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Competing for the Abortion Dollar
New York Times verifies what prolifers have been saying for years.
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"why all the constant whining about "provider shortage?""
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Dateline: 1/8/01

On December 30, the New York Times finally reported what the prolife movement has been reporting for years: abortion is a money-maker for doctors, but a competitive field for clinics, resulting in cutting corners.

Available online (registration required, but at no cost), the article, by Gina Kolata, is entitled As Abortion Rate Decreases, Clinics Compete for Patients.

Kolata notes that despite public lamenting by abortion advocates about a "shortage" of abortionists, there is actually an abortionist glut, particularly in larger cities. In rural areas, yes, there are few abortionists -- not due to a lack of people willing to sell abortions, but simply because there is no profit in selling abortions in sparsely-populated areas where abortion just isn't in demand.

Kolata notes, "while women in rural areas must sometimes drive hundreds of miles to the nearest clinic, in cities and suburbs there are price wars and competition over amenities. Doctors have refused to train colleagues, fearing they will only help a potential competitor in a lucrative, often cash-only, business."

Citing Alan Guttmacher Institute statistics, Kolata notes that in the past seven years, the number of abortions reported per year has gone down 17.4 percent. Both prolife and abortion advocacy groups claim credit for the drop, with prolifers attributing it to consumer protection measures and abortion advocates such as Stanley Henshaw attributing it to what Kolata calls "better birth control." However, from listening to tapes of National Abortion Federation meetings, I know of a third factor that abortion advocates don't mention -- fear of sexually transmitted diseases, particularly AIDS, which has led to increased condom use and decreased sexual activity outside of at least semi-stable relationships. Admitting that people are capable of choosing to change or curtail their sexual activities undercuts the contraceptives-based "pill-pusher" mentality that will be increasingly an important source of income to "family planning" facilities as abortion numbers drop.

But, as Kolata notes, despite a decrease in abortion sales, the number of facilities competing for abortion customers has remained stable, at 690 high-volume (400+ abortions/year) facilities. These facilities are responsible for 89 percent of the nation's abortion sales.

Competition for abortion patients has kept abortion costs astonishingly low. Kolata says that had the cost of abortion kept pace with rising costs of medical care, an abortion that would have cost $300 in 1972 would cost $2,251 today. But even without adjusting for inflation, the charge has gone down to typically less than $300 for a first-trimester abortion.

Kolata quotes Warren Hern, high-profile member of the National Abortion Federation and owner of Boulder Abortion Clinic in Colorado:

To lower costs, and thus lure in more patients, facilities cut corners by having low-paid staff who do almost everything but the actual abortion. When the abortionist arrives at the facility, the patients are prepared by the cut-rate staff, and therefore only take two to three minutes of the physician's time for a first-trimester abortion.

Despite the public outcry to the contrary, Kolata found that it is not prolife protestors, but competition from other abortionists that is the pressing problem for abortion clinics. She noted that in New York, Eastern Women's Center and Parkmed managed to compete with each other for more than a decade until a 30 percent drop in clients led to a merger.

Another thorn in clinic owners' sides is Planned Parenthood. Because it is heavily subsidized with donations and tax money, which covers expenses such as salary and physical plant, Planned Parenthood is able to undercut for-profit clinics' prices on abortions. Hern had been charging $370 for a first-trimester abortion until a Planned Parenthood opened in nearby Fort Collins, charging only $300. Hern lamented that his abortion sales dropped 25 percent within a month of Planned Parenthood's opening. In order to remain in business, Hern increased his focus on second- and third-trimester abortions. But even this niche, Hern noted, is insecure. At a recent abortion physician meeting, Kolata noted, Hern found the room filled with abortionists eager to do later and later abortions. "Twenty years ago," Hern told Kolata, "there were just two or three doctors in the country doing late abortions."

Inside the National Abortion Federation, which has both Planned Parenthood and for-profit members, there is intense resentment of what for-profits consider an unfair advantage. I gained familiarity with this rivalry while listening to years of tapes of National Abortion Federation meetings. Planned Parenthood, the for-profits point out, can sell abortions at a loss in order to gain clients for the heavily-subsidized government-reimbursable birth control and STD services that provide a large portion of the Planned Parenthood budget. Planned Parenthood responds that by spending a lot of its resources creating a social climate friendly to abortion, and by underwriting expensive litigation that benefits all abortionists, it provides valuable support to for-profit abortion facilities. The resentment has heated up as Planned Parenthood has expanded its use of abortion to attract clients. Kolata notes that the number of Planned Parenthood facilities to perform abortions has gone from 99 to 147 since 1991.

Into this mix comes chemical abortions. Despite how cheap the drugs are reported to be when used for obstetric purposes, when used for abortion they are said to be prohibitively expensive. Competition for chemical abortion patients is already leading to cost-cutting, such as one facility that is considering dispensing only one-third of the recommended fetocidal dose, telling patients that it's a low dose but usually enough to kill the fetus and produce the abortion. Another clinic owner plans to sell chemical abortions at what she claims is below cost, as a loss-leader to bring patients to her facility and sell them other services.

Why, one might ask, are doctors like Hern scrambling for a shrinking pool of potential abortion patients, instead of simply providing needed medical care? As prolifers have been saying for decades, the reason is simple: it's a quick way for somebody with a medical degree to get rich. As Dr. William Ramos of Las Vegas pointed out, "There is less work and more income."

Kolata noted that "While few want to talk about the money that abortion doctors can make, clinic owners and doctors agree that doctors can make several hundred thousand dollars a year working part time, a few hours a day with their fees averaging $60 for a first-trimester abortion. Although they do have hefty fees for malpractice insurance, doctors who travel from clinic to clinic have no overhead and no record keeping."

One Detroit doctor lamented to Kolata that he when he finished medical school, trained in obstetrics and gynecology, he was unable to find an area abortionist willing to train him. He had to team up with an older abortionist who was preparing to retire in order to get the training to launch his career as a "circuit-rider," traveling from facility to facility doing abortions.

Ron Fitzsimmons, of the National Coalition of Abortion Providers, says that he's approached by more abortionist-wannabes than he has places available to hire them. Clinic owners are scrambling to keep their heads above water, while abortionists wait in the wings to suck up (so to speak) a large chunk of the cash that passes through the facilities.

Kolata's excellently researched piece leaves us with the question about why abortion advocacy organizations won't shut up in public about the "shortage" of "abortion providers." The most likely reason is that the endless complaints about there being too few abortionists to meet the supposed demand for abortion maintains a sense of crisis, and of abortion as a "service" to be "provided," rather than a political and personal cash cow for those who have latched onto a teat.

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