Sunday, December 14, 2008

Didn't You Hear Me? I Said UNBUNDLING!

I've always wondered if, in advertising, people simply modulate their tone to make perfectly normal or meaningless things sound wonderful or scary. If you surround "contains monochromaglutimate!" with enough colors and starbursts, I'm going to assume it's a good thing, even though I have no idea exactly what it is I'm getting. And the reverse is true -- a sinister tone can make even utterly benign actions seem like the worst form of evil and malice on the planet.

Though I can't hear his tone of voice, I'm pretty sure that is what's going on in this Ross Douthat post, where he takes issue with the claim that only 3% of Planned Parenthood's expenditures go towards abortions. Now, before we go any further let's remember what we're arguing about. The reason this 3% number is coming up is defense against those who want to strip Planned Parenthood of public funding. Opponents of that proposal are noting that doing that will have the primary effect of reducing Planned Parenthood's ability to give STD exams, distribute contraceptives, and provide other rather generic but important woman's health initiatives.

In his rejoinder, Douthat links to a Weekly Standard piece by Charlotte Allen which wrote the following:
The 3 percent pie slice in the 2005-06 financial report, representing 264,943 abortion customers served, can only be described as deliberately misleading.

One way Planned Parenthood massages the numbers to make its abortion business look trivial is to unbundle its services for purposes of counting. Those 10.1 million different medical procedures in the last fiscal year, for instance, were administered to only 3 million clients. An abortion is invariably preceded by a pregnancy test--a separate service in Planned Parenthood's reckoning--and is almost always followed at the organization's clinics by a "going home" packet of contraceptives, which counts as another separate service. Throw in a pelvic exam and a lab test for STDs--you get the picture. In terms of absolute numbers of clients, one in three visited Planned Parenthood for a pregnancy test, and of those, a little under one in three had a Planned Parenthood abortion.

Let's push aside that my eyeball math translates Allen's figures to "11% of Planned Parenthood clients have an abortion" -- still leaving a massive 89% of customers that don't have one. What Douthat and Allen's argument boils down to is that we shouldn't count many of PP's health services (or should "bundle" it under the metric of "abortion") because many of the sluts women who receive the services also receive abortions. But unless you think that these women are somehow undeserving of gynecological or reproductive health care because they had an unwanted pregnancy and are seeking an abortion, there is no reason to find this remotely problematic. Indeed, if it wasn't for Douthat's clear yet inexplicable agitation, it wouldn't have even occurred to me that this type of accounting would be anything but above board.

One might note that women currently carrying an unplanned pregnancy might be one of the groups most in need of STD exams, contraceptives, and other reproductive health accessories, and laud the fact that PP is providing services to this segment of the population. But Douthat and Allen are essentially arguing the reverse -- they're saying that any reproductive health service provided to a woman seeking an abortion should be grouped under "abortion services" and thus (in the putatively pro-life worldview) not count as a harm if it is cut.

Look at this way. Suppose there was a proposal to cut PP's funding by the precise amount they spend on "abortion". So liberals would say: "that means cutting 3% of PP's budget -- the amount the spend on abortion". Douthat and Allen would argue that number is too small -- it doesn't include pregnancy tests for women seeking abortions, it doesn't count contraceptives given to these women, it doesn't count STD tests administered, etc., etc.. Add the costs of those procedures in, and then you get the dollar amount that we should be cutting. The clear upshot of that argument, though, is that it is not a problem -- indeed, it'd be a good thing -- if Planned Parenthood were not able to provide these services. Women who want abortions, Douthat is saying, don't deserve to be screened for STDs. That right, I imagine, is reserved for women who are not baby-killing whores.

