It is shame, and it's opposite, pride and indifference which are at the core of this story. It highlights that the shame of infertility can be profoundly damaging, and the inflexible gender ideas around it, procreation and parenthood fence people in. It was Karbaat's pride and indifference to the mothers, fathers and children he was creating that was the catalyst for the whole thing.
In a system that is largely run by private business it was probably inevitable that sooner or later the profit-before-all fake-it-till-you-make-it narcissism of many businesses considered successful today would finally also hit American health care. As ever, while rich people play at saving the world, the ordinary among us are the ones who pay the price in our lives.