Four challenges with #DefundPP

Last updated on: January 22, 2016 at 8:10 am by Jane the Actuary

Four challenges with #DefundPP 2016-01-22T08:10:46-06:00 Jane the Actuary

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1) Is contraception “(medically-necessary) health care” or a wholly separate consumer-product category of drugs and devices, some of which are FDA-regulated because of their potential side-effects? The discussion over the last several days has been to emphasize that other Title X providers, such as community health clinics, actually provide a full range of healthcare services, which, much as PP claims otherwise, isn’t the case there. Here, for instance, is the text of Monday’s (now pulled) Senate bill:

(1) State and county health departments, community health centers, hospitals, physicians offices, and other entities currently provide, and will continue to provide, health services to women. Such health services include relevant diagnostic laboratory and radiology services, well-child care, prenatal and postpartum care, immunization, family planning services including contraception, sexually transmitted disease testing, cervical and breast cancer screenings, and referrals.

(2) Many such entities provide services to all persons, regardless of the person’s ability to pay, and provide services in medically underserved areas and to medically underserved populations.

(3) All funds no longer available to Planned Parenthood will continue to be made available to other eligible entities to provide women’s health care services.

But if we push the conversation, in the context of provision of services for poor women, towards a notion that funds for contraception shouldn’t be segregated but are all a part of healthcare and should be delivered as a part of a strengthened community health clinic model, then where does that leave conscientious objection to some or all types of birth control, on the part of religious employers?

Is it better, from this perspective, to keep delivery of contraceptives to the poor segregated to a separate program, even if it were to operate differently than it does today, for instance, with food stamp-like vouchers?

2) Planned Parenthood supporters do have a point when they say that, for better or worse, a significant number of women are accustomed to receiving services at their centers. This article at MSNBC points out some of the impacts that local bans have had, and, while it’s clear that the author wants to prove a point, it is fair to say that, even if provided the reallocated funds rather quickly, community health clinics would not be able to immediately ramp-up their services to position themselves as successor providers to the local PP clinic. Would it be more appropriate to phase out the subsidies, specifying, for instance, that for each of the next 4 years, a further 25% tranche of the Title X allocation is inaccessible to providers who also, in some component of their corporate structure, provide abortions?

3) Planned Parenthood’s abortion services are clearly a big part of its business. But here’s the catch: they’re a profit center. It’s not as if Planned Parenthood is using some of the Title X cash to subsidize their abortion business, to provide abortions to poor women at reduced cost. (OK, I haven’t researched this just now, but I assume that I wouldn’t hear so many stories of poor women scrambling to find the cash for the abortion if there were sliding-scale subsidies at the abortion side of the PP operation.) Now, where the money goes, I don’t know — does it simply mean that the abortion side of the business is better compensated, or that, in general, their employees are better paid that at a standard Title X clinic? Does it fund their lobbying, or their pretty substantial expansion over the years? In any case, the rhetoric that the money is all intermingled is reasonable, but I’m not sure that it’s honest to imply that Title X money is indirectly subsidizing abortion; at best, since they seem to provide abortion at a market rate, it just helps their abortion business be more profitable if grant money pays for the overall clinic overhead.

4) Wesley J Smith has proposed that we “Break Up Big Abortion” in the same manner as the government mandated that AT&T split up into the baby bells and the long-distance provider. Now, I support this, but I don’t know how easy it would be to keep these two entities operating genuinely at arm’s length. If Planned Parenthood and, let’s say, Abortion Service, Inc., are obliged to become two separate entities (or do so in response to a de-fund of abortion-providing entities), would there be anything standing in the way of sharing the same office space, administrative staff, referring to each other, etc.?

And, yes, I’m playing devil’s advocate here, in the hopes of generating some useful discussion. But there it is.

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