Douthat is correct to argue that the raw number of abortions Planned Parenthood provides is enough for someone who finds abortion to be an unquestionable moral evil to justify withholding funding. That's true irrespective of what proportion of PP's resources are devoted to woman's health outside of abortion -- it's a deontological claim based off Planned Parenthood's clear participation in something many people consider to be immoral. But what is illegitimate -- what is, in fact, fundamentally "pro-herpes" -- is arguing that giving an STD exam isn't "really" part of woman's health because the woman also received an abortion. That's nothing more than dressed up slut-shaming, and it isn't improved just because Douthat and Allen hyperventilate and call accurate reporting "massaging the numbers".


Julia said...

If I may quote my good friend John McCain...

*airquotes* "Women's health, pssh" *airquotes*

Anonymous said...

Dave, I like you and I like your blog. You're very informed and insightful, but I wonder if you could have been a bit more restrained here. You made a good effort at the end of the post, but there were a couple of "come on dude" moments for me.

While many members of the religious right enjoy whore bashing, if abortion services come bundled with other services from the consumer's perspective, they should come similarly bundled for budgeting and accounting purposes when tax dollars are at stake. This opinion does not require the moral vice you often attribute to your opponents.

I think your charge that neither of the linked authors think that women seeking abortions deserve other health services because they are such whores is a terrible kind of straw-manning. I, for one, think the services should be bundled for accounting and budgeting, but also think that women with unwanted pregnancies should have all of the access to health care that our tax money can buy. I think that most other pro-life people would agree with me.

Like I said, I like your blog. i just think you're a bit footloose with calling names and charging moral vices. If it takes you three or four logical steps to get there, there's usually a good chance the person you're talking about would have gone a different route on one of those steps.

On the other hand, posting polarizing attacks like that is probably good for your reputation and traffic level, as it's an easy way to score points with your audience. Feel free to ignore me. I've never run a blog, and I'm not even sure if you have an intent here or not, or if too much restraint might be contrary to that intent.

David Schraub said...

I disagree. I don't think it's particularly useful to have a debate over what is proper accounting procedure when it's rather clearly a facade for "how much of a proportion of Planned Parenthood's services are in areas I find morally objectionable?" The only reason one would waste energy trying to group "STD exam given to abortion patient" into "abortion" is because one wants to label that, too, as objectionable -- particularly since, as indicated, it's not a step that needs to be taken because the better hitch for the argument is deontological anyway. But the move itself, I think is bogus, and holds abortion-seeking women in shockingly (well, not too shockingly, unfortunately) low regard.

Anonymous said...

If a procedure is always included with the abortion, then there is a plausible argument, independent of one's regard for abortion-seeking women, that said proceudre is really part of the abortion procedure (i.e. pregnancy test). Is it medically unethical, impractical, or negligent to preform an abortion without doing certain exmas first, or certain follow-ups afterwards (I don't know the answer to this question)? If so, and if we're not funding abortion procedures, we might not want to fund such procedures when women get them in anticipation of an abortion.

I agree that the argument is not necessary for most pro-lifers (Douthat makes that point too), but it may be persuasive to some fence-sitters. And I don't think it is implausible, or that it depends on a negative view of specfic groups.

Alice Ronald said...

Grant, many procedures are recorded for accounting purposes as separate items. You have a hip replacement, it'll be recorded as a physio appointment, several appointments with the surgeon, pre-admission appointments with the anaesthetist, nurse prior to the operation, the operation itself (during which there will be drugs, the implant, different lines for each staff member's time), post-operative physio and occupational therapy, antibiotics and follow up appointments with the surgeon. There'll be separate accounting charges for bandages, support socks, crutches, the cool booster seat for the toilet.

For certain purposes, these costs will be bundled. But they are also recorded separately for other purposes. The organisation needs to be able to say how many physio appointments were seen in a given period, they also need to be able to say how much those cost, what number were charged to what specialty and which were part of accident recovery, pre-op assessment and post-op recovery.

You want to see the numbers bundled? Ask questions that will require it. But don't jump on an organisation for recording their accounting line items correctly and individually. It's like telling a bakery that they're being ambiguous for recording their flour and sugar purchases separate from their bakers' labour. 'Cos it all ends up in the cake at the end.