tr", {}, [d.mName, AG.money(d.m), d.fName, AG.money(d.f), AG.pctExact(d.pct)].map(function (t) { return h("td", { text: t }); })); })))])); root.appendChild(AG.footer()); function drawCard() { card.innerHTML = ""; if (!sel) { card.appendChild(AG.tx("p", "pattern.emptyCard", { class: "ag-pt-empty" })); return; } var d = sel; card.appendChild(AG.pairRows(d)); card.appendChild(AG.stat(d, { small: true })); } var circles = {}; function layout() { var W = wrap.clientWidth; if (!W) return; var narrow = W < 520; var r = narrow ? 5.5 : 7, gap = 1.5, D = 2 * r + gap; var padL = r + 4, padR = r + 4; var sx = function (p) { return padL + ((p - LO) / (HI - LO)) * (W - padL - padR); }; var placed = []; AG.data.slice().sort(function (a, b) { return Math.abs(a.pct) - Math.abs(b.pct) || a.id - b.id; }).forEach(function (d) { var x = sx(d.pct), cands = [0]; placed.forEach(function (p) { var dx = Math.abs(x - p.x); if (dx < D) { var dy = Math.sqrt(D * D - dx * dx); cands.push(p.y + dy, p.y - dy); } }); cands.sort(function (a, b) { return Math.abs(a) - Math.abs(b); }); for (var i = 0; i = D * D - 0.01; }); if (ok) { placed.push({ x: x, y: y, d: d }); pos[d.id] = { x: x, y: y }; break; } } }); var maxY = Math.max.apply(null, placed.map(function (p) { return Math.abs(p.y); })); var annH = 8, axisH = 22; var cy = annH + maxY + r + 6; var H = cy + maxY + r + 6 + axisH; svg.setAttribute("width", W); svg.setAttribute("height", H); svg.setAttribute("viewBox", "0 0 " + W + " " + H); svg.style.width = W + "px"; svg.style.height = H + "px"; var old = svg.querySelector(".ag-pt-axes"); if (old) old.remove(); var axes = h("g", { class: "ag-pt-axes" }); TICKS.forEach(function (t) { var x = sx(t); axes.appendChild(h("line", { class: t === 0 ? "ag-pt-zero" : "ag-pt-grid", x1: x, x2: x, y1: annH - 4, y2: H - axisH + 2 })); axes.appendChild(h("text", { class: "ag-pt-tick", x: x, y: H - 6, "text-anchor": "middle", text: t === 0 ? "0" : (t < 0 ? "\u2212" : "") + Math.abs(t) + "%" })); }); svg.insertBefore(axes, svg.firstChild); var dots = svg.querySelector(".ag-pt-dots"); if (!dots) { dots = h("g", { class: "ag-pt-dots" }); svg.appendChild(dots); } AG.data.forEach(function (d, i) { var c = circles[d.id]; if (!c) { c = h("circle", { class: "ag-pt-dot is-" + AG.side(d), r: r, cx: 0, cy: 0, "data-id": d.id }); c.style.transform = "translate(" + sx(0) + "px," + cy + "px)"; c.style.opacity = "0"; circles[d.id] = c; dots.appendChild(c); } c.setAttribute("r", r); var place = function () { c.style.transform = "translate(" + pos[d.id].x + "px," + (cy + pos[d.id].y) + "px)"; c.style.opacity = ""; }; if (entered) { if (landed) c.style.transitionDelay = "0s"; place(); } c.__place = place; c.__at = SWEEP * (d.pct - sorted[0].pct) / (sorted[sorted.length - 1].pct - sorted[0].pct); }); svg.__cy = cy; } function enter() { entered = true; var reduced = AG.reduced(); AG.data.forEach(function (d) { var c = circles[d.id]; c.style.transitionDelay = reduced ? "0s" : Math.round(c.__at) + "ms"; c.__place(); }); setTimeout(function () { landed = true; for (var k in circles) circles[k].style.transitionDelay = "0s"; }, reduced ? 0 : SWEEP + 950); } function select(d) { sel = d; for (var k in circles) circles[k].classList.toggle("is-on", sel && +k === sel.id); svg.classList.toggle("ag-pt-dim", !!sel); if (sel) circles[sel.id].parentNode.appendChild(circles[sel.id]); drawCard(); } function nearest(evt) { var b = svg.getBoundingClientRect(), x = evt.clientX - b.left, y = evt.clientY - b.top, best = null, bd = 22 * 22; AG.data.forEach(function (d) { var p = pos[d.id]; if (!p) return; var dd = (p.x - x) * (p.x - x) + (svg.__cy + p.y - y) * (svg.__cy + p.y - y); if (dd < bd) { bd = dd; best = d; } }); return best; } svg.addEventListener("pointermove", function (e) { if (e.pointerType === "mouse") { var d = nearest(e); if (d && d !== sel) select(d); } }); svg.addEventListener("click", function (e) { var d = nearest(e); select(d || null); }); function outside(e) { if (!document.contains(root)) return document.removeEventListener("click", outside, true); if (!sel || (e.target.closest && e.target.closest(".ag-pt-svgwrap, .ag-pt-card, .ag-pt-find"))) return; select(null); } document.addEventListener("click", outside, true); svg.addEventListener("keydown", function (e) { var i = sel ? sorted.indexOf(sel) : -1; if (e.key === "ArrowRight" || e.key === "ArrowUp") { select(sorted[Math.min(sorted.length - 1, i + 1)]); e.preventDefault(); } else if (e.key === "ArrowLeft" || e.key === "ArrowDown") { select(sorted[Math.max(0, i -1; }) : []; for (var k in circles) { var hit = match.some(function (d) { return d.id === +k; }); circles[k].classList.toggle("is-hit", hit); if (hit) circles[k].parentNode.appendChild(circles[k]); } svg.classList.toggle("ag-pt-finding", !!q); if (match.length === 1) select(match[0]); hits.innerHTML = ""; if (!q) return; if (!match.length) { hits.appendChild(AG.tx("li", "shared.noMatches", { class: "ag-pt-none" })); return; } match.slice(0, 3).forEach(function (d) { var b = h("button", { type: "button", class: "ag-pt-hit" }, [ h("span", { class: "ag-ink-m", text: d.mName }), " vs. ", h("span", { class: "ag-ink-f", text: d.fName }) ]); b.addEventListener("click", function () { select(d); }); hits.appendChild(h("li", {}, [b])); }); if (match.length > 3) hits.appendChild(AG.tx("li", "pattern.moreHits", { class: "ag-pt-none" }, { n: match.length - 3 })); } findIn.addEventListener("input", find); drawCard(); layout(); if ("ResizeObserver" in window) { var lastW = 0; new ResizeObserver(function () { if (wrap.clientWidth !== lastW) { lastW = wrap.clientWidth; layout(); } }).observe(wrap); } AG.onVisible(wrap, function () { setTimeout(enter, 120); }); }; })(); window.AG.mountAll();

King, the director of reproductive bioethics at Harvard Medical School Center for Bioethics and a contributor on the study, believes that when the RVU system was created back in the 1990s, gynecological services were largely ignored, leaving the specialty undervalued from the start. While Medicare and Medicaid Services have undertaken some efforts to make RVUs more equitable across specialties over the years, that undervaluation has persisted. 

That problem may come down to how those values are determined in the first place — and who determines them. RVUs are set by a committee of doctors convened by the American Medical Association (AMA), with most of the seats allocated to members of major medical societies. The committee surveys different doctors on the time and skill required for procedures in their specialties. Based on these responses, the committee recommends values for each service to the federal government, which has historically accepted nearly 90 percent of them.

While the data quality of the underlying surveys has improved over the years, it is still not very high, said Dr. Miriam Laugesen, a tenured associate professor of health policy and management at Columbia University Mailman School of Public Health. Because the committee’s process isn’t transparent, it is often unclear what evidence its valuations rest on. This leads to distortions of all kinds, she said.

