should insurance and medicaid cover routine circumcision

Great Debates
1

There was an article in the NY TImes this weekend (I can’t give you an exact page reference) saying that more insurance companies want to drop coverage for routine circumcision. If there is a medical necessity for it, then it would be covered, but under normal circumstances it is considered cosmetic surgery and the parents can pay for it themselve.

A little medical background, most medical groups from the Canadian Paediatric Society to the American Medical Association to the American Academy of Pediatrics do not recommend routine neonatal circumcision

The American Academy of Family Physicians “Most parents base their decision whether or not to have their newborn son circumcised on nonmedical preferences (i.e. religious, ethnic, cultural, cosmetic)”

So… if it’s cosmetic issue, why should insurance and Medicaid pay for it?

2

Because insurance pays for a lot of cosmetic stuff.

Ever hear of breast implants?

3

My impression is that health insurance will normally cover breast re-construction of enhancement after breast removal surgery, but not for purely cosmetic purposes.

4

Insurance and Medicaid should classify circumcision with clitoridectomy, bloodletting, and phrenology.

5

First off, it surprises me that Canadian and American medical authorities do not recommend circumcision.

I thought it was a matter of cleanliness. I have always heard that circumcision was healthier, anyways. I admit, however, that I haven’t done much reading on the subject. There was a recent Straight Dope (I think) on penile cancer, and I think Cecil said that circumcision reduces the risk of that cancer.

At any rate, I am all about healthcare. As much as possible. I don’t think it should cover purely cosmetic surgery, however. Breat implants, for example, one should pay for by herself (if it is recreationally cosmetic and not due to a masectomy (sp?) or something like that). But, if there is reason to believe that said surgery is preventative medicine, then insurance companies should pay for it.

Is there information on why not being circumcized is better?

Sidenote: Many of the Jewish prohibitions (in Exodus and Leviticus especially) were prescribed to keep the wandering, exiled people from being sick. Shellfish is a great example. I was taught in theology school that eating shellfish (especially in the exile from Egypt) was potentially dangerous, and that was why it was forbidden. It just kind of stuck around. Same with the milk and meat thing. Since water was not plentiful, it was common practice to cook meat in its own milk. Cruelty and health issues were abound, and that was forbidden. But, to this day, kosher Jews will not drink milk at the same meal with meat.

If circumcision can follow this logic, then perhaps (back then atleast) circumcision was a healthier and thus safer alternative.

Am I wrong about my assumptions of really old Testament prohibitions/prescriptions? Is this a remnant still lingering from my Lutheran theology school days that is totally untrue?

As the SD prescribes, I would like to end my ignorance on this issue. Can somebody drop some science on me?

colin

6

“Is there information on why not being circumcized is better?” you ask? Do you really not know the arguments vs. circumcision?

Well, to keep it short, one, it’s not necessary. If something isn’t necessary, why do it? To avoid healh risks, males simply need to be careful to keep the area in question really clean. Two, it is very widely believed that circumsision reduces sexual pleasure. Three, there is the danger of something going wrong with the operation. This is very rare, but a VERY major disaster for the victim, so why take the chance? Four, there is the danger that, years later, your teen or adult son will annoy you with a lot of whining about how you, out of abysmal ignorance and superstition, mutliated him, and how can he ever forgive you? etc. Why let yourself in for that?

And to answer the OP, I’d say, no, insurance should NOT pay for this proceedure.

7

FWIW here in Arizona the budget crunch forced the state to stop funding free circumcisions! So I am confused: if Medicare funded that, why was the state paying for it?

Oh, and Hazel said what I think.

8

One site gave this info without saying where they got the information:

“In most states, Medicaid tax dollars are used to cover non-therapeutic neonatal circumcision. Currently, California, Nevada, North Dakota, Oregon and Washington do not pay for routine neonatal circumcision through Medicaid.”

They don’t mention Arizona, but it could be dated.

I don’t know how it works, but it sounds like the states can at least partially determine how to use the Medicaid money sent by the federal government.

9

Speaking from the Orthdox Jewish perspective, the reason we keep the commandments is because God commanded us to. Period.

There may have been some side health benefits that arose from keeping the commandments (the famous “not eating pork is a defense against trichinosis”), but they are not the main reason. Thus, even if, for example, trichinosis was wiped off the face of the earth tomorrow, we could continue to keep the commandment to not eat pork.

As for the OP: I don’t think routine circumcision is a necessary medical procedure and therefore should not be covered. Of course, where it is deemed medically necessary, it should be covered. Why is this even a debate? This is common sense, no?

