"Defunding."

Today in Washington, DC, there is a Pro-Life rally and march. One of the things that the people marching and their supporters in Congress like to repeatedly call for is the "defunding of Planned Parenthood." They decry the organization, claiming that they don't want their tax dollars being spent on abortions, which is what Planned Parenthood provides.

Well, it's time to understand why this rallying cry is ultimately a lie.

Planned Parenthood is a federal program, isn't it?

Uh, no. Most people I talk to don't seem to understand this. PP is not a federal program like SNAP (food stamps). There is no actual item in the Congressional budget for Planned Parenthood. It is a non-profit organization which runs private medical clinics that provide reproductive health services and counseling. Imagine your doctor's office. Now, imagine if your doctor's office were owned by a non-profit national chain. That's, essentially, what Planned Parenthood is.

If PP is not a federal program funded by tax dollars, why does Congress talk about defunding it?

The only way to "defund" Planned Parenthood would be to bar it as an organization from accepting payment by federal programs like Medicaid.

Now, would that lead to the destruction of PP? Probably not. Planned Parenthood also accepts cash payment from patients, as well as private insurance. Granted, Medicaid makes up a big chunk of the revenue Planned Parenthood collects, but it isn't the only way PP makes money. More on that later.

Anyway, when Congress and political gas bags talk about "defunding" Planned Parenthood, what they're really saying is that they want to prevent Medicaid (and to some degree, Medicare) from reimbursing PP for medical services--ALL medical services.

Let me put it this way. The next time you hear someone say "We want to defund Planned Parenthood," try substituting your doctor's name or clinic in there. It would be the same as saying "We want to defund Dr. Smith" or "We want to defund Sandhills Family Medical Clinic." Doesn't make sense, does it?

But, I don't want my tax dollars funding abortions.

Great. They don't. There is already a ban on the use of federal funds (Medicaid) for abortion services. Your tax dollars don't pay for abortions, even if a patient goes to Planned Parenthood. If a woman terminates her pregnancy, she has to pay cash out of her pocket. Some private insurance companies do cover abortion services, but we're talking about the targeting of this specific organization, and not private insurance companies.

So, don't worry, poor women who are on Medicaid aren't spending your money to get abortions. They have to spend their own.

Why can't Medicaid patients just go to other doctors to get their reproductive health services?

That's a question with a pretty complex answer. Some patients obviously do. But here's a list of reasons why a woman (or a man) on Medicaid may want to go to PP instead of a private doctor's office for pap smears or STD testing:

*Some doctors' offices limit the number of Medicaid patients they accept, making it difficult in smaller communities to find a provider who will see them. So they have insurance, but can't find a doctor who will accept them. Remember, having insurance isn't the same as having care.

*Sometimes the wait time for an appointment is impossible at private clinics, even for patients with private insurance. I've been in medicine for 15 years now one of the top complaints I hear from patients? It takes so long to get an appointment, especially as a new patient. As an example, right now, if I call my doctor's office for an acute illness, I can probably get in with her in the next 48 hours. Maybe. There's a chance she'll tell me to go to the urgent care. But if I call and say "I need my pap and birth control," I will have to wait at least 2 months (I know this because I just called to schedule that appointment earlier today and they said it would be in 2 months).

However, if I call Planned Parenthood and say "I need my pap and birth control" they will tell me "We are open until <x> o'clock, just walk in and we'll see you in the order you arrived." That's right, I can walk in and get it done. I know this because, well, that's how I used to get it done before I had some flexibility in creating or changing my schedule (as a student and then later as a resident). If it's a busy day for them, I may wait an hour or 2 (I often waited over an hour at my OB/Gyn's office when I had a scheduled appointment), if not, then I can probably be in and out in less than 45 minutes.

For a working woman on Medicaid, a student with an inflexible schedule, a working person with no benefits insurance, or a woman who relies on others for transportation, the flexibility Planned Parenthood has that many private clinics don't or can't offer is a life saver.