“It’s not a government process; It’s not a federal advisory committee,” Laugesen said. “It’s just a committee that was put together by the [AMA]. It’s pretty unusual in terms of how policy is made.”

In particular, King said that the surveys have a very low response rate from some specialties and are only sent to a small subset of doctors. She has never received a committee survey in the 17 years that she has practiced. 

The American College of Obstetricians and Gynecologists (ACOG) has a core seat on the committee that determines RVUs. But most ACOG members are general OB-GYNs, who split their time between obstetrics and gynecology and typically operate relatively rarely. The surgeons who perform the bulk of gynecologic operations are subspecialists – gynecologic oncologists, urogynecologists, and minimally invasive gynecologic surgeons — who complete an additional fellowship after residency. They mainly belong to their own societies and don’t have a seat at the table when RVUs are being determined. 

“From a purely cynical or economic standpoint, [ACOG] has no reason to advance billing for gynecology. It doesn’t represent a large portion of the practices of their members,” said King, adding that ACOG has been heroic in its efforts to obtain reimbursement equity for its own members. (One unintended possible result of that advocacy is that pushing for a smaller pay gap for services related to pregnancy has in turn sent the message that women’s bodies are literally worth less, and are less deserving of care when they’re not engaged in the god-given duty of reproduction.)

The result is that doctors in specialties like OB-GYN who operate infrequently are answering the surveys about complicated surgical procedures that gynecologic surgeons perform more frequently. King said that her surgical schedule aligned more closely with those of general surgeons. For example, she operates two to three times a week whereas, according to her, an average OB-GYN will likely operate once a month. 

“So they’re not the right people to be answering these surveys. They [the survey committee and ACOG] don’t target the surveys to people who operate a lot,” she said. 

Part of the problem with using surveys to determine a key foundation of medical reimbursements is that the data is self-reported by doctors. This is especially relevant when more objective avenues may be available. One of those avenues is the American College of Surgeons’ National Surgical Quality Improvement Program, which is an initiative that collects and manages key surgical data to track quality and improvement in surgical fields, including the actual time spent performing surgical procedures, making it a more definitive measure than self-reported surveys.

Dr. Shitanshu Uppal, a gynecologic oncologist and division chief for gynecology oncology services at the University of Michigan, and his colleagues analyzed 901,917 surgeries using both the National Surgical Quality Improvement Program as well as the self-reported surveys used to determine RVUs. They found that median RVUs per hour vary widely between specialties. Gynecology had the third-lowest median RVUs per hour of all the specialties studied. In effect, that means that gynecological surgeons are paid less for every hour that they work. 

The researchers also found that compared to the operating times logged for real surgeries in the Surgical Quality Improvement Program, surgeons in certain specialties tended to report longer procedure times in the self-reported surveys sent out by the RVUs committee. Specialties that reported longer operating times were more likely to be awarded higher RVUs, leading to greater hourly rates of reimbursement.

According to Uppal’s analysis, urologists — a profession most often associated with procedures on men because their work routinely concerns the prostate and the testicles — reported times that exceeded the baseline data by a median of 20 minutes. By contrast, estimates from gynecologists only exceeded the actual time by a median of five minutes, meaning that urologists tended to overestimate their time spent in surgery by four times as many minutes. Generally, urologists earn much more than general OB-GYNs, who in turn earn more than other subspecialties like gynecologic surgery. Despite having access to reliable electronic records of operating time, Uppal and his colleagues note, the AMA committee still continues to use self-reported operating times, which influences their RVU recommendations, ultimately cementing disparities in female-specific procedures. 

“The system that they have now developed over time,” King said, “now creates discrimination because of its complexity.” She added that this is how systemic discrimination is perpetuated, even if systems or rules appear seemingly neutral.

How low reimbursement rates make women’s lives worse

The US healthcare system has never been especially good at putting its money where its mouth is when it comes to women’s health. Experts have been sounding the alarm on sex-based disparities in medical billing for a long time — long enough that governing authorities like the committee responsible for RVUs and ACOG have had time to respond to the concerns. 

Over the years, the gap between male-specific procedure reimbursements and female-specific reimbursements has decreased slightly. But researchers of the Price and Prejudice study showed that between 2003 and 2023, there were no statistically significant improvements to the pay disparities. Comparing a smaller set of procedures across 1997, 2015, and 2023, they found that the gap had narrowed only minimally.

One common justification that ACOG provides for the pay gap is that obstetrics and gynecologic services see a higher-than-average share of patients on Medicaid, which pays doctors less than other insurers. King agreed this is a real factor, but it doesn’t explain why Medicare itself values procedures on women lower in the first place. And as her account of double discrimination makes clear, undervaluing gynecology ultimately affects women everywhere for the worse.

“I have patients who are waiting for surgery with me for a year at a time. I mean, that’s crazy.”

Dr. Louise King

Lower reimbursements in gynecologic surgery disproportionately affect female surgeons because they represent a majority of this specialty. It’s not just the surgeons’ salaries that are affected. Hospitals and facilities work on a revenue-based model — if gynecologic surgeries are not bringing in enough money, institutions tend to allocate fewer resources to those procedures. That, in turn, can limit access to operating rooms, surgical staff, and operating times. 

“I have patients who are waiting for surgery with me for a year at a time. I mean, that’s crazy,” King said. As a minimally invasive gynecologic surgeon, she surgically treats women with endometriosis, fibroids, cysts, or other such conditions.

It also affects the training that gynecologic surgeons receive. When there aren’t enough resources to operate regularly, opportunities to train residents are rarer than they should be. The result is that low reimbursement rates have contributed to a workforce of low-volume gynecologic surgeons who are sometimes not as well-trained as other surgeons who operate frequently.

The relationship between volume of surgeries performed and patient outcomes is well-documented in other fields. Research shows that surgeons who operate infrequently have worse outcomes, including more complications before, after, and during surgeries, compared to surgeons who operate regularly. 

Low-volume gynecologic surgeons — who perform a particular procedure less than 12 times a year — have significantly higher rates of causing bowel and urinary tract injuries in their patients. Especially in benign gynecological surgery (procedures not related to cancer), having surgeons who operate frequently also increases the number of minimally invasive procedures performed, which is related to better patient outcomes. 

Payment reform is an uphill battle, but not a lost cause

It takes multiple years and pressure from different entities to update or add new RVUs for procedures — but crucially, it is not impossible. The first few steps to creating a sustainable system might look like submitting gynecology-related procedure codes for reevaluation to the AMA committee or prompting a congressional report on the matter. 

For example, for years there has only been one billing code for endometriosis, regardless of the complexity of surgery or technique used. This disincentivizes surgeons from taking on complicated surgical cases of endometriosis because of the low reimbursement rate. Reevaluating that rate or diversifying the various surgical approaches that different cases require would help affected women get the care they deserve.

Medicare’s payment system also has what’s called a budget neutrality rule, which dictates that significantly increased payments for any given procedure must be offset by cuts elsewhere. The AMA itself believes that reforming this rule would make it easier to work toward reimbursement equity for female-specific procedures.  

Experts have suggested creating gynecology-specific conversion factors to bring parity to a system that naturally undervalues these procedures, while others think that eliminating sex-specific billing codes whenever possible is the right move. For example, the code for genitalia biopsies is different for men and women. This means that those procedures can be reimbursed differently even though they are essentially similar. Adopting one sex-neutral code for any genitalia biopsies would avoid this. While the reform required for this would be substantial, researchers believe that it would narrow the billing gap significantly.     

Authorities often justify lower RVUs for female-specific procedures by pointing to training: Gynecologists spend fewer years learning to operate than urologists and other higher-paid surgical specialists, according to King.

Historically, surgeons who operated on the female pelvis trained in ways that were more closely aligned with general surgeons than OB-GYNs. When obstetrics and gynecology merged into one specialty in the 1900s, the training for gynecologic surgery was truncated. 

“General OB-GYNs will train for four years and of that four years about 18 months is devoted to surgical training in gynecology,” said King, contrasting the new training period to those of general surgeons, which is in years. 

