I used to buy illegal drugs sometimes and in addition to me, personally, not being a huge fan of said substances I really didn't enjoy the purchasing process. The quality of customer service was just deplorable. And the problem, roughly speaking, was that even though it was not in practice all that difficult to obtain marijuana you still had to get it from a drug dealer rather than, say, a highly efficient global retailer operating with industry best practices and huge economies of scale. And for better or for worse, that's one of the goals of drug prohibition in the United States. It's not simply that making something illegal deters some people from use. It inhibits the emergence of above-board providers with strong franchises and brand value and robust competition between multiple high quality providers.
And that is my Moneybox take on what, if anything, we can learn in policy terms from the Kermit Gosnell case in Philadelphia.
One line of thinking about the case is Tim Carney's, namely that what Gosnell was doing isn't actually any different from what any other provider of late-term abortions is doing. In that light, strict bans on late-term abortions makes perfect sense. On the one hand, such bans should reduce the number of late-term abortions. On the other hand, such bans would push the residual demand for late-term abortions out of high-quality channels and into sketchy and unsafe ones like Gosnell's. The very sketchiness and unsafeness of these underground providers is yet another virtue of the ban, since the knowledge that she can't get the procedure performed in a safe and sanitary facility will act as a further deterrent to women against seeking a late-term abortion. It is true that some women won't be deterred by either the illegality of obtaining the procedure or the unsafety of the available facilities and that, consequently, some women will die who might otherwise have lived. But that's perhaps a small price to pay for a reduction in the quantity of abortions performed.
On the other hand, if you don't agree with Carney—if you think the Gosnell story is noteworthy precisely because his conduct is so shocking and horrifying—then the policy lessons are the reverse. Making it difficult to establish an above-board competitive marketplace with multiple legal providers of late-term abortion facilities ensures that the demand for the procedure will be pushed into low-quality channels. As you close the legal noose around remaining providers, you'll more and more have a market served by dubious individuals and you'll have a market that's lacking easy access to information and alternatives.
My sympathies are strongly on one side of this argument, but the policy problem is that the analysis really holds up either way. If you want to minimize the number of women who have abortions in general or late-term abortions in particular, more Kermit Gosnells is part of the solution. As long as the medical knowledge exists, you'll never have airtight enforcement such that it's impossible to obtain an abortion but you may have a world where it's impossible to obtain an abortion from a reliably safe provider and that affords an extra measure of deterrence. Conversely, if you want to minimize the number of Kermit Gosnells then you can't quarantine abortion off as a "special" kind of procedure that's isolated from the whole rest of the medical community.