There are certainly other reasons women (and men) choose PP for their services, but ultimately, it's none of anyone's business why someone chooses their doctor or healthcare provider. Isn't that one of the things people derided President Obama for with passage of the Affordable Care Act? He promised you could keep your doctor and then found that sometimes their doctor didn't participate in the insurance plan they chose. So if we believe that provider choice is a fundamental feature of the American healthcare system, why do we deny that choice to women on Medicaid? So, really, it's none of your business why someone would choose PP any more than it's my business why you chose not to go there.

But Planned Parenthood provides abortions and I hate abortion! I want them to end. If Planned Parenthood goes away, then so do abortions.

I get it. I do. I am not a fan of someone finding herself in a situation where she has to make this choice and it is a heartrending choice. However, let me hit you with some facts:

--Making abortion illegal (or putting clinics that provide abortion services under such incredible restrictions that they cannot stay open, like in Texas for example) does not end abortion. It doesn't even reduce abortions (studies have shown this to be true. Oh, look, here's one).

--In 2014, Planned Parenthood provided 324,000 abortions (which was only 3% of their overall services provided). But in the same year, just over 1 million abortions were performed in the US. Most abortions are performed in private clinics or hospitals, and NOT at Planned Parenthood.

--Planned Parenthood is the single largest reproductive health care provider in the United States. And yes, that does include abortion services. However, in 2014, PP reported 4 million clinic visits, which resulted in 9.5 million unique services provided, only 324,000 of which were abortions.

In other words, of the all of the procedures that PP performed in 2014, by far the majority were STD testing, pap smears, breast exams, birth control prescriptions and counseling, STD treatment, and sex education, while only 3% of those procedures were termination of pregnancies. (Ninety seven percent is all the other healthcare stuff that's important to prevent pregnancies and sexually transmitted diseases. And when you prevent unwanted pregnancies, you prevent abortions.)

Planned Parenthood clinics are not just "abortion clinics," and many clinics don't even provide abortion services, but do provide the services listed above. They are healthcare clinics.

So, how do we get rid of abortions?

Well, the truth is that you're not going to. I know, I know, you really feel strongly that abortion is murder and that we're doomed as a society because it's legal. But the truth is this: abortion in this country IS legal. That is not up for debate, nor is it the point in this discussion.

But, if you truly, sincerely, in your deepest recesses of your heart want to reduce or even end abortion in the US, you can definitely take steps to do just that. No, it's not by picketing at Planned Parenthood, it's not by murdering abortion providers, it's not by blowing up abortion clinics, it's not by making fake videos to frame abortion providers for things they aren't actually doing. It's actually a very simple, straightforward thing that you can do to reduce the abortion rate: make contraception widely available and affordable (if not free). Study after study has demonstrated that widely available contraception at little or no cost reduces both unplanned pregnancy rates and abortion rates both in the US and around the world.

I know, I know, you don't want people having sex unless they're married, but once again, that's none of your business. It's a tough truth, but it's one you're going to have to accept. And I get it, kids shouldn't be knocking boots until they're ready. But the truth is that only teaching kids in school about abstinence leads to increases in unplanned pregnancies and increases in sexually transmitted diseases, some of which are deadly and others can cause long term damage and infertility. Talking to kids (and adults) honestly about sex, sexuality, sexually transmitted diseases, and pregnancy, and then providing them with judgement free and low cost contraception prevents unplanned pregnancy and abortions. You want to stop abortion? Allow people to plan their families, and prevent unwanted pregnancies in the first place.

Okay, so is there a program that provides sex education, counseling and cheap (if not free) contraception that I can support?

Well, as a matter of fact, there's a GREAT non profit organization right here in the US that works to provide contraception, STD and sex education counseling and is working to reduce the abortion rate through preventing unintended pregnancy. You might have heard of it. It's called Planned Parenthood.