She believes that training periods should be increased for gynecologic surgeons. That change would secure better reimbursement for the speciality, while also producing better trained surgeons who would be more attuned to advances in minimally invasive surgery that will ultimately improve the outcomes for their female patients. In some cases, the experience gained during a two-year fellowship in gynecologic surgery was equivalent to 19 years in practice.  

In their initial work on double discrimination, Watson and King argued that failing to implement solutions for parity is tantamount to saying that female patients deserve less well-trained surgeons than male patients.  

As with most women’s health issues, it is unclear if this systemic disparity in medical reimbursement is the result of conscious misogyny or a by-product of ignorance. But that question of origins matters little when its consequences have been enshrined in medical policy, with lasting consequences for the practice of medicine more generally. We have allowed this wage gap to persist, even as many have sounded the alarm for decades. It is long past time to heed their warnings.

October 7, 2026, 5:50 pm ET: This story was originally published on October 2 and has been updated to include the sourcing on the RVU gap resulting from training for gynecologic surgery.  

After moving to West Virginia last year, Steve Kuo signed up for a new insurance plan that would cost him $500 a month. But there was one upside: He knew he was entitled to a free preventive visit. He wanted to take advantage of it, so he made an appointment at a clinic near his new home.

But then when he got there, they asked about his medical history and he mentioned prior kidney problems. When he received a bill a few weeks later, he had been charged twice for the same appointment: Once as that free preventive visit, once as an “office sick visit” because of the kidney conversation. He was flummoxed — and very annoyed, as he shared on social media. “No copayment means no copayment, exactly as stated in the insurance guidelines,” Kuo told me over email. “What is written and agreed upon should be honored.”

He is far from alone. On Reddit, I easily found more than a dozen examples in just the past year of people getting a surprise bill for what they thought was going to be a free visit. 

One woman posted a nearly $1,000 bill she’d received for what she thought was going to be a preventive gynecology visit. Another woman said that she ended up facing roughly $3,000 bills because she was given an ultrasound (which she said she didn’t request) at a preventive visit, and then her blood draw was sent to an out-of-network lab. Another person lamented that they had been billed $170 for an office visit because they had briefly mentioned back stiffness.

It’s not supposed to be like this. Americans don’t get much when it comes to our healthcare, but most of us are supposed to be entitled to at least one thing: Once every year, no matter your health insurance, you can go to the doctor with the goal of preventing future health problems by discussing important vaccinations, cancer screenings, and cardiovascular health screenings. The Affordable Care Act made that the law in 2010.

But more than 15 years later, people all over the country are walking into their doctor’s office, thinking they’re entitled to that one free visit every year, and walking out being billed for a sick visit, blood labs, and more. Researchers estimate that Americans spend tens of millions, maybe hundreds of millions of dollars every year on services that are supposed to be free under the ACA.

Dr. Yalda Jabbarpour, a family physician in the Washington, DC, area and medical director of the Robert Graham Center for Policy Studies, told me she still deals all the time with people’s confusion about what a preventive visit really means.

“Every single time I’m in the clinic, this issue comes up with a patient. And it’s sad that it comes up,” Jabbarpour told me. “In my mind, the blame is not to be put on the patient. The blame is not to be put on the physician. Really, this points to a bigger system issue that we need to solve.”

How could a seemingly simple promise of one free annual doctor’s visit result in a situation so convoluted that patients and doctors are still struggling with it nearly two decades later? And how might we fix it?

Patients are getting surprise bills from their doctors — and they’re pissed off

The goal of the ACA was to expand coverage and make sure health insurance would be comprehensive to actually help people stay healthy. As part of that project, the authors of the law added a mandate for insurers to cover those services, including an annual wellness exam. The problem is, they did not define what the parameters of that preventive visit actually were, said Alex Hoagland, a healthcare economist at the University of Toronto. 

“It didn’t establish a clear definition of…all the diagnosis codes and procedure codes and how frequently you get that combination within a year,” he said. “They don’t define what actually is preventive care and what’s not.”

That has left each insurer to define a preventive visit on their own — and that’s where the perverse incentives that leave patients in a lurch begin. Preventive visits are supposed to be reserved strictly for screenings and talking about other preventive measures you can take to protect your long-term health, but you may get billed for an “office visit” or a “sick visit” if you talk about any specific symptom you’re experiencing, the same as if you had come in because you had the flu. 

Health insurers have an incentive to keep the definition of preventive care as narrow as possible, so they have to pay fewer claims without any contribution from the patient. At the same time, doctors want to be paid for the actual services that they are providing. If somebody does bring up a bigger health problem during a preventive visit, then the doctor reasonably wants to be paid accordingly. 

“I know, particularly in the healthcare space, it’s really popular to blame one party or another, and here I don’t think it’s a matter of corporate greed or physician incompetence or whatever,” Hoagland said. “It’s just a natural mismatch of incentives.”

So the reality is that “one free doctor’s visit” sounds straightforward, but, in practice, it’s much more complicated. You as the patient might think of it as one visit, but in our fee-for-service healthcare system, where providers bill based on each specific thing they do, it’s not. The conversation about your vaccination may be free — but asking about your back pain is not. If you get blood tests ordered, that’s another line item. The list goes on. “It’s not like you walk into a doctor’s office and it’s just one thing that happens, right?” said Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University. “It’s multiple different things that are happening when you go into a doctor’s office.”

Part of the problem may be that it’s one free visit. We Americans are consumers at heart: Tell us we’re going to get something for free and we want to take advantage of it. But having just one free visit may also lead to people bringing a laundry list of questions to that preventive visit, because they think of it as their only chance to ask everything of their doctor. 

That makes it easy for the discussion to tip over into a sick visit — and not only does that lead to a surprise bill, it can also crowd out the conversation about prevention that the visit is supposed to be focused on.

“What ends up happening a lot…is that a patient comes in for their annual visit, and in their mind, that is their time to bring up every single thing that’s been happening during the year, because they see it as the free visit to bring up everything that’s happened during the year. For some patients, that takes up the entire visit,” Jabbarpour told me. “They leave, and it’s like, ‘Oh my god, we forgot to do all the screening things: the vaccinations, the cancer screenings, and the cardiovascular risk screening.’ And then something happens down the line because you never address those screenings.”

A 2021 study by Hoagland and Paul Shafer, both of Boston University at the time, estimated that Americans with employer-sponsored insurance had in 2018 alone paid between $75 million and $219 million in medical bills that should have been free. They were more likely to be charged for things like contraception or cholesterol and diabetes screenings, with individuals sometimes paying hundreds of dollars for those services.

Hoagland told me he had been billed for preventive visits because he has type 1 diabetes and the system automatically categorized his appointment as a diabetic visit. Earlier this year, he co-authored a study that found people with chronic conditions were more likely to be charged for preventive care. Corlette said that she too had recently been charged for what was supposed to be a preventive visit after she mentioned an issue as an aside. And these are folks who study health care for a living.

“It was literally maybe a 10-second conversation where I would ask the doctor a question about something,” she said. “And that triggered it.”

Colonoscopies are another dramatic example of how this issue plays out in real life; Corlette told me the procedure was one of the first services where this fuzzy line between prevention and treatment under the ACA became obvious. People go under for what is supposed to be a preventive colonoscopy. But then their doctor finds a polyp and decides to remove it — good clinical practice, but as a result, their patient could end up being charged thousands of dollars because the colonoscopy was no longer preventive once that polyp was snipped.

“All of a sudden, that would trigger what the patient thought was a preventive service into a cost-sharing obligation,” Corlette said. “Colonoscopies can be thousands of dollars. That was when we were first like, ‘Oh, yeah, this is a more complicated area than I think the lawmakers that drafted this provision originally envisioned.’”

How the US could fix our preventive visit headaches

The ACA’s preventive visit promise was clearly well-intentioned and it’s worth remembering that, if you look in the aggregate, more Americans are getting more free preventive care than they did before the law was passed. The problem, as much as anything, is expectations: People think they’re entitled to a free visit and are understandably frustrated when they get billed for it.