Zev Steinhardt

10

Because Medicare wasn’t funding it; Medicaid was.
Medicare is the health insurance program associated with Social Security Old Age, Survivors, and Disability Insurance (OASDI). Medicare is 100% paid for by the federal government, although Medicaid will cover co-pays, non Medicare-covered services and the like for certain low-income OASDI recipients.

Medicaid, OTOH, is the health insurance program associated with (state and federal) welfare programs. It is funded 60% by the feds, 40% by the states, and the states have some leeway as to which services are covered.

Sua

11

I disowned my parents for having me circumcised. :rolleyes:

And this isn’t IMHO. It was also widely believed that the Earth was flat. So what?

As far as the OP is concerned, if circumcision is shown at all to be preventive care (anyone have a cite?) then sure it should be covered. Otherwise, no.

12

Circumcision has been shown to be a likely reducer of several nasty male “problems” and diseases. It probably does pay for itself over all of society.

13

Proper hygiene also reduces those “nasty male problems”. Which is better: giving your kid wooden teeth at birth so he won’t have to worry about cavities, or just teaching him how to brush?

14

Hazel,

Is it your position that circumcision should never be done (or even outlawed) then? The OP simply asked if it should be paid for with public money, but you went well beyond that in your response.

Zev Steinhardt

15

Yeah, but you’re no JDT

(oh, come on, someone had to bring him up).

And no, insurance shouldn’t pay for circumcision, unless it is deemed medically necessary. And most nasty health problems related to circumcision are related to poor hygiene, not leaving the foreskin intact. Its simply easier to clean a circumcised penis.

16

First of all, insurance does not cover circumcision done for purely cultural reasons. If I have a moyle circumcise my son, the insurance company will not pay for it. I have to pay the fee myself.

Circumcision in the routine, noncultural setting should be covered because it is a medical procedure that requires some measure of skill, not to mention anesthesia. If you don’t want it done, then don’t have it done. In any case, the actual cost of circumcision is relatively inexpensive. (I think the moyle’s fee is around $300, but that’s the circumcision and the ceremony.) However, if it’s not covered by insurance, that effectively takes the choice away from people with insurance but no cash to pay the doctor.

One possible solution is to include it in the cost of the normal newborn care given while in the hospital.

Robin

17

An unnecessary medical procedure should be paid for by insurance and tax dollars simply because some people wouldn’t be able to afford it otherwise? I disagree.

Does this logic also apply to giving a newborn baby shiny wooden teeth so he’ll never have to brush? How about cosmetic breast enlargement?

If someone came up to me asking for money for either of those procedures, I’d say “learn to brush” and “live with what you’ve got”, respectively.

18

Lots of “unnecessary” procedures are paid for by insurance and tax dollars, some of which are far more expensive and dangerous than a circumcision. Colonoscopy comes to mind, for one. Most of these are performed for routine purposes, yet it’s suggested that they be given. There are other routine procedures that are done on a purely preventive basis that insurance covers merely because they are. If you look at it from a certain perspective, circumcision is also a preventive procedure.

As for purely cosmetic procedures like breast enhancement, they are almost never covered by insurance, and as far as I know, never have been except when the patient has had a mastectomy or some other disfigurement. Nor are most cosmetic procedures, although, again, there are exceptions for disease and disfigurement, or if the procedure is a necessary part of another surgery (for example, tummy tuck during breast reconstruction). So these procedures aren’t really equivalent to circumcision, at least not as far as insurance coverage is concerned. And as for your example of artificial teeth, if someone needs them, they’re covered, because it’s known that there is a correlation between dental health and overall health.

Now let me ask you this. Do you think that voluntary, surgical sterilization (vasectomy or tubal ligation) should be covered by insurance? They’re not necessary for life or health, and there are other means of accomplishing the same thing. So why should insurance pay for these?

Robin

19

I was answering the question in the OP (the one I quoted in my post). To answer your question, plainly it can’t be outlawed. But, for the reasons I listed, my advice to parents would be not to have this done to their sons. Do teach them good hygene habits; don’t subject them to unnecessary surgery they are way too young to give informed consent to.

20

Medical evidence for that is sketchy at best, and from what I’ve seen it’s only preventive in the sense that you don’t have to worry about washing a body part that you don’t have, or getting cancer in it.

If someone needs them, yes. And I have no issue with insurance and Medicaid covering circumcision when it’s needed–but most of the time, it isn’t, it’s just a cosmetic or pseudo-preventive decision.

If insurance also pays for birth control and childbirth, it becomes an economic question: will our money be better spent buying birth control for the next few decades, delivering an unintended child, or providing a one-time sterilization?

Also, sterilization has a well-defined medical purpose, and it fits in as one more option among the various choices for birth control. I don’t know of any other procedure where body parts are routinely removed without solid medical evidence (especially at birth); even tonsils aren’t removed unless something goes wrong.