“The difference is before the Affordable Care Act, maybe they anticipated some kind of cost-sharing,” Hoagland said. “But after, they expect it to be free.”

It doesn’t have to be this way. Corlette’s team at Georgetown University recently released a proposal that Americans be entitled to three primary care and two urgent care visits every year with no cost-sharing. This approach has two virtues, she told me: It will help people feel like they are actually getting value from their insurance — the very complaint that Steve Kuo raised — and, because we know primary care helps prevent problems down the road, it should also improve people’s health in the long term. Take the pressure off that one free visit and let people see the doctor a few times a year without worrying about being charged.

“In employer-based insurance, a lot of people feel like, ‘What the hell am I getting for my premium each month?’” Corlette said. “We wanted people to feel like they’re getting good value, and we wanted to get to better population health.”

Hoagland also endorsed the idea of at least one free physician’s visit every year, no matter what’s discussed. In the long term, Jabbarpour said she’d like to see copays eliminated entirely for primary care. 

But any payment reforms are not going to happen immediately. What can we do right now?

For one, doctor offices could make an effort to be as transparent as possible. Jabbarpour’s MedStar system has started calling people a couple of days before their appointment with a brief script that tells the patient that they could be charged if the conversation with their doctor touches on additional medical problems. If your doctor’s office doesn’t proactively bring it up, ask when you schedule your appointment or when they call you to confirm it. Worst-case scenario, ask your provider what they consider preventive care when your visit begins. You might also want to educate yourself on what services are generally considered preventive and should be available for free: Your insurer may make that information available on their website, or KFF has a database you can peruse.

It’s not a perfect solution. “What ends up happening is patients come in, and they say, ‘I know I’m not supposed to talk to you about anything else, so I’m not going to tell you about anything else.’ And you don’t want that to happen,” Jabbarpour said. You should ask your doctor directly: What do you consider to be preventive care? Establish boundaries at the start. That way, you can at least be aware if you are going to get charged because the conversation crossed the line to discussing an active health problem.

And if you want to see the underlying laws change, start organizing. Contact your state and federal reps and ask them what they are doing to ensure this stops happening. Things could be different: Jabbarpour said she hopes to one day work in a health system where the cost of a single primary care visit isn’t so high-stakes, where doctors and their patients can manage their health according to their particular needs, rather than worry about how to bill for one specific conversation that covers the whole range of somebody’s health — like primary care is supposed to do.

“I think some patients can be managed by seeing us once every year, once every two years, and some patients need to see us monthly,” Jabbarpour told me. “To put all patients in the same box and say you can only see your primary care physician once a year if you want it paid for, it makes zero sense.”

This story was originally published in The Highlight. To get access to member-exclusive stories like this every month, become a Vox Member today.

My favorite restaurant, here in Madison, Wisconsin, closed this week. 

It was not my favorite because it had the greatest food I’d ever had, nor the most memorable ambiance. But I loved the Mad Rabbit Cafe because it had become my anchor in the neighborhood — it felt like home to me and a core group of friends as surely as the century-old houses lining the surrounding city blocks. Most importantly, it was entirely vegan — a rarity in this city, which, despite its ultra-progressive politics, embraces Wisconsin’s identity as “America’s Dairyland.” It was a refuge where my most closely held values found expression.

That closure is part of a national trend. US plant-based restaurants appear to be going through a contraction, amid the tumultuous aftermath of the Covid-19 pandemic and, perhaps, an anti-plant-based cultural vibe shift.

VegNews magazine reported that data from HappyCow, an app that lists vegan and vegetarian restaurants, finds the number of vegan restaurants in three of the country’s top destinations for vegan dining — New York City, Los Angeles, and Portland, Oregon — decreased by between 21 and 25 percent from 2022 to late 2024. Those cities alone make up a significant share of America’s vegan restaurants. Then, in 2025 and 2026, some of the country’s most renowned, long-running plant-based restaurants also announced that they’d shut down: Modern Love and Candle in New York City, the Vegan Joint in LA, Millennium in Oakland, a more than three-decade-old institution (though it later reopened as a leaner operation), among many others. 

According to a Vegan Society report, in October 2025, HappyCow (which is like Yelp but for plant-based dining) listed 1,717 all-vegan restaurants in the US. As of this writing, HappyCow lists 1,509.

Madison has never had anything like the vegan riches of New York or San Francisco, but even we are having our own vegan recession. When Mad Rabbit opened in early 2024, the city had four fully vegan restaurants; now, depending on how you count, one or two remain (and even the one that’s unambiguously vegan is a food-court-style stall). I visited Mad Rabbit at its last Sunday brunch, where it served what many people have described as the best tofu scramble they’ve ever had, and a crowd-pleasing rotation of crepe specials (this month, it was mango lassi). It’s a culinary niche that, once gone, is hard to replace in a mid-tier city like this one. 

Mad Rabbit’s owner, Nate Anger, told me the business hadn’t been in particularly bad financial shape; it was profitable for each of the three years in which it operated, but not profitable enough to justify the punishing time commitment required to run it. Managing it had taken over his life, as it’s wont to do for many people in the food service industry. “I live here. I spend far more time here than anywhere else,” he told me in a recent interview at the restaurant. “I’ve missed my kids’ baseball game and tournaments and school band recitals.” I looked around at the oddball, DIY space he’d conjured — walls covered in houndstooth print, an Alice in Wonderland-like vortex, and art of rabbits in mischievous-looking moods, one brandishing a pair of large knives (the sort of room you wouldn’t want to encounter while stoned). 

The animal rights movement has two very different emotional registers: the grief and terror of looking squarely at factory farming, and the joy of discovering how much creativity, abundance, and pleasure can exist outside it. All-vegan restaurants represent perhaps the fullest embodiment of that second feeling — like “a little heaven,” as Krupa Panchal, co-owner of Bombay Food Junkies, a vegan Indian spot in suburban St. Louis, put it to me. 

Even as vegan businesses struggle to survive, plant-based options at non-vegan restaurants have become far more mainstream than they were a decade or two ago. Set against the stagnating (if not declining) share of Americans who identify as vegan or vegetarian, that raises difficult and even paradoxical questions for the animal movement.

For that reason, the mass die-off of plant-based restaurants has been much dissected and lamented in the vegan community. As I faced losing my own — a possibility I’d always feared and tried to forestall by supporting it as much as possible — the problem became much more visceral for me. I found myself thinking about why it mattered to me so much: What is lost when these places disappear, and what does that tell us about whether the plant-based movement can grow and endure?

What vegan restaurants are for

The vegan restaurant predates the word “vegan” itself — and so, apparently, do questions about whether they can be financially viable. More than a century ago, French anarchist Georges Butaud co-founded the Foyer Végétalien in Paris, writing in a 1923 letter that he was unsure whether it would attract a sufficient “clientèle végétalienne” to sustain itself. Why start such a business at all, when the audience for plant-based food is so vanishingly small? “I already have some positive results. A few people have become vegan since we opened,” Butaud wrote. The restaurant “is a school where we reciprocally teach one another…I have believed in the usefulness of creating it, and I will be happy if, over the months to come, the number of vegans increases.” 

Many vegan restaurant proprietors today still share that ambition — to be good enough to help the movement grow. 

Long before it became routine to find plant-based options on normie restaurant menus (iceberg lettuce leaves don’t count), plant-based restaurants compensated for vegans’ exclusion from mainstream cuisine. But they have also aimed to provide proof of concept of the diverse, surprising possibilities of plant-based food for a larger audience, showing that plant-based food need not be confined to marginalia. 

Today, of course, restaurants are far more central to our daily lives than they were in Butaud’s time. Americans consume about a third of their calories and the majority of their food budgets outside the home, and food-serving businesses are perhaps our most important third spaces. Meanwhile, the problems associated with animal agriculture and overconsumption of animal products grow unabated in America and around the world. The US alone slaughters 10 billion land animals for meat every year, the overwhelming share of them raised in appalling conditions, and those farmed for milk and eggs endure no better. Reciting these grim facts tends not to be a very fruitful path toward making friends or convincing people that veganism can be a positive and enjoyable lifestyle. Plant-based restaurants, on the other hand, make veganism feel less like a prohibition than an invitation; hospitality rather than horror. 

Anyone who has ever gone vegan knows what it’s like to incessantly be asked the well-meaning but bewildering question: “What do you eat?” (And, I get it! It’s confusing for those of us who grew up viewing food free of animal products as side salad or overcooked green beans.) Plant-based businesses have long been laboratories for answering it, developing techniques that draw richness and variety from ingredients not often treated as the main event in Western cuisines.

The more than 50-year-old Moosewood Restaurant (although mostly vegetarian, not fully vegan) was an early conduit between restaurant experimentation and home cooking, its recipes spreading far beyond Ithaca, New York, through its enormously popular cookbooks. Soul Vegetarian in Atlanta, opened in 1979, developed a plant-based soul food repertoire that helped cut a path for dozens of other vegan soul restaurants across the US; the Chicago Diner, in the city long identified with stockyards and slaughterhouses, helped popularize plant-based versions of American diner and deli staples. And chef Miyoko Schinner, at her erstwhile San Francisco restaurant Now & Zen, experimented with plant-based cheeses long before launching Miyoko’s Creamery, one of the most acclaimed and influential vegan dairy companies of the past decade. 

The 21st century in particular has seen a flowering of vegan restaurants serving every palate and national cuisine, in every possible aesthetic — punk, hippie, psychedelic, fussy and upscale. They still expand my mind today, showing that a lifetime wouldn’t be enough to discover all the ways we can eat without the exploitation of animals.

The longtime Grasshopper restaurant in Boston, whose pan-Asian fare draws partly from Vietnamese Buddhist temple cuisine, makes mock meats that are worlds away from the rubbery substitutes that many Americans associate with the category (it closed its beloved, homey restaurant space in 2024, later reopening a stall inside a food court). Mad Rabbit changed even this longtime vegan’s idea of what tofu could be. Chicago-based Penelope’s Vegan Taqueria makes, as far as I’m concerned, the most exceptional Mexican food — vegan or not — this side of the Rio Grande. V-Grits, a Southern comfort spot in Louisville, Kentucky (RIP, 2024), provided evidence that some of America’s most exciting plant-based food could be found far from the big coastal cities best known for it. 

So why are so many of these places shuttering now? 

The vegan restaurant death spiral? 

Theories abound about the great dying of vegan restaurants.

Some of the casualties, it must be said, just weren’t very good in the first place. The raw vegan boom of the 2000s and 2010s, for example, produced numerous establishments built around that especially unforgiving constraint — no cooking. The result was often less-than-thrilling food (which isn’t to say it’s never good!), all in service of a restriction with scant evidence of health benefits to support it. Lots of these restaurants have closed in the 2020s, reflecting diminishing demand for that particular variant of vegan food. 

But the 2010s weren’t merely a golden age for zucchini noodles and date-walnut brownies — vegan restaurants of all stripes were multiplying, as was interest in the new generation of plant-based meats (Beyond and Impossible). It really did appear, for a minute there, that the future might be plant-based, vindicating decades of animal advocates’ work to push veganism into the mainstream. 

“I felt like veganism had really hit a big stride” in that period, Anger, the Mad Rabbit founder, said. Everyone was streaming documentaries advocating for plant-based diets — Forks Over Knives, Cowspiracy, What the Health, among others. Some polls suggested the share of Americans who called themselves vegan was growing. Anger said his market research led him to believe that the overall trend line for veganism would continue going up, even a little. Instead, “it just rolled right back over.” His restaurant had a core customer base of committed vegans, but its heavy reliance on regulars also showed how limited its reach was; stagnating interest in veganism may have been putting a ceiling on its growth. Keith Uruski, owner of Nooch, a vegan restaurant in Windsor, Ontario, open since 2018, told me that the business had thrived in its first few years, but has since slowed considerably, and he hasn’t paid himself in three years.  

In the years leading up to the pandemic, the assumption that the audience for vegan food would keep growing shaped much bigger bets than Mad Rabbit. Vegan chain restaurants including Veggie Grill, Native Foods, and Planta had pursued aggressive growth plans in the 2010s and early 2020s but eventually retrenched, closing locations and abandoning the scale they’d once envisioned. (Again, some of this may be merit-based rather than evidence of a broad rejection of veganism — YMMV, but I found Veggie Grill, at least last time I had it pre-Covid, to be mid.) “Most dedicated vegan chains are now in kind of a managed decline,” Lizzy Bartlett, senior director of menu research and insights at Technomic, a food service industry research firm, told me.  

The cultural winds have certainly shifted. The Make America Healthy Again (MAHA) movement has probably contributed to a thermostatic swing away from “unnatural”-seeming diets and simulacra of traditional foods, like plant-based meat and milk. I also think society has deep carnist antibodies that activate whenever meat-eating faces heightened moral scrutiny. In the last few years, that’s taken the form of a protein obsession that has hijacked the minds of otherwise rational people, convincing them tofu and beans lack sufficient protein to build muscle.

But perhaps my favorite explanation was articulated by Financial Times journalist Henry Mance last year: “The decline in idealism,” reflected in the reelection of Donald Trump — the triumph of our collective id.  

There’s a risk of reading too much into all this, however. Many restaurants, vegan or not, suffered during Covid and from prolonged inflation in food and energy prices. This year, consumers are spending less at restaurants because of elevated fuel prices due to the war in Iran. Panchal, of Bombay Food Junkies, said that her sales have been down in 2025 and 2026 compared to the years prior, but she doesn’t believe vegan restaurants have been faring worse than non-vegan ones. Some vegan businesses have recently closed in St. Louis for personal reasons rather than failing in the market, she told me.

This is part of the natural life cycle of independent restaurants — many disappear within a few years, and even highly successful ones eventually run their course. US cities had many vegan restaurants open in the 2000s and 2010s, so we might now be seeing a wave of closures that reflects the aging of that cohort. 

Preliminary results shared with Vox from a 2026 survey of the global vegan restaurant industry, by the nonprofit Vegan Hospitality, also complicate the idea that plant-based restaurants are being killed off because of waning demand for vegan food. In responses from about 59 vegan restaurants (a self-selected group, to be sure), mostly in the US and Mexico, roughly four in five said they’d still choose to be fully vegan if they were opening today. Of 13 businesses that were closing or had been sold, six said that being vegan actually helped them, and four said it made no meaningful difference.

And there’s some tension between the “death of veganism” hypothesis and what may be one of the biggest forces now disadvantaging dedicated vegan restaurants: the widespread adoption of plant-based options on omnivorous restaurant menus. That it’s now easier to be vegan at mainstream establishments is “unquestionable,” Anger said. He viewed Mad Rabbit’s competitors as not just fully plant-based businesses, but any restaurant that offers “more than two or three” vegan options; it was located just a block away from one of Madison’s best-regarded restaurants, a Laotian place with several very good plant-based offerings.

Likewise, Michael Fifelski, general manager of Red Sushi in downtown Madison, which has a solid list of vegan options, told me, “Our vegetarian and vegan rolls actually are quite popular” — a foundational part of the menu. There can be a real advantage to simply letting vegan food blend in — Amanda Byrd, the manager of Everly, an eclectic, globally inspired restaurant in Madison, told me that its top dish, a butternut squash and forbidden rice curry, is incidentally plant-based. In many cases, “if you de-emphasize the vegan statement, but the dish happens to be vegan,” it will sell better, Claire Conaghan of the food industry research firm Datassential said.

Though nothing compares, for me, to the feeling of total alignment that comes with dining at an all-vegan restaurant, there is also something affirming about seeing plant-based food finally taken seriously by the wider culture — and vegan dishes surviving on their own merits alongside everything else on the menu.

Do vegan restaurants still matter?

In a world where you can find a satisfying vegan entrée at Chipotle or Taco Bell or your local brewpub, are fully vegan restaurants still needed? What purpose do they serve?

The most fundamental problem beneath the downturn in vegan businesses is simply that the vegan population does not seem to be growing much at all. Polling on the question is messy and often inconsistent, but according to Gallup’s 2026 survey, 2 percent of Americans call themselves vegan, the same figure as in 2012, when the firm first started asking the question. If expanding the number of people who abstain from animal products remains an important goal (a point debated within the animal movement, though I think dietary change still matters a great deal), then which is more likely to move that objective forward: vegan restaurants, or an abundance of vegan options at omnivorous ones? Which does more to increase the number of plant-based meals consumed rather than animal-based ones and generate excitement about vegan food?  

I put those questions to Seth Ariel Green, a research scientist at Stanford’s Humane and Sustainable Food Lab, who writes the Substack “Regression to the Meat.” He’s one of the most intellectually honest researchers anywhere on meat reduction. His answer, via email, is that we don’t really know: “I have no idea how to weigh the pros and cons of, when I’m choosing between meals, 1) signaling to the world that vegan businesses are viable or 2) signaling to a particular business that their vegan options are viable. That’s a hard problem!” (It might be “a microeconomic structural equation modeling paper waiting to be written,” he added.)

Reducing prevailing levels of meat consumption even a tiny bit, much less convincing people to become vegan, is really, maddeningly hard, as Green has written. One frequently cited obstacle to growing the animal rights movement — its “central unsolved problem,” as one movement leader recently put it — is that it lacks much in the way of an in-person social world and sense of community. Vegan restaurants alone can’t fix that, of course, but they are among the few physical institutions the movement has. At their best, they provide a space where a private dietary choice can be reinforced by a shared sense of identity — a place to run into someone you already know or meet someone new, at a speaker event or social mixer. These spontaneous, embodied connections made Mad Rabbit such a warm presence in my life, and its final days all the more melancholy.

That function may be especially useful when plant-based restaurants are rooted in traditions people already belong to — cultural, religious, or otherwise — and help them view veganism as continuous with an identity they already have rather than as something alien to it. As Green has suggested, “let’s tap into pre-existing identities, explain how plant-based diets are consistent with them, and then take folks somewhere to enjoy convenient, delicious plant-based food together.” 

On the other hand, plant-based options at omnivorous establishments matter for almost the opposite reason. People often struggle to stay vegan because eating differently isolates them from non-vegan friends and family; restaurants that can accommodate mixed-diet social groups help remove that social penalty. These options also need a customer base — if no one orders them, they’re unlikely to remain on menus. 

I’m enough of a weirdo that I try to almost exclusively support plant-based restaurants whenever I eat out. I desperately want them to survive, and at the end of the day, no one is more invested in advancing the craft of plant-based cooking than vegan restaurants themselves.

Not everyone needs to be like me — in a world where almost all people still eat animal products, a healthy ecosystem needs both places built entirely around veganism and those where plant-based food is woven into broader food culture. It needs, most of all, excellent vegan food, wherever it might be found. And now that veganism has made at least a small breach into mainstream dining, vegan restaurants still offer something their meat-serving counterparts cannot. They’re like miniature utopias where the normal order of things is inverted and, for the length of a meal, we can see what a future without animal exploitation would look like. 

This story was originally published in The Highlight. To get access to member-exclusive stories like this every month, become a Vox Member today.

This story was originally published in The Highlight. To get access to member-exclusive stories like this every month, become a Vox Member today.

Todd Waller wasn’t expecting to spend the latter half of his 30s living with roommates. But in late 2022, following a breakup with his girlfriend, he needed to find a new place to live, quickly. 

A social worker based in the Atlanta metro, Waller started googling “efficiency apartments” and stumbled onto an ad for PadSplit, a company founded in 2017 that lets property owners rent out individual furnished bedrooms in single-family homes by the week. “It said I could get approved right away and move in tomorrow,” he recalled. There was no security deposit required.

All of a sudden, Waller found himself living with six other people and able to save a lot of money. His rent was just $180 per week, or less than $800 per month. Though he earned a decent salary, he never really had anything left over after all his bills were paid, and the new financial breathing room made the tradeoff of housemates feel worth it.

After a while, Waller decided he would be willing to upgrade to a nicer PadSplit unit, one with more amenities but still with roommates. Now he pays $1,250 a month to live on one side of a 2,000-square-foot home, with access to his own private bathroom, a private entrance, and a renovated kitchen. Three other people live on the other side of the house, and he rarely interacts with them.

“My house is awesome; I pay $500 less a month than I would if I were renting [a place of my own] without roommates, and I just was able to buy a new car,” he told me. He knows one day he’ll move somewhere else and perhaps even buy his own home, but he likes that he feels he can make that decision comfortably at his own pace.

With rents outpacing wages in most of the country, legislators are increasingly looking at co-living — sometimes called house-sharing or adult dorm rooms — as an overlooked piece of America’s housing stock. Zillow counts roughly 21 million “empty nest households” — or homes where older residents living with no children have at least two extra bedrooms. Some lawmakers want to make it easier for those homeowners to rent them out, which could put workers closer to their jobs and help seniors stay in houses they can no longer afford alone. Others are eyeing a different kind of vacancy: Post-pandemic remote work has left about a fifth of American office space empty, and there’s growing interest in turning some of it into apartments. 

Many advocates for people experiencing homelessness also argue that co-living is a needed solution, something that could help people going through emergencies avoid the scary slide into shelter living, especially models where you can move in almost immediately and without a deposit. PadSplit surveyed its renters in December and found a population that mostly works (83 percent were employed) and mostly hadn’t been to college. The median income was $32,500.

That co-living needs advocates at all is a legacy of the last century. Renting a single room in a boarding house or residential hotel was once an ordinary way to live in an American city, but in the decades after World War II those rooms became shorthand for poverty and vice, and cities responded by banning new ones and paying landlords to get rid of the old. Half a century later, many people still see sharing space with strangers as a last resort, or feel embarrassed about having roommates past a certain age. And discriminatory zoning codes written in that era are still on the books in most communities, enforcing traditional nuclear family arrangements when it comes to single-family housing, by defining “family” as people related by blood, marriage, or adoption. Those rules can be wielded against home-sharing, and against specific renters neighbors want to keep out.

But these longstanding barriers are starting to finally give. Doubling up with people you aren’t related to is less unusual than it used to be. Between 2017 and 2022, the number of households sharing space with nonrelatives grew by more than 500,000. Lawmakers desperate for anything that adds more housing supply also seem less picky about where it comes from. Companies like PadSplit are putting private capital behind the model, and a wave of new laws and litigation — much of it led by conservative legal groups arguing on property-rights grounds — is making it harder for cities to tell homeowners who can and cannot sleep in their spare rooms. 

For the first time since cities banned cheap rooms, the people trying to bring them back have the momentum, and the next couple of years will go a long way toward deciding whether co-living stays a niche workaround for people like Waller or becomes something a lot more people are able to consider.

The return of SROs

At the turn of the 20th century, as American cities swelled, immigrants, day laborers, and factory workers crowded into downtowns looking for somewhere cheap and temporary to sleep. A small room could be rented by the day, the week, or however long someone needed it. Some “boarded” in private homes while others took beds in bottom-rung hotels known as flophouses. These arrangements varied widely, but became broadly known as single-room occupancies (SROs).

The turn against them came after World War II, as middle-class white families decamped for roomy new houses in the suburbs, and SROs grew more closely associated with shoddy housing for the poor and the deviant. New York and other cities started banning SRO construction in the 1950s. By the 1970s, SROs were a regular media villain, even as they still housed hundreds of thousands of people, including the mentally ill who had been turned out by the closing of state asylums. Cities started to offer landlords incentives to convert their SROs into luxury rentals. Between the mid-1970s and the 1990s, roughly a million of these affordable market-rate units disappeared from the market across the country.

The idea that perhaps cities made a mistake in banning these lower-cost housing options has been simmering in urbanist policy circles for the last 15 years, particularly as the homelessness crisis has gotten worse. The Furman Center at NYU argued in 2018 that reintroducing SROs could help address the housing shortage. The architecture critic Karrie Jacobs argued in 2021 that cities had blamed a kind of housing for problems that belonged to the people living in it. “The notion took hold that if you eliminated the housing, the marginal people would simply vanish,” she wrote in Curbed.

Still, lawmakers have dragged their feet on actually making it easier to rent these kinds of units again, and until recently the people pushing for it had little to show beyond op-eds and white papers. What’s different now is that the fight has moved out of the world of policy papers and into places where it can produce actual results, including a lawsuit that could reach the Supreme Court.

Suing over who counts as family

In early 2022, a home-sharing startup called HomeRoom was renting out two houses in Shawnee, Kansas, a suburb of Kansas City. The company rented rooms one at a time to unrelated adults who wanted cheaper housing, and at a local city council meeting that year, Shawnee’s community development director asked whether the city should support such arrangements in single-family neighborhoods at all. Two months later, the council passed an ordinance banning “co-living groups,” which it defined as four or more unrelated adults sharing a home. 

Under the ordinance, if even one adult in a house wasn’t related to the others by blood, marriage, or adoption, the whole household counted as unrelated.

While the new law forced HomeRoom to evict its tenants, it also put Val French, a Shawnee homeowner, in a bad situation. She lived with her husband, their two adult sons, and one son’s girlfriend. Because the girlfriend was related to no one, the house was now deemed in violation of the city’s occupancy rules. Her son and his girlfriend had to move out, and French couldn’t rent the empty room to anyone else.

French and HomeRoom sued in federal court in May 2023, with assistance from the libertarian Pacific Legal Foundation. They argued that their right to choose who they live with is protected under the 14th Amendment, but they ran into legal precedent from a 1974 Supreme Court case, Village of Belle Terre v. Boraas, which upheld a Long Island village’s nearly identical rule against six college students sharing a house.

The decision came down in the same years cities were clearing out their SROs, and it has given local governments cover to decide who counts as a family ever since.

A federal judge dismissed the Shawnee suit in September 2023, citing Belle Terre, and this past April the US Court of Appeals for the 10th Circuit upheld the dismissal. A few months later, the Pacific Legal Foundation (PLF) petitioned the US Supreme Court to hear the case and reconsider Belle Terre once and for all. The precedent has already frayed in places — state courts in California, Michigan, New Jersey, and New York have struck down local “unrelated occupants” limits under their own laws — but it still governs everywhere else. 

There is “a fundamental liberty right to choose household living companions — whether as an articulation of the right of intimate association or independently — that is deeply rooted in American history and tradition,” PLF’s lead attorney on the case, David Deerson, told me. 

The Supreme Court hears only about 1 percent of the cases it’s asked to take, and even if it took this one, the plaintiffs would be asking a conservative majority to recognize a new constitutional right, which that majority has spent the past few years insisting courts should almost never do. 

Deerson’s argument is aimed at that skepticism, though. When the Supreme Court overturned Roe v. Wade in 2022, it held that an unwritten right counts only if it is “deeply rooted in history and tradition.” Deerson and his allies are arguing that living with people you aren’t related to qualifies as such because, for most of American history, boarding houses and lodgers were typical staples of family life. Belle Terre is also a short opinion written by William O. Douglas, a liberal justice whose legacy has little connection to today’s conservative justices. 

The legislative front

A Supreme Court reversal would be the cleanest fix for co-living, but advocates aren’t waiting on it. State legislatures have already shown they’ll act: Iowa barred cities from enforcing relationship-based occupancy limits in 2017, Oregon and Washington followed in 2021, and in 2024, Colorado lawmakers passed a law prohibiting cities from restricting how many unrelated roommates can live under one roof absent a clear health or safety reason. 

The Pacific Legal Foundation worked on that last bill too, and has since turned it into model legislation for other states. They colloquially call it the “Golden Girls bill” since occupancy caps like these would have prevented the four unrelated women of the hit 1980s sitcom from sharing a house. 

This year Pennsylvania lawmakers introduced their own version, with supporters citing not private property rights but the potential to ease the state’s affordable housing shortage. As legislators considered the proposal, Pacific Legal Foundation published research showing that nine of the 10 most populous cities in Pennsylvania capped the number of unrelated adults who could live together. The state House passed the Golden Girls bill this summer, though the Pennsylvania Senate version has not yet received a vote. 

The objection lawmakers hear most is the same one that animated Belle Terre — that lifting occupancy caps could turn quiet, orderly, neighborhood homes into de facto frat houses. That college partying concern killed Connecticut’s proposed Golden Girls bill this year. While the bill cleared the state Senate, it never got a vote in the House, amid reported concerns from the speaker about college students moving into wealthy neighborhoods. “What if a neighbor is unhappy about four unrelated people who are 19 years old or 22 years old living in the house?” state House Speaker Matt Ritter asked in an interview with the Connecticut Mirror. 

Pennsylvania’s sponsors tried to head off those fears by amending the bill to exclude protections where someone is enrolled at a college or university. In other words, the law would have covered Blanche, Dorothy, Rose, and Sophia from Golden Girls unless one of them signed up for a class at their community college.

Nevertheless, advocates are expanding their push. Jim Manley, state policy director for the Pacific Legal Foundation, told me he expects Texas, Florida, Pennsylvania, North Carolina, Rhode Island and Utah to take up new versions of the legislation in 2027.

And occupancy caps aren’t the only co-living target. Sam Hooper, a lawyer who has been lobbying state legislatures to re-legalize SROs, and his former colleagues at the Institute for Justice are now focused on the ROOM Act, model legislation that would bar cities from restricting SROs and other co-living arrangements, including rules that make it hard to convert offices into apartments. A version was first introduced in Rhode Island earlier this year. 

For Meagan Forbes, Institute for Justice’s director of legislation, the goal is for co-living to be treated like any other form of housing. “Other local laws can regulate things like noise and fire safety, but current regulations just go way too overboard in preventing this kind of housing,” she told me. 

Hooper, who drafted the ROOM Act, says he wanted to “take a massive sledgehammer” to existing restrictions. The resistance he runs into isn’t only the frat-house worry, but older cultural fears that SROs would recreate the poor tenement conditions of the early 20th century. “I think there’s this real problem of letting the perfect be the enemy of the good in housing policy,” he told me. “People accuse us of wanting people to live in undignified housing, but they just struggle to understand that it can be a perfectly fine option for many people at different points in their life.” Hooper credits his own London co-living experience in his 20s with introducing him to some of his best friends and his wife. 

Even so, he cited a broad political coalition backing him up, from property rights champions in conservative states to Democrats and progressive YIMBYs drawn to the housing justice and homelessness angles. There are business leaders interested in workforce housing, he said, and he noted that the AARP testified for the ROOM Act in Rhode Island. “I’m hopeful we’ll be able to keep this bipartisan coalition that hasn’t succumbed to the culture wars,” Hooper added.

Not every co-living proposal is about removing rules. DC’s Senior Co-Living Program Establishment Act, also nicknamed the Golden Girls bill, would pay senior homeowners $300 a month to rent a room to another senior, plus up to $2,500 for home modifications. 

The 21st Century ROAD to Housing Act, the federal housing package that became law in July, doesn’t touch occupancy rules. But it does fund a pilot program for converting vacant commercial buildings into housing, which could make adult dorm office conversions easier.

The demand question

While momentum for co-living is real, demand is also complicated. Americans are doubling up more than they were before the pandemic — about 8.2 million households in 2024, up 4.3 percent since 2019, according to analysis shared by Zillow. Yet the share made up of unrelated adults living together actually fell slightly, by roughly 50,000 households, while homes shared with couples or families grew by nearly 400,000. In other words, when Americans need to save on rent, they still mostly turn to people they already know.

PadSplit is betting that changes. Atticus LeBlanc recently announced his company is expanding into New York, Chicago, and San Francisco, three of the most expensive rental markets in the country.

“Does that mean things have gotten more desperate, that it’s forcing this cultural acceptance?” he asked me in an interview. “I think there’s certainly an argument to be made there. But you could just as easily make the argument that, holy cow, we are really, really wasteful with space.”

Hi readers! Shayla Love here, science journalist and longtime fan of Your Mileage May Vary. I’m honored to be subbing for Sigal Samuel while she’s out on parental leave. I’m diving into your questions as a way to help understand human nature and our choices through multiple lenses: philosophical, psychological, and beyond. Please send in any emotional, body/brain, sociological, perceptual, or other kind of life quandaries you might have.

My best friend confessed his love for me one year ago and I rejected him because I was unhappily in love with another man, and I was never really physically attracted to my best friend. He was devastated. I am happy our friendship survived.

Over a year later, I find myself thinking about how it would be like to be in a relationship with my best friend. He is the only man who ever showed me genuine love and support, and I wonder what if I try…maybe I will fall in love with him. However, I am concerned about hurting his feelings again. Is it selfish of me wanting to try this love out because it promises security and appreciation?

Dear Fanning the Flame,

I can’t blame you for being curious about the common “friends to lovers” storyline. It’s often portrayed as the best kind of pairing: Two people have the foundation of their friendship plus a newfound love; the romantic relationship is like a soaring addition to an existing sturdy house. 

But real life is not always like the movies, and it sounds to me like you haven’t actually had an awakening of desire for your friend. In fact, it’s the opposite: He once expressed feelings for you, and you confronted a lack of physical attraction for this person. Now you’re wondering if it would be possible for you to fall in love if you tried. I think you’d agree that your timing is suspect. After a breakup, it’s common and understandable to seek out comfort and intimacy. Still, I detect a philosophical streak in your question beyond the issue of whether or not this would simply be a rebound. 

If your friend has always appreciated you, made you feel safe, and loves you — could that be a form of love that’s better than what you had in your last relationship? Maybe that is what love is.

Is it? Over a long night of drinking some 2,400 years ago, one group of thinkers allegedly debated the true nature of love, as Greek philosopher Plato describes in The Symposium. 

Aristophanes, a playwright, tells a story that most closely aligns with the love we see in the rom-coms of today. He said that humans used to be larger creatures with four arms and four legs. After annoying the gods, Zeus cuts all the humans in half, creating the two-limbed bodies we have today. The result is that people wander the world looking for the one person who used to literally complete them. If you followed Aristophanes’s fable, you shouldn’t try to be with your friend unless you felt that deep longing that one has when meeting their other half. 

The rest of the dinner party companions have more circumspect ideas. Phaedrus, a Greek aristocrat, thought that true love inspired people to become the best possible version of themselves. Pausanias, a military man, thought that love driven only by attraction to someone’s body was “vulgar love”, and that “noble love” was the love of someone’s values. Eryximachus, a doctor, asserts that love is also about moderation, and it needs order, much in the way the natural world does. Finally, Socrates says that even if you start out with physical infatuation, you can eventually transcend that and end up loving wisdom itself, the highest form of love. As I read it, the men are grappling with how to make love make sense, while acknowledging that it can make us lustful and impulsive. Shouldn’t its best manifestations instead be practical and virtuous?   

You could easily justify trying to date your friend with these theories that try to wrangle and tame love. For example, if your friend inspires you to be the best version of yourself, you could decide that’s enough to go for it. You could also decide that because you admire your friend’s character, and not his body, that’s a noble love, and better than the vulgar love of attraction. 

German philosopher Arthur Schopenhauer wrote in his 19th-century essay “The Metaphysics of Sexual Love” that he distrusted the feeling of being desperately in love. He considered romantic love to be a biological drive disguised as a real emotion — one whose goal is to trick us into procreating. You could even see your lack of attraction as an indication that you’re able to act more rationally, and not be deceived by that cunning trickster, passion. 

I know you’ve recently gone through a breakup, but I hope you can feel how bleak these views can become: to see love only as the window dressing for the propagation of a species, or as just a bridge to the love of wisdom. 

This cynicism has other consequences. Wondering if you could redefine love in a relationship with your friend isn’t like a wine-fueled dinner party bouncing around thought experiments. It involves your best friend and his own feelings too, and could risk not only hurting him, but also robbing him of a better romantic partner. 

For Simone de Beauvoir, the 20th-century existential philosopher, the most important aspect of life was freedom: We are technically free to do whatever we want, and it’s the choices we make with that freedom that determine our authenticity, or lack of it. De Beauvoir worried about forms of love that stole freedom from other people. In narcissistic love, she wrote in The Second Sex, a partner doesn’t love the other person, but loves the fact that the other loves them. It’s a relationship built on the self-interest of one of its members. 

I want to gently point out that it sounds like there may be aspects of the narcissistic relationship in your dilemma. While it may be intriguing to consider what it’s like to date a friend, you don’t seem to be as romantically interested so much as you are interested in his interest in and support of you. Actually involving yourself in such a dynamic could take his freedom, as well as your own capacity to learn from your break-up, then find a partner you’re genuinely drawn to for their own merits.  

I’m not saying friendship isn’t an important ingredient in love. Many of the most successful, very long-term partners I know have developed a deep friendship with one another. This friendship helps them stay kind to each other and have fun over many years when work, health, or stress can interrupt more passionate times of connection. But those same couples also had the undeniable spark of attraction at the start of their relationships too. They didn’t have to try. Sometimes they tried not to feel as strongly as they did, and still weren’t able to stop. 

Even in cases when a relationship first launches platonically, if something more is there, the undeniable, reciprocal pull tends to emerge soon thereafter. In H.G. Wells’ 1911 novel, The New Machiavelli, which was largely based on a real-life affair Wells had, he writes about a college graduate called Richard who meets a young woman, Isabel. The two become friends and are entranced with each other’s minds. But they quickly start to notice more between them, despite trying to push such thoughts away.

They fail at this attempt. Richard has a moment of realization, when he turns to look at Isabel’s face one day. “And something — an infinite tenderness, stabbed me,” Wells wrote. “It was a keen physical feeling, like nothing I had ever felt before. …From that time forth I knew I loved Isabel beyond measure.” I think you owe it to yourself, and your friend, to pursue connections that have this quality, especially at the start. 

You should also make room for and appreciate your friendship. If it never becomes romantic, that doesn’t make it a lesser relationship. The couples therapist, Esther Perel, calls friendships their own kind of love story. She once described a simple exercise to help appreciate that bond. Take a few minutes and think about a friend who isn’t a family member or romantic partner. “Recall a time when that friend reflected you back to yourself, created space for joy, or helped you remember who you are,” Perel suggests. Then, send a message to that friend about that moment, and thank them. 

Having a good friend by your side in the aftermath of a breakup is a gift. Work on maintaining and nurturing that friendship, and make sure you spend some time helping him with his life too. Don’t fixate on whether you should attempt to fall in love. The truth is, for better or for worse, if you love him, you won’t have to try.

Bonus: What I’m reading

• I’ve always been interested in the history of love, by which I mean the differences over time in how love has been expressed and discussed. William Reddy, a historian of emotion, has an excellent book called The Making of Romantic Love; you can also check out a syllabus for a class at Duke University he taught on the subject. 
• For a deeper dive (and refresher!) on Plato’s Symposium, I found that there was no better person to turn to than Melvyn Bragg and his guests on the BBC In Our Time episode on the philosophy of love. 
• Arranged marriages are an interesting window into understanding the growth of love. Mansi Choksi’s nonfiction book, The Newlyweds, follows three couples in India who attempt to marry for love; here’s an excerpt that was published in Harper’s Magazine. 

This story was originally published in The Highlight. To get access to member-exclusive stories like this every month, become a Vox